Gabapentin vs Pregabalin for PLMD without RLS

[Ganadaramabasa]

Hi, I have PLMD without RLS.

Which is the preferred choice for PLMD? Gabapentin or Pregabalin?

It would be great if you could share your expertise. If possible, please refer to below points :

1. Safe for Long-Term Use

2. Less Side Effects

3. Help with Sleep

Any reply would be greatly appreciated.

Thank you

[SueJohnson]

Welcome to the forum. You will find lots of help, support and understanding here.

RLS and PLMD are treated the same way. When you see your doctor ask for a full iron panel. Stop taking any iron supplements 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. Have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your ferritin to be over 100 and you want your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice.

Gabapentin and pregabalin are basically the same. The only difference is that you need to divide the doses with gabapentin. Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). (Pregabalin is more expensive than gabapentin in the US.) It will take 3 weeks before it is fully effective. After that increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you. Take it 1 to 2 hours before bedtime. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. (You don't need to split the doses with pregabalin) Most of the side effects of gabapentin and pregabalin will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of your symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin) daily." If you take magnesium even in a multivitamin, don't take it within 3 hours of taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and don't take calcium within 2 hours for the same reason (not sure about pregabalin).

Have you had a sleep study done? Is that how you know you have PLMD? If so have they ruled out the need for a CPAP machine?

By the way it would really help us to give you advice if you would indicate on your profile what country you live in and your gender and any other health conditions you have.

[Ganadaramabasa in reply to SueJohnson]

Hi Sue thank you for your reply.

As per your advice, I have updated my profile.

I know I have PLMD because I have done PSG test (37x PLMS/hour) and I have recorded myself through CCTV where I have involuntary movements in the feet, arms, upper torso, and etc. I awaken frequently at the later stage of my sleep which leads to fragmented sleep which then leads to lethargy and difficulty concentraing the next day. From the sleep study, I can also rule out the need for CPAP machine. I have no RLS as well (from the four diagnostic test).

Two weeks ago, I have received the full iron panel test and I have received IV Iron infusion. However, I am seeing no benefit from it.

In addition to the full Iron panel test, I have looked into other reasons that could possibly cause my PLMD, and cannot find a reason behind my PLMD - leaving me to suspect my PLMD is a primary disorder with no definitive cause. I am no expert but one month prior to my first PLMD appearance, I took at 17 hour flight sitting down with an ongoing prostatis inflammation. After doing some readings alone, I am suspecting if this could be the culprit (nerves in spine/hip damaged from inflammation) - what if your take on this?

Since Pramipexole (took two times and had instant worsening of PLMW) and IV Iron infusion are not beneficial for me, I am left with Clonazepam and Gabapentin/Pregabalin (if I am not mistaken). This morning, I managed to find a Mayo clinic care network hospital here in Indonesia and I have booked an appointment next Tuesday. I am hoping I could get pregabalin from the doctor.

So I should start with 75mg of pregabalin prior to my bed time? Also I take Vitamin C, Vitamin B 12, Omega 3, Magnesium, and Probiotics after dinner. Do I have to worry about any of these supplements interfering with pregabalin?

Thank you in advance Sue, your insights are a lifesaver.

[SueJohnson in reply to Ganadaramabasa]

It's not surprising you haven't seen improvement from your iron infusion after only 2 weeks. It takes awhile. You should be tested again at 8 weeks by which time you should have the improvement you will get from the iron infusion. Even then it may not have improved your ferritin to over 100 and may take more than 1 infusion. What was your ferritin?

None of the supplements will interfere with pregabalin.

Inflammation can certainly make PLMD worse.

[Ganadaramabasa in reply to SueJohnson]

Mu ferritin prior to the shot was 182 ng/mL which I have realized is quite a high number.

After reading that some people need ferritin level to be above 200~300, I asked the Doctor for the shot and he approved. Although he did mention I was not likely to benefit from the shot because my ferritin level was quite high to begin with. But I went for it as I was desperate to find a solution.

I neglected to find out what type and dose of iron shot was given to me.

I will take your advice and get my levels checked on the 8th week.

[SueJohnson in reply to Ganadaramabasa]

I am amazed you were able to get an iron infusion with your ferritin at 182. Most people with ferritin as low as in the 30's have trouble getting their doctor to give them one. I guess the difference is the country you live him.