Gabapentin

[Tbone87]

Hi all, I am starting Gabapentin for my RLS. My question is for those who take Gabapentin. What dosage have you found that works and what is the severity of your symptoms (mine is considered severe). How long does it take to work? I am not taking any other medications, 36 male. Any other advice with Gabapentin is much appreciated! Thanks

[SueJohnson]

Ahh - my fellow Dr Stein patient - how do you like him by the way?

The only thing is he doesn't know that gabapentin isn't well absorbed above 600 mg, 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. He knows I take it this way but doesn't know why and I haven't bothered to enlighten him. Most of the side effects 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 the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin." If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason - I'm not sure he knows this either.

I take 1500 mg. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin"

[Tbone87 in reply to SueJohnson]

Thank you SueJohnson! You have a great memory! I have not reached out to Dr. Stein yet. I am still working with my GP locally for now. I showed her the Mayo algorithm but I know she didn’t read it, which is frustrating. She wants me to start Gabapentin at 100mg which I told her 300mg was the recommend dose for me age (she told me to take 100mg for a week and then we can up the dose). Anyways, I was going to wait for my hematologist appointment before starting meds for my RLS but I can’t wait any longer and need relief. My GP wants me to check for a blood disorder since my labs showed high some high levels, particularly my reticulocyte count.

[Huntingleroy]

Hi there i take 600mgs at 16.30 18.30 and 20.30 but trying cut that down a bit as a bit sleepy . My legs were very severe. I also take 2 mgs Clonazepam at 20.30.and 10mls of Targinact at bedtime . I had to see a neurologist privately to get the Targinact but life is improving , its not perfect but its still early days . Good luck Angela

[BJamn]

Hello from the US. I suffer periodically from RLS. Maybe stress related but I presently take 300 at 5pm, 300 at 7:30pm and 200 at bedtime. If needed I will get up in the night and take 100. That pretty much ALWAYS fixes it.

[SueJohnson in reply to BJamn]

Unfortunately, you're taking it wrong. Take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. Since you need more than 600 mg take the extra 200 or 300 4 hours before bedtime as it is not as well absorbed above 600 mg. If you still wake up at night, then take 200 mg 4 hours before bedtime and take the 100 mg when you wake up at night.

[tttlandddd in reply to SueJohnson]

Hey, does that apply also with Gabapentin? or only with Gabapentin enacarbil?

[SueJohnson in reply to tttlandddd]

That applies only to gabapentin - not to Gabapentin enacarbil. This is the full information:

Take it 1 to 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. (You don't need to split the doses with pregabalin) Most of the side effects 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 the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin" If you take magnesium even in a multivitamin, don't take it within 3 hours of taking gabapentin as it will interfere with the absorption of gabapentin and don't take calcium within 2 hours for the same reason .

I assume you are taking gabapentin. Does it control your RLS?

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

By the way check out the pinned post on filling out your profile especially the country you live in and your gender.

[tttlandddd in reply to SueJohnson]

Great thanks, my doctor told me "900 mg two hours before bedtime".

I started one week ago so I'm not able to give you an asserted "yes" but seems to help (easier to stay focus, got less emotional change / irritability).

How to determine if I take 600mg 1 hour or two hours before bedtime?

Will try 300mg 4 hours before bedtime tonight.

[SueJohnson in reply to tttlandddd]

Either 1 or 2 hours should work.

Have you had your ferritin tested?

[tttlandddd in reply to SueJohnson]

Yes, results are perfect! My restless syndrome is because of years of Abilify unfortunatly (and worsen by stress following moving)

[SueJohnson in reply to tttlandddd]

So it was over 100?

[tttlandddd in reply to SueJohnson]

yes, 312 to be precise

[Bulldogmom2003 in reply to tttlandddd]

Im on abilify and have been for 7yrs. I did not realize that can trigger RLS. My RLS began with covid in 2021. Interesting to know that can be the cause.

[tttlandddd in reply to Bulldogmom2003]

I quitted Abilify 2 years ago, too many "dopamine induced troubles" (I became an heavy smoker, gain a lot of weight, went through hypersexuality and had to raise my dose a lot to be effective) and I started to not believe anymore to my bipolar diagnosis. RLS started almost one week after abilify soft decrease and it was horrible during abilify withdrawal but did not know that was RLS. Started to take magnesium and omega 3, helped a lot and I choosed to enjoy life by moving to South of France. A lot of stress then and since 6 months I'm having mood swings again and irritability. Now I know that I'm missing dopamine and it explains a lot of trouble that I have since I'm young (poor concentration, mental hyperactivity, sensitive...) so a new world is waiting me now cheers!

[tttlandddd in reply to SueJohnson]

Tried the 300mg / 600mg split and my night was not good even if no night-time waking. Here my analysis based on my "case": I don't have RLS before sleep or very small one, mine is starting during night-time so maybe taking meds 4 hours later is not a good idea but taking the 600mg 1 hour before sleep can help. Any opinion on that?

[SueJohnson in reply to tttlandddd]

I'm a little confused. If you had no night-time waking how was your night not good?

If you take the 600 mg 1 hour before bed, you could take the 300 mg 2 hours before that or 3 hours before bed since they should be 2 hours apart. Although 4 hours works for most and makes it easier for me to give advice, the actual need is to take them 2 hours apart.

[tttlandddd in reply to SueJohnson]

I have an app telling me how many mouvements per hour I have per night and the score was higher than 3*300mg attempts (+20%).

And concluding that a night is good if no night time waking happened is a bit too simple

[SueJohnson in reply to tttlandddd]

It would be if you only had RLS but you also have PLMD which is treated the same way. You might want to try increasing your gabapentin.

[tttlandddd in reply to SueJohnson]

Good point! since PLMD is happening during night and not before sleep I'll try to take gabapentin next to bed time to see if there is any difference before thinking about increasing to 1200mg daily. Regarding the 600mg "limit" I found articles telling that the "limit" is 1200mg, what are your sources? Thanks for taking time to discuss here!

[SueJohnson in reply to tttlandddd]

According to the Mayo Clinic Updated Algorithm on RLS "Because of nonlinear kinetics and substantial interindividual variability, the gabapentin dose often does not always reflect serum level, especially at single doses above 600 mg. For this reason, multiple doses of gabapentin, spaced at least 2 hours apart, may be necessary to enhance absorption and efficacy."

[tttlandddd in reply to SueJohnson]

Regarding increasing gabapentin: I started gabapentin 10 days ago, is it enough to conclude that 900mg is not enough?

[SueJohnson in reply to tttlandddd]

No I would wait for 3 weeks and then increase by 100 mg every couple of days. Or you could increase now and after 3 weeks reduce by 100 mg every couple of days to see if it still controls it.

[tttlandddd in reply to SueJohnson]

I agree with the second one, my goal is to take the less gabapentin possible and starting high and decreasing is aligned with my « philosophy ». Thanks!

[Tbone87 in reply to SueJohnson]

Does gabapentin work immediately or does it need to build up in your system first?

[SueJohnson in reply to Tbone87]

It takes 3 weeks before it is fully effective. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin." Ask your doctor for 100 mg capsules and after the 3 weeks increase it by 100 mg every couple of days until you find the dose that works for you. 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 (it is OK with pregabalin) as it interferes with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason (not sure about pregabalin)

[tttlandddd in reply to SueJohnson]

Hello SueJohnson, have do you interpret pain in leg and feet when I woke up? does that mean that I had a lot of mouvements during night?

I took 1200mg since 6 nights, seems better but still pain when I woke up.

[SueJohnson in reply to tttlandddd]

Sorry - I have no idea how to interpret your pain in your leg or feet when you wake up.

[tttlandddd in reply to SueJohnson]

Did some stretching and pain disappeared, muscles were only tense. Will continue 1200mg until the 3 weeks period (in one week) and then will increase to 1500mg if still pain. Overall gabapentin works, sleep app results are way better. Still side effects but nothing serious 🤞

[SueJohnson in reply to tttlandddd]

I'm glad that worked. I would only increase by 100 mg as you may not need the

full 1500

[tttlandddd in reply to SueJohnson]

Thanks for the advice, how many days after the increase to increase again?

[SueJohnson in reply to tttlandddd]

just a couple of days

[K2D2]

I take 600mg at 4 pm, 600mg at 6 pm and 600 mg at 8 pm daily and my restless leg problems have disappeared. So thankful for Gabapentin.

[Cobobay]

Hi, I'm now on gabapentin after being on pramioexole and ropinerole for a couple of years, ending with ropinerole solely. I have been clear of it for 8 weeks tomorrow, I started on 300mg Gabapentin whilst still taking ropinerole, but cutting down very slowly and I then took 300mg followed by 600mg 2 hours later. I find now I have to up it, so I'm now on 400mg around 7pm and the 600mg around 9pm, some days I sleep almost immediately and through till morning, the next I'm restless and wake at around 2/3am and can't get back to sleep. I do think that does have a lot to do with the fact I feel so good now, I don't always take the 1st dose on time, so I'm holding out to upping my 1st dose till I'm actually sure I need it. Before gabapentin I couldn't sleep at all and was having to keep upping the ropinerole till doctor told me to switch back to pramipexole till they stopped working again, that was enough for me to realise I had to give gabapentin another go and boy am I glad I did and I didn't have any problems being on it altho 1st time trying it my ankles swelled up quite badly, hence why I gave up, this time around I've had nothing at all. Coming off Ropinerole was not good at all and was hard, I almost gave up several times and went back on it, but I didn't and I'm so proud of myself, that with the help from Sue and others on here I had the strength to do it and as I've said many times I cannot thank them enough. So I do hope you find the relief and help that I've had, good luck to you.

[Discopage]

how long is a dose of Gabapentin working in one’s system? If   SueJohnson a person takes doses beyond the 600mg earlier in the evening (ie 4 or 6 hours before bed), are those doses still doing their magic while you’re sleeping? I read Gabapentin lasts 5-6 hours. I’m now taking 600mg at 7pm and 600mg at 9:30pm — bedtime at 11:30pm — and still dealing with RLS in my feet. Curious if taking another 300mg at 5pm will help. I don’t have symptoms most days till 8:30-9pm. Trying to avoid going back on a DA. Neuro wont prescribe opioids.

[Eryl]

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