Gabapentin - advice on dose schedule and drowsiness?

[Discopage]

I’m treating RLS with Gabapentin and currently take 600mg at 7pm and 600mg at 10pm. Most nights I still experience symptoms between 11pm-1am and end up moving from the bed to the couch, eventually falling asleep. Experiencing tiredness and drowsiness from the med after I take it, too.

Considering Gabapentin isn’t absorbed well beyond 600mg, when would it be best to take an additional 300mg? Hoping it’ll help tackle my late night symptoms.

As for the side effects, does the drowsiness tend to lessen over time?

[SueJohnson]

First move your 7 pm dose up an hour to 8 so it is only 2 hours apart. and see if that works. You can increase your dose by 100 Mg every couple of days taking it at 6 pm to see if it helps. I wouldn't jump by 300 mg at a time, because you might not nee that much, but if you only have 300 mg you could try it for a couple of nights to see if it works and if so then get 100 mg capsules so you can reduce it to see if you need that much. If it doesn't work you could try an additional 300 mg but if that doesn't help and gabapentin has never helped and you have you been off pramipexole for awhile and on gabapentin for at least 3 weeks then your dopamine receptors are probably damaged and you will need a low dose opioid. I would recommend buprenorphine as it lasts 24 hours. You can reduce the gabapentin immediately back to 1500 mg and after several days on that back to 1200, but if you have withdrawal symptoms from that reduction then go back to 1500 mg and ask your doctor for 100 mg capsules. You need to do the withdrawal very slowly to avoid withdrawal effects. Reduce by 100 - 200 mg every 2 weeks. If you do so you will have no withdrawal effects.

If the gabapentin works it depends on how long you have been on it as to whether the tiredness will go away. I assume you are talking about the next day. Let me know how long and I can give you some advice.

[Discopage in reply to SueJohnson]

I'll try 600mg at 8pm and 600mg at 10pm. I can try another 300mg at 6pm. Last night I took the extra 300mg at 1am and I did get to sleep shortly thereafter but I'm not sure it was because of the dose. I don't have 100mg capsules right now.

I was on Neupro 1mg for 4 years or so and took 600mg of gabapentin as well during the latter 2 years. I've been on Gabapentin only for about 6 months, I think, starting at 600mg and scaling up. Still experiencing symptoms so my dopamine receptors are likely damaged. My neuro won't prescribe an opiod, nor will my former neuro.

If I'm not having much luck with Gabapentin, does that mean Horizant wouldn't likely help any more than Gabapentin? I tried Horizant before Neupro but only for a week, didn't get relief, and switched to Neupro at the recommendation of my old neuro. Reason I tapered off Neupro was I was experiencing RLS symptoms again, and was concerned about augmentation. I'm on Medicare now and Neupro is cost prohibitive since I can't get a coupon anyway.

I feel very tired in the evening and the next day from the Gabapentin. It's 1pm here and I still feel tired.

[SueJohnson in reply to Discopage]

Horizant is probably not going to help but you can certainly try it. Dr. Brian B Koo, Yale University - New Haven, CT who is one of authors of Mayo Algorithm did a virtual visit with person in NY. and prescribed opioids for him. 203-932-5711

[Discopage in reply to SueJohnson]

Thanks, I'll reach out to his office if taking the extra 300mg of gabapentin at 6pm doesn't do the trick. Is the typical approach a combo of gabapentin and an opioid, and not just an opioid?

[SueJohnson in reply to Discopage]

I would wait until you have tried 1800 mg first and if that doesn't work there is no point in taking gabapentin with an opioid.

[Coeso]

Ive been on gaba now for one week and take 600 at 5pm and 600 at 8pm. I have been on 0.09mgs mirapexin for years but it augmented. Also tramadol is augmenting. Last night I took the gaba without tramadol and slept from 10 until now which is 1.30. I had also taken a 30mg codeine.Im now experiencing mild rls so I took another otc codeine and paracetamol. Im scared my dopamine receptors are damaged but Im hopeful. I'll carry on for 3 weeks but I'll increase the gaba by 300. Ive only got 300 pills. At what time would it be best to take the extra gaba. I'd be very grateful of some advice

[SueJohnson in reply to Coeso]

If you need more than 1200 mg, take the extra 6 hours before bedtime. I would only increase it by 100 mg every 2 days as you may not need 1500 mg or if you only have 300 mg capsules if you find 1500 mg works you could then ask for 100 mg capsules so you can reduce by 100 mg every couple of days and see if that works.If you take magnesium, even in a multivitamin, don't take it within 3 hours of the gabapentin as it reduces the absorption of the gabapentin. If you take calcium don't take it within 2 hours for the same reason.

[Coeso in reply to SueJohnson]

Thanks Sue. Im now taking 600 at 6pm, 600 at 8 pm and last night I added 300at 10pm. I also took 30g codeine with 400mg paracetamol and I akdpt all night from around 1am to 9am. I think the gaba is working. Tonight I will take less codeine and see what happens. I have otc codeine and paracetamol. Crossing my fingers. I have augmented on tramadol unfortunately and when I last took it it was hell. Thanks for all the help. Im flying from Greece to San Fransisco mid February and I really have to get it under control by then , if I can

[SueJohnson in reply to Coeso]

That's great - but you have it backwards. Try 300 mg at 6 pm then 600 mg each at 8 pm and 10 pm.

For your trip book your flight for early in the day and book an aisle seat so you can get up and walk around and preferably an emergency exit or bulkhead. Pack activities that serve as distractions. If you belong to the Restless Legs Syndrome Foundation, download the Restless Legs Syndrome Special Accommodations Card to give to the flight attendant. You can join for $40 even if you don't live in the US and it is well worth it. RLS-UK also has a medical alert card available to members for things like flights. Otherwise be sure to talk to the flight attendant and explain that you will be walking a lot. Also taking an extra dose of your medicine can help.

[Coeso in reply to SueJohnson]

Thanks for all your help. Unfortunately my flight is at 4pm from Copenhagen to San Fransisco. Im very hopeful that with the help of codeine I wont be walking around the plane too much. I have an aisle seat. Should I take a stilnox on the plane. Also should I carry my prescriptions with me in my hand luggage. I wish Tramadol would still work. Could it work again after a break

[SueJohnson in reply to Coeso]

Yes I would take them in your hand luggage in case any checked luggage gets lost. It's up to you whether to take Stilnox. I assume you are used to taking it.

[Coeso in reply to SueJohnson]

Yes I take half when I cant sleep

[Coeso in reply to SueJohnson]

My doctor has now prescribed 400 mgs gaba. How can I increase this if the body doesn't absorb more than 600 at a time. I have some 300mgs left but not a lot and I'm not seeing my doctor for another 10 days