Gabapentin and liver resection

[Ozzey]

The help I have been given from this forum has been invaluable, I don't know where I would be without it. I have weaned myself off of Pramipexole and am now using Gabapentin, I don't think I have suffered anything like some of the other members. My question is, I need to up the dose, I am taking 1 x 300mg tablet at 6pm and 2 at 8pm (total 900mg). I had liver cancer 1 year ago and half of my liver was removed. It was all successful and my liver is growing back but I've been told by my doctor that upping the dose would not be the best for my liver. Also, my ferritin levels are at 37 which is within the normal range but very low if you're suffering with restless legs. I'm taking Maltofer to keep levels where they are but when I asked about a transfusion I was told it's very bad for my liver. I'm 53 years old, the restless legs had been getting worse over the past couple of years, the Gabapentin is working but I need to know if there's anything I can do that won't affect my liver. I feel for you guys when I read some of the stories because my problem is nowhere near as bad. I have a few nights a week with very little sleep but I can cope, it would be great to get a good night's sleep though. Any info would be much appreciated and please keep up the great work. Many thanks in advance

[Ozzey]

Thanks DesertOasis, I was taking Fluvoxamine for panic attacks some time ago but came off when I found that they can exacerbate RLS. That's interesting about the iron tablets because I've been taking them in the morning, I'll take them at night from now on. With regards to the cancer, I've never had covid, we think I'm immune although some people say I must have already had it. Apparently I've just been unfortunate to get a dodgy gene, although I class myself as very fortunate to have lived to tell the tale. There's plenty of people walking about with this cancer who don't know because there was no pain associated with it, that's why I'm a very lucky man. I'll look into Wellburin, thanks for the advice

[SueJohnson]

The liver usually grows back in around a year which is where you are now. Have they checked how much it has grown back? Once that happens you can increase your gabapentin and have an iron infusion. You are already taking the maximum amount of iron so that should definitely help raise your ferritin.

Take your iron with 100 mg of vitamin C or some orange juice since that helps its absorption. Ferrous sulfate is fine for most people, but if you have problems with constipation, iron bisglycinate is better.

Take it every other day, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption.

If you take magnesium, calcium or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after.

Don't take your iron tablets before or after exercise since inflammation peaks after a workout. Don't take tumeric as it can interfere with the absorption of iron or at least take it in the morning if you take your iron at night. If you take thyroid medicine don't take it within 4 hours. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months.

DesertOasis has found that for some people taking it every night stops their RLS that night. You can try that for a few days but if that doesn't work go back to every other night,

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.

[Joolsg]

I'm so sorry to hear about the liver cancer.Most medications used to treat RLS, including gabapentin, can cause liver problems. So it's not just iron that is a problem. Both iron pills and iron infusions can damage the liver.I would ask for a referral to a haematologist and discuss in detail with the team that treated you for cancer.

They may decide an iv iron infusion is preferable to increasing gabapentin to the average dose of 1200-1500mg.

We have a lot of information on RLS, but are not as knowledgeable about liver damage and which treatments are least likely to cause further damage.

[Tildabri in reply to Joolsg]

That's really interesting Jools, re iron tablets/infusions affecting the liver. I had been experimenting for about a year taking various amounts of iron (bisglycinate), with inconclusive effects on my RLS. I was very surprised when I saw, on a subsequent blood test, not only a lowering of my iron ferritine, but a red flag (first time ever) on my liver results. I stopped taking the iron (about 3 months ago now), and it's had no effect on the RLS (in fact, the RLS incidence has decreased somewhat, which I put down to my elderly cat dying - less stress and night-time awakenings due to the poor creature's health problems - and my starting to wear compression socks). I will be interested to see the liver outcomes on my next blood test.

[Joolsg in reply to Tildabri]

I am currently on a strong immuno therapy for my MS. It's a form of chemotherapy. I have to have regular blood tests to check for liver damage. I was telephoned by the hospital pharmacist after the last blood tests. My ALT levels were very high. They arranged a repeat blood test 2 weeks later.

In the meantime, I looked up ways to lower ALT. The advice was to drink coffee, take folic acid and Vit B6, reduce sugar and eat leafy green veg. I did all that and liver ALT was back to normal.

So, liver results can vary, depending on meds and supplements.

Low serum ferritin is a risk marker for RLS, but not everyone responds to iron therapy.

Iron supplements are best taken once every other day to increase ferritin levels. If you take iron pills daily or more than once a day, hepcidin blocks absorption.

[Tildabri in reply to Joolsg]

Thanks Jools. My folic acid and Vit B6 levels are good, and I'm a veggie, so hopefully that will all help. Sugar is my weak point, so I'm trying to follow the Glucose diet as much as possible. I think I'll stay off the iron tabs, as they don't seem to be having much effect on the RLS. I'm very susceptible to caffeine (severe withdrawals from stopping even mild intake), so I rarely have coffee or tea, but I'm experimenting with dandelion coffee and tea, which are supposed to be good for the liver (don't taste great though!).