gabapentin dosage

[Kanags]

I am switching over to Gabapentin from Ropinarole. I have managed to reduce from 1.25mg to 0.75 but now I feel the pain. I am taking 300 mg Gabapentin and 0.75 Ropinarole for the last one week. I am dreading going down further. Should I increase Gabapentin to 600 before further reduction

[grassgree]

Withdrawal pain will settle in stages. It might be best to just take your time with reducing ropinirole, rather than taking more gabapentin. Can you get cannabis or Delta 8 (THC + CBN) to help with sleep and pain? What about Kratom? It is addictive, so be careful. You can ask your doc for an opioid, but I didn't have any luck with that.

[SueJohnson]

You can increase up to 900 mg but it probably won't help much. I agree with grassgree to try cannabis or kratom which helps many or if you can get a low dose opioid. It is these last reductions that are the hardest. You can get an inexpensive jewelry scale that measures down to .01 gram from Amazon ($11 in the US) and shave off a bit of the tablet and measure it. Then reduce by that amount every 2 weeks if you find reducing by 25 mg or using a pill cutter to reduce by half that is too much

[Kanags in reply to SueJohnson]

Thank you Sue. You really are a great contributor to this site.

[Sunshine458]

slow down decreasing Ropinirole and continue increasing Gabapentin 300mg at a time is how I did it. I take 600mg of Gabapentin 2-3 times a day I have neuropathy now too with RLS but I am down to 1/2 of a 0.5mg of Ropinirole at nighttime and very seldom I take the other 1/2 of a 0.5mg if my legs are jerking. I take 600mg Gabapentin at noon and again at 5:30pm and 9:30pm … sometimes I don’t take the 5:30pm dose but I try to keep it at the same time every day … I set my alarm on my phone … it takes a long time to get off Ropinirole and I am not worried about staying on the low dosage I am taking now as long as it stops me from jerking. Just decrease yours very slowly and don’t worry about it. Good luck!! It’s a horrible disease RLS and neuropathy isn’t good either!!

[Quesadillas]

I take 600 mg gabapentin, 75mg ropinirole, Percocet & fentanyl patch. Horrible, debilitating pain & muscle spasms kept me writhing and bawling for hours at a time until the Dr tried this combination (this took more than two years). I'm afraid my body thinks this isn't enough. Too much time with my legs curling involuntarily for nearly an hour. I don't know enough about ropinirole dosage to know if you can take more. I didn't realize it is so slow to decrease. It's an awful thing to depend on these medicines. I'm thinking you will need to increase gabapentin or it will be too painful for you. Sorry I'm no real help. This forum is so wonderful, I'm new to it & can see how helpful it is. Thank you all for sharing.

[Birdland in reply to Quesadillas]

Do you mean .75mg of ropinirole? 75mg would be an incredibly high dose! Even though .75 is a relatively small dose, I’m wondering if you are augmenting on ropinirole. If so it is possible you won’t get any relief until you come off of it. Are you familiar with augmentation?

[SueJohnson in reply to Quesadillas]

I agree with Birdland. The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen.

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, don't eat a heavy meat meal the night before, fast after midnight and 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 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.

Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, eating late at night, estrogen including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, eating late at night, stress and vigorous exercise.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse

Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[booras]

I have had a pharmacist working with me on the RLS. She helped me wean slowly off of the Ropinerole using GABA 200mg at 7pm then another 400mg at bedtime. For the breakthrough Rls she had me alternate with Tramodol, 25mg 2-3 nights a week or carvidopa/levodopa 3-4 nights/week. Once off the Ropinerole (which I reduced by 0.25mg every 2 weeks), I was able to reduce the GABA to 100mg at 7pm followed by 300mg at bedtime, still alternating the tramodol and carvidopa/levodopa. Recently. I have tried THC:CBN with good success too but it is not legal everywhere in the US so not always easy to find. On the THC:CBN I use 5mg (or 1/2 of a gummy) at bedtime with the 300mg GABA and that gets me through the night usually with a decent nights rest. When I am using the THC:CBN, I don’t need tramodol or carvidopa:levodopa. Hope this helps.

[SueJohnson in reply to booras]

Are you aware that carbidopa/levodopa acts just like a dopamine agonist? And can result in augmentation?

Also you are taking gabapentin wrong and not nearly enough. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin." Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. 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. If you take magnesium, even in a multivitamin, take it at least 3 hours before or after gabapentin as it interferes with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason.

Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on 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, don't eat a heavy meat meal the night before, fast after midnight and 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 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.

Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, eating late at night, estrogen including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, eating late at night, stress and vigorous exercise.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse

Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[booras in reply to SueJohnson]

Thanks Sue, yes my ferritin is over 100, and I am aware that the carvidopa/levodopa is also an opioid agonist but the pharmacist said the risk of augmentation was less than that of Ropinerole. Nevertheless, risk of augmentation is why I am not taking it every night of the week because I did experience some augmentation on the Ropinerole but was able to get off of it before the dosage got as high as some. I was willing to give the carvidopa/levodopa a try since the risks were reportedly less than that of Ropinerole per the pharmacist. My hope is that by not taking any one thing every day (except for gaba, because that has helped) but alternating a few different things, I may perhaps prevent a dependance and or augmentation. The main reason I am on such a low dose of the GABA is sexual side effects and fortunately I had someone willing to work with me on trying other things and weaning down from the dose of 800 GABA that I had been on. Coming down to 400 from 800 has definitely helped me in that respect. I still get restless legs breaking through from time to time but am willing to deal with this occasionally since it is no longer every night on the current regimen.

[SueJohnson in reply to booras]

You might want to try switching to pregabalin. Although it is basically the same drug except you don't need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. Divide the gabapentin amount by 6 to get the correct dose. You can switch directly and switch back if it doesn't help.

By the way, GABA is something entirely different from gabapentin so to avoid confusion you should say gabapentin in your posts. I knew what you were talking about from the context but others might not,

[SueJohnson in reply to booras]

Actually the risk of augmentation is not half of that on ropinirole which is up to 70%. "In a multicenter, open-label study using flexible dosing of levodopa (mean maximum daily dose, 311 mg), 60 percent of patients developed augmentation at a median time of 71 days into therapy" uptodate.com/contents/manag...