Horizant tapering

[JustVisiting23]

Dear All:

Apologies- I might be unintentionally reposting this:

I have been on Horizant for about seven months, at 600mg in the morning and 600mg in the evening (1,200 mg total). Before that, I was on 600mg Gabapentin daily for two years. Recently, my doctor and I have agreed to reduce my Horizant to 900mg per day, starting with 300mg in the morning and 600mg in the evening. I’m reaching out to the group because I want to be sure this plan is not too aggressive, leading to withdrawal sickness. Last year, my tapering off Sinemet was medically mis-managed and I was very sick with DAWS, so I’m especially wary. Thank you.

[SueJohnson]

Since 300 mg is the smallest size, you have no choice.

[JustVisiting23 in reply to SueJohnson]

Although not ideal, perhaps I could use a pill cutter if I need something more than #300 but less than #600? Do you think the proposed tapering schedule is too quick?

[SueJohnson in reply to JustVisiting23]

Actually I think it is fine.

[JustVisiting23 in reply to SueJohnson]

That’s a relief. Such a difficult condition to manage. Happy Holidays

[UsableThought in reply to JustVisiting23]

I agree with Sue that simply dropping to 900 mg should be okay and in any event is the only option you have.

Also I strongly suggest NOT cutting Horizant pills. Some pills are safe to cut (e.g. regular Mirapex) but others are not - always check if in doubt. In the case of Horizant, the maker includes this warning in the drug information: “Tablets should be swallowed whole and should not be cut, crushed, or chewed.” They don’t say why but likely the pill is either coated (it certainly feels that way to the touch) or the matrix inside is designed a certain way - either way, the purpose is to deliver the drug to the gut with a very specific timing. Cutting a pill that has been designed this way defeats the intended timing & with some medications can even be dangerous.

So stick with the whole pills. The only caution I’ve ever read with tapering Horizant is not to drop more than 600 mg in a single step if you have been taking more than 600 mg. Since you are dropping just 300 mg you should be fine.

Also good to keep in mind that not all drugs have the same side effects when tapering off. Sinemet is in an entirely different class of drug than Horizant so you are unlikely to experience anything like the same withdrawal effects. Of course your concern is perfectly understandable given what you’ve gone through in the past! Good luck & hopefully it won’t be hard. But do let us know how it goes.

[JustVisiting23 in reply to UsableThought]

The package insert does caution against cutting- I was informed by a pharmacist that cutting the Horizant interferes with the extended release function. However, my sleep specialist (Dr. Poceta, San Diego) isn’t concerned. Fingers crossed!

[LotteM]

May I ask why you take the Horizant? And why you and your doctor want to reduce? Looking through your previous posts, it appears you also take methadone 20mg. If for RLS, the latter dose is somewhat high for RLS. And if the Horizant for RLS, why the morning dose? Are you still suffering from the after effects of DAWS? Maybe including daytime symptoms?

In general I think it is wise to be on as little medicines and on as low doses as possible, so I can understand the aim of reduction. I hope this is the case and your RLS is currently sufficiently or even well controlled. Given your earlier DAWS experience, you want to go as slowly as possible. If you are worried about the dose reduction, do try to cut the pill. Your pharmacy may have a pill cutter for you. A very sharp knife or a utility knife with snapp-off blades (don't know the names of that type of knife in English) may work too.

[JustVisiting23 in reply to LotteM]

Thank you for your comments I take the Horizant in a somewhat successful attempt to control quite a bad case of RLS. I’m reducing as I want to take the least amount of meds as possible and I think most of the relief I obtained is from the Methadone and not the Horizant. So many side effects from these medications as well.

[DogBella]

I was taking Horizant, 1200 at 6pm. The cost was all out of pocket. I reduced to 600 and added 900 mg Gabapentin at bedtime. After a few months I replaced the 600 mg of Horizant at 6pm with 900 mg of Gabapentin about 6 weeks ago with no side effects. My RLS was severe but seems now under control.

[tagaxel]

I don't think anything is known about Horizant since it is a relatively new medication. Moreover, I believe that since it is time released you cannot cut the capsule. In order to reduce at anything lower than 300 mg (the lowest available dose from the manufacturer) you would have to take the pills to a compounding pharmacist who could then render the pills into a liquid form from which you could micro taper.

There is no danger of DAWS since Horizant is not a dopamine agonist. I would imagine the worst that could happen would be seizures that could probably be controlled by gabapentin. If I were you I would reduce by 300 mg but do it every other day for a couple of weeks. If that doesn't work have your physician write a prescription to a compounding pharmacist and then you would have a liquid form from which you could reduce at a very small rate each day thereby tricking the central nervous system into not missing the drug.