can gabapentin make RLS worse or cause anxiety attacks?

[Kejimkujik]

Hi Friends, me again. I have now been taking 300mg Gabapentin once a day in the evening about two hours before bedtime while still taking my regular o.25mg pramipexole 3X a day. On alternate days I have been taking an iron supplement. I am now near the end of the third week of taking gabapentin with the aim of starting to reduce the pramipexole at the end of the third week on Gabapentin. I am finding that some days the level of RLS still breaks through, (and yes I do think the augmentation is worsening), but as tonight, day 17 on gabapentin, it seems I am increasing my level of anxiety. I call it this as my heart rate seems higher, my breathing shorter, I am pacing and feeling a sense of panic and stress.....could this be the gabapentin? If so will this decrease given time and should I increase the dose at the end of week three as I start to decrease the pramipexole. If this is what the next few months are going to be like, I am not sure I can do this.Actually that is not true, I can and will do this; This is just the panic and anxiety I feel nd I have not even started to come off pramipexole.

[RestlessNinja]

I’ve been taking Gabapentin/Neurontin for about 2 months now. I began with a 300mg dose, and while it didn’t completely eliminate my RLS, it did make it more bearable. Initially, I experienced some typical side effects like shallow breathing, mood swings, being overly reactive, and suicidal feelings. It was a bit challenging, but most of these side effects have disappeared. The shallow breathing bothered me initially, but since I do a lot of aerobic exercises, it’s become less of an issue over time. Recently, I bumped up my dose to 2 x 300mg at night time. The urge to move my legs has practically vanished, and I now get a solid 8 hours of sleep each night. Mornings are better too. After a strong cup of coffee, I feel at ease and motivated to tackle the day. Gabapentin is a tricky medication. Figuring out the right timing and dosage can take time. But it’s worth experimenting. Don’t be discouraged by the initial side effects. 300mg isn’t a very high dose. If you can tolerate the side effects for a while, consider gradually increasing your dose. After 3-6 months, you might start reaping the full benefits. [👉Remember, always consult your doctor before making any changes to your medication.]

[SueJohnson]

Panic attacks and shortness of breach are possible side effects. It can't make RLS worse but muscle twitching and involuntary contractions are possible. As RestlessNinja mentioned they may go away. I would delay increasing your dose. If they continue to bother you after some time has passed you can 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.

[wantokporo in reply to SueJohnson]

Also with the pregabalin you don't have to increase the dose as often. I have always gotten the worst side effects when I increased my dose.

[Adalgisa]

Hi Kejimkujik, I’m a 64 year old woman in Toronto. I was on increasing doses of pramipexole for 15+ years and suffered major augmentation and compulsive behaviours. I weaned off it and was prescribed pregabalin, which didn’t work very well. 2 years ago I was referred to a neurologist. My current regimen is iron supplements every other day, and 700 mg gabapentin in total, plus 50 mg pregabalin, and .50 mg pramipexole. I take 100 mg gabapentin at 1 pm, 300 mg at 6 pm, and 300 mg at 9:30 pm with the pregabalin and pramipexole. It’s managing the leg symptoms and I’m sleeping. I do have daytime sedation and brain fog but it beats not sleeping. I will caution that combining gabapentin AND pregabalin is not usually recommended and is being carefully monitored by my neurologist and family doctor. It was prescribed for ongoing pain apart from the restless legs.

I’ve had lifelong anxiety and depression. My psychiatrist said some of his patients found gabapentin to be helpful with mood. I can understand your concern with the anxiety you’re experiencing. Keep track of it, and try to continue with the gabapentin . I know side effects vary with everyone, and they also can reduce or go away with time.

[Kejimkujik in reply to Adalgisa]

Thank you for this. I am going to keep on track with this. I am tracking things and see how things progress. In the wee small hours things often feel darker, harder, more overwhelming. I suffered a traumatic brain injury two years ago and have come a long way back from then, and in the process developed techniques to help manage anxiety, brain fog mood swings etc. I just have to remind my self of these as this could have been the restless legs triggered anxiety.

[SueJohnson in reply to Adalgisa]

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

You are on the maximum amount of pramipexole for RLS. I can't imagine what you were on if you weaned off it. Combining your 50 mg of pregabalin which is equivalent to 300 mg of gabapentin with the 300 mg of gabapentin you are taking at night is only 600 mg of gabapentin and according to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)." Of course it is not going to help you very much at any dose while you are on pramipexole.

I would strongly recommend you get off the pramipexole. It will only get worse. I would not increase the gabapentin or pregabalin at this time. To come off pramipexole, reduce by half of a .125 tablet every 2 weeks or so. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it.

On the gabapentin or pregabalin if you prefer start increasing it 3 weeks before you are off pramipexole although it won't be fully effective until you are off pramipexole for several weeks. After that increase it by 100 mg gabapentin (25 mg pregabalin) 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. (You don't need to split the doses with pregabalin). If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) 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 (not sure about pregabalin).

Check out the Mayo Clinic Updated Algorithm on RLS which discusses the latest guidelines on RLS treatment at Https://mayoclinicproceedings.org/a...

Have you had your ferritin checked? If so, what was it? This is the first thing your doctor should have done.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 in a multivitamin that has iron in it 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, artificial sweeteners, carbs, foods high in sodium(salt), foods that cause inflammation, ice cream, eating late at night, oestrogen (estrogen) including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, 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.

By the way for depression the only safe ones for RLS are Wellbutrin and trazodone.