Horizant and Gabapentin

[Littlegran]

My doctor just switched me to Horizant after I have been on Gabapentin 1800 mg for over 20 years. I just recently weaned off Requip. My doctor did not give me any instructions on weaning off Gabapentin,, and I cannot find any information regarding if, or how I should do this. I feel like I am having to do my own research, as ususal, and gather valuable information from you all. I am afraid to stop Gabapentin cold turkey, but I am also concerned about taking Horizant and Gabapentin together. Does anyone have thoughts on this?

Sue Johnson, I told you I would give you the name of the Oklahoma doctor who was referred to me by the RLS doctor at Vanderbilt. Her name is Shannon Foster, DO, at University of Oklahoma Sleep Medicine Clinic, Edmond, Oklahoma 73034. I just saw her, and she switched me to Horizant per the recommendations of Dr. San at Vanderbilt. My Ferritin is 55, and my Iron Satuation is 21%; however, she does not want to refer me for an iron infusion because she does not think that my iron numbers are low enough and has not seen any help due to an infusion. So, she is recommending an iron supplement which I purchased at my pharmacy. She also is recommending a sleep study, but in 4-6 months. She does not prescribe opioids and has only one RLS patient who is on opioids. She believes that if that is necessary, one should go to a pain management doctor. I am not sure about her RLS knowledge, but she is the only doctor that I now have, so unless I find someone else, she is all that I have access to. She did tell me that most of her RLS patients are very mild, so she find me in the minority. I have weaned off Requip, but I am still not sleeping , only 2 hours last night. I am so very weary and find that I have little hope for any help unless I find information on my own. Thanks as always for the support from this group. I now know more than I ever did from any doctors here in Oklahoma.

[Madlegs1]

You are ok to switch directly from Gabapentin to horizant. Horizant is just a form of Gabapentin made to be more quickly absorbed in the stomach. The dose should be about half.

[Littlegran in reply to Madlegs1]

Thanks Madlegs1. That really helps 😊

[SueJohnson]

As Madlegs1 said you can switch directly. It is expensive. If your insurance does not cover it, you you can order it from Truax Pharmacy which makes it fairly inexpensive. (tps-rx.com/) Take it at 5:00 pm with food because the bioavailability is greatly increased depending on the meal's fat content.

Which iron supplement did you get and how many mg is it? this is my usual recommendation but if you let me know which one you are taking and the mg it may be A-OK.

If you take blood thinners, iron binds with blood thinners, potentially reducing the effectiveness of the blood thinners and of the iron so check with your doctor. Otherwise, take 325 mg of ferrous sulfate which contains 65 mg of elemental iron, the normal amount used to increase ones ferritin, or 50 mg to 75 mg (which is elemental iron) of iron bisglycinate 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. 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.

[Littlegran in reply to SueJohnson]

Thank you Sue as always for your support and great information. I take Orthro Molecular Products Redacted Iron which is Ferrous Bisglycinate Chelate 29mg. My pharmacist recommended this because of my Reflux. I just started taking this supplement. I believe it has 60 mg of elemental iron if you take 2. Do you think this is enough iron?

[SueJohnson in reply to Littlegran]

Yes that is fine.

[Bernaldi]

So few people here comment on whether what they eat (or if they eat) affects the RLS. For me, total fasting results in no RLS that night. Avoiding lectin-containing foods (mostly grains and legumes) reduces it dramatically. Gundry says lectins cause leaky gut, and my theory continues to be that many people's RLS is caused by things getting into the bloodstream that shouldn't and then crossing the BBB resulting in the mayhem that we call RLS.

IF someone has not tried a) total fasting, just to see what happens, and b) eliminating lectins for a period of time, you won't know if this will be of benefit, because no "study" has been done because there is no profit to a drug company for something that is not a drug.

[Madlegs1 in reply to Bernaldi]

Yes-- food intake is incredibly important.

Keeping a diary is a good start to identifying triggers. Food, drink or meds.

[InheritedfromDad in reply to Bernaldi]

I know this is an older post but when you say total fasting, do you mean the entire day? Or just within say 8 hours of bedtime?

[Bernaldi]

My comment was intended to draw attention to leaky gut, which does not seem to be on anyone's radar, and is something that theoretically can be fixed.

[Wanttorelax]

I was taken off gabapentin and put on pregabalin 75. 1 at noon and 2 at 7 along with 0.5 requip at 7. He gave me tramadol 50 mg to take 1-2 a day for break thru moments. I go back July 15 for update. Hoping to qualify for the NTX100 Tonic Motor Activation System. I also had a sleep study done and will be fitted for sleep device mouth piece. Medicare has not allowed the Tomac yet. I feel the pregabalin makes me feel slightly off balance, not significantly. I wake up frequently around 3-4, he feels it is the breathing and if I did not wake, the restless leg would not start. I am putting my faith in this doctor hoping for the best I can get. I am 71.

[Littlegran in reply to Wanttorelax]

Good luck. So far, the Horizant has not helped, but I am giving it time. I also am taking Tramadol. I am waiting on a sleep study. It seems that this is such a slow moving process. I only slept 3 hours last night 2 hours the night before. Not being able to sleep is very hard and causes daily problems.

[SueJohnson in reply to Wanttorelax]

Are you still trying to get off the requip? Good going on getting it down to .5 mg, The pregabalin won't help you much while you are on requip plus there is no point taking it at noon unless you have symptoms during the day. And if you do, then you are augmenting on the requip. And at night take it 1 to 2 hours before bedtime.

[Wanttorelax in reply to SueJohnson]

I have symptoms during the day and night. This seems to help.

[Wanttorelax in reply to Wanttorelax]

I was taking 4 requip a day.

[SueJohnson in reply to Wanttorelax]

I saw that which is why I said good going on getting it down to .5 mg. I know it wasn't easy. Now you just need to finish the job and get off it completely. Reduce by .25 mg and if that is too much to reduce, you can get an inexpensive jewelry scale on Amazon for $11 that measures down to .01 gram and shave off a bit of the tablet and measure it. Then reduce by that amount every 2 weeks. You may need to increase your tramadol a bit as the last reductions are the hardest. Once you are finally off it, then after a few weeks the pregabalin will start to really help and you will find you won't have symptoms during the day and can combine the pregabalin you take at noon with what you take at night. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 300 to 400 mg of pregabalin."

[Wanttorelax in reply to SueJohnson]

Thank you. I am encouraged that I am getting there.