finished Neupro taper and looking for guidance on increasing my Gabapentin dosage

[Discopage]

I’ve been taking Neupro 1mg and 400mg x 2 Gabapentin daily for my RLS. In the last 3 months I tapered off Neupro (1mg to 0.75 to 0.5 to 0.25 to 0) with my neurologist since I was experiencing more RLS symptoms despite being on Neupro. My RLS symptoms appeared most nights during the taper and I managed the symptoms with Gabapentin and at times vaping cannabis. It wasn’t nearly as bad as I expected.

Now that I’m off Neupro I’m experiencing RLS symptoms beginning in the late afternoon ie 4pm. This is what I expected.

Should I ask my neurologist about increasing my Gabapentin dosage? If so, to what level and at what time of day for each dose?

I also take Lithium and Lexapro for mood. Ideally, in due time I can reduce my Lexapro dosage but no immediate plans to embark on that journey.

[Madlegs1]

You can increase Gabapentin dose up to at least 1800mg. Time the doses according to RLS demand.Make sure you avoid magnesium by at least 3 hrs from Gabapentin intake. That includes most stomach meds. Check ingredients.

I haven't checked the effects of lithium or lexapro on RLS or Gabapentin. You can do that yourself by entering the" name and RLS" into search engine.

Good luck.

Searching Gabapentin dosage in this site will bring up many conversations that should help you.

Good luck.

[SueJohnson]

That's great that you are off Neupro and it wasn't as bad as you expected !!! Ask your doctor for 100 mg capsules. Take 600 mg 1 to 2 hours before bedtime assuming your RLS is at night. Then your 200 mg 4 hours before bedtime as it is not well absorbed above 600 mg. Increase by 100 mg every couple of days until you find the dose that works for you. If your need more than 1200 mg take the difference 6 hours before bedtime. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin ." As Madlegs1 said take magnesium take it at least 3 hours before or after taking gabapentin. If you take calcium don't take it within 2 hours.

[Discopage in reply to SueJohnson]

my symptoms are now appearing around 4-5pm and they’re lasting till about 5am. Not much sleep the last two nights.

What dosage schedule do you suggest if I can get the pharmacy to fill 100mg or if they’ll only do 300mg? I’ve never been able to get them to fill 100mg before

Is it recommended to take magnesium and if so which type?

[SueJohnson in reply to Discopage]

I would then follow the schedule above but start an hour before your RLS starts although it may not take you through the night. Magnesium glycinate is the one usually recommended and it helps some people with RLS.

By the way Lexapro is a SSRI antidepressant that makes RLS worse for many. Trazodone and Wellbutrin (zyban) are safe for RLS. Lithium also makes RLS worse for many. Ziprasidone (Geodon) seems a safe substitute. Discuss these with your doctor.

[Discopage in reply to SueJohnson]

if I can’t get the pharmacy to fill 100mg capsules, would this make sense?

3pm take 300mg

7pm take 300mg

10:30pm take 600mg

[SueJohnson in reply to Discopage]

You can certainly try it. It's a shame Horizant isn't approved in the UK as it is basically gabapentin that lasts 24 hours.

[Discopage in reply to SueJohnson]

I’m in the US. We have it but it’s very expensive.

[SueJohnson in reply to Discopage]

Horizant has a prescription savings card which makes it inexpensive which you might want to check out at horizant.com/savings. And then there is Truax Pharmacy (tps-rx.com/) for 30 pills it costs $55 (that's with shipping), and it goes down from there if you buy it for 3 months which wantokporo a member of the forum found.

[Discopage in reply to SueJohnson]

thanks I heard about Truax from my old neuro. Didn’t realize it was that good of a deal. I called them and if you order 3m supply, shipping is free. So $165 total. Monthly is $55 plus $5 shipping. They charge the same price for 300mg or 600mg capsules. The pharmacist said generally if one takes 1200mg Gabapentin, they’ll want to take 300mg Horizant twice daily. Is that what you’ve heard?

My neurologist called in a script for Gabapentin 300mg x 5 daily so I can test the waters with 1200mg up to 1500mg. I think I’ll try this out and consider Horizant as an alternative. I pay less than $10 per month for Gabapentin.

[sylvanwanderer]

Discopage, I'm curious because I'll be starting a taper off of Neupro 1mg soon. How did you do the taper? Decrease the amount of time you wore the patch? Thanks!

[Discopage in reply to sylvanwanderer]

I cut the patch. Reduced the dose to 3/4 mg for a month, then 1/2 mg for a month, then 1/4 mg for a month and stopped.

[SueJohnson in reply to sylvanwanderer]

The usual advice is to cut the patch in quarters as Discopage did. Then reduce by one quarter every two weeks. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. But in the long run, you will be glad you came off it.

Have you had your ferritin checked? If so, what was it? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not when you see your doctor ask for a full iron panel. Stop taking any iron supplements including multivitamins that have iron in them 48 hours before the test, fast after midnight and have your test in the morning. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your transferrin saturation to be over 20% but less than 45% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice. Improving your ferritin will also help with your withdrawal.