Various Questions

[Goagal]

Hi

I'm now 3 weeks off pramipexole and started Gabapentin a week ago. The first 2 of those weeks I was in hospital having surgery for something else and recovering with opioid painkillers which removed the need for anything else.

The 3rd week I started gabapentin but I don't have the levels right yet as I am having some break through feelings of RLS.

Apologies in advance is the first questions is a really dumb question.

1) If the peak plasma level of Gabapentin is 2 hours after taking the dose. Why if taking 600mg (like me currently) at 9pm would the advice be to take another dose 4 hours before when I don't have the symptoms. Would I not want to take it during the night?

2) How long should I try one dose of gabapentin before moving up doses. Last night I took 600mg at 8pm and another 600 at 10pm and could still feel it enough that I would not get to sleep and so took a 50mg of tramadol.

3) Before stopping completely I had reduced my pramipexole tablets to 1/2 a 0.08 mg tablet a night. The amount of gabapentin tablets seems excessive in comparison ?

Thanks in advance for reading.

[SueJohnson]

1) You don't take the second dose 4 hours before, you take it 2 hours before.

2) You don't increase the gabapentin until after 3 weeks being on it as it takes that long to be effective. And since you are only 3 weeks off pramipexole and your symptoms were masked by the opioids, the withdrawal symptoms may not have settled yet so I would wait a few weeks before increasing it again.

3) There is no comparison between the amount of pramipexole and gabapentin. They are different medicines entirely. Have you read the Mayo Algorithm?

Surgery makes RLS worse because of inflammation and possibly medicines given to you. Also withdrawal from opioids will make RLS worse. Another reason to give it a few weeks before increasing the gabapentin.

Congratulations for getting off pramipexole.

[Goagal in reply to SueJohnson]

Apologies Sue my writing was unclear. I meant 2 hours.

Once again thanks for your advice. I'll try your suggestions and revise my understanding from the Mayo Algorithm

[SueJohnson in reply to Goagal]

Then to answer your first question when you meant 2 hours, it is because the 2 doses build on one another. Hopefully you won't need any during the night if you take enough before you go to bed. I take 300 mg at 5:15, 600 mg at 7:15 and 600 mg at 9:15 and go to bed at 10:15 and sleep through the night.

[Goagal in reply to SueJohnson]

Ahh I understand now. Thanks again

[Rameau in reply to SueJohnson]

Hi Sue, Is the 600mg maximum dose age dependent. My GP in the UK was suggesting less than that. I am taking 500mg about 1 or 2 hours before bed but even this dose is not always effective. Sounds like I need to take another dose 2 hours earlier.

[SueJohnson in reply to Rameau]

It is not age dependent. Normally one takes it all at one time, but a few people on the forum have found taking half of the total 2 hours before bedtime and half at bedtime works for them. You might try that with your current dose. If that doesn't work go back to taking it all at one time 1 to 2 hours before bedtime and add 25 mg every couple of days until hopefully it controls your symptoms.

I am really surprised that it doesn't at 500 mg. Usually the reason is the dopamine receptors are damaged by taking ropinirole or pramipexole, but you haven't taken them.

[Rameau in reply to SueJohnson]

Nor sure I understand. You say you take 300 mg at 5:15, 600 mg at 7:15 and 600 mg at 9:15. - So you are taking 1500mg daily compared with my 500mg?

[SueJohnson in reply to Rameau]

That is gabapentin.. The equivalent pregabalin dose would be 250 mg.

[Rameau in reply to SueJohnson]

I am currently taking only 500mg of Gabapentin daily - as I said 1-2 hours before bedtime.

[SueJohnson in reply to Rameau]

Oh - sorry since 600 mg is the maximum for pregabalin I thought you were talking about pregabalin.

The maximum for gabapentin is 3600 mg.

It takes 3 weeks before it is fully effective. After that increase it by 100 mg every couple of days until you find the dose that works for you.

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.

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 . Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it at Https://mayoclinicproceedings.org/a...

[Rameau in reply to SueJohnson]

Many thanks for clarifying.

[Munroist]

Gabapentin is not well absorbed in doses above 600mg so it’s best to take in a series of 600mg doses separated by 2 hours otherwise it won’t all be absorbed. Obviously becomes a bit tedious the more you take but you will get the most benefit. It’s often suggested to take pregabalin instead of very high Gabapentin doses as the drugs are very similar but pregabalin can be taken in one dose. However despite being effectively the same drug, people can often react differently both in terms of effect and side effects so if Gabapentin is doing the right thing for you it might be worth sticking with it.

[Goagal in reply to Munroist]

Thank you. I appreciate your response.