Horizant problem

[tagaxel]

Is anyone taking more than 600 mg of Horizant? I’ve been on it for around three years but now it’s starting to wear off after 12 hours while it is supposed to last 24 hours.

[SueJohnson]

You can take 1200 mg but research shows it is not much better than 600 mg and would probably also run out after 12 hours. You could try 2 things. You could take a 2nd 600 mg at the 12 hour mark but I wonder why you need it for 24 hours as RLS is usually at night?

Do you take it at 5:00 pm with food because the bioavailability is greatly increased depending on the meal's fat content? You might want to increase your meal's fat content.

Or you could supplement the dose with pregabalin or gabapentin.

[tagaxel in reply to SueJohnson]

Here’s the problem: when I tried to get off pramipexole I had to increase the dose to avoid the withdrawal syndrome but the increased dose has two side effects “sleep disturbance” and “fatigue”. At best I get an hour and a half sleep before waking up. I’m up for an hour and then get another hour and a half. With any luck I might get six hours out of 12 hours. Last night, for example, I only got three hours of broken sleep. Now I am incredibly tired. For me the worst part of RLS is what I have always called “negative orgasm”. A terrible feeling all over the body. I would desperately love the fall sleep but at the instant of sleep I get the RLS symptoms – with the “negative orgasm” being worst.

I tried taking it at 5 PM but then it wears off at 5 o’clock in the morning. I resumed taking it at 9 PM with food.

[SueJohnson in reply to tagaxel]

I didn't realize you were on pramipexole. You talked about micro tapering pramipexole in the past. The solution then is to follow your own advice and use it to come off the pramipexole. Staying on pramipexole you are in danger of augmentation. I know with gabapentin which is horizant is an extended form of, that it doesn't fully work when you are still on a DA like pramipexole. Once you are off pramipexole you will only need it at night and it should completely control your RLS.

Actually the fact that you are having symptoms during the day is a sign of augmentation.

I know it is hard but you can do it.

[tagaxel in reply to SueJohnson]

I have been micro tapering from pramipexole for almost 3 years. I am down to 0.5108 mL of pramipexole from 0.875 mL/milligrams. I am still experiencing the side effects of the increased dose which are sleep disturbance and fatigue. It will still take at least two more years before I am free from pramipexole. It is a very unforgiving neurotoxin. Even if you miss part of a dose you go into withdrawal and have to increase the dose.

[SueJohnson in reply to tagaxel]

I know you don't believe in using opioids to taper but it would really help you and speed up the process of getting of pramipexole.

[tagaxel in reply to SueJohnson]

Thanks, Sue. I have what is called a “kindled central nervous system” due to having used Valium and not being advised how to taper from it. I was put on and off that drug for almost 20 years. Now any drug that I take which affects the CNS I will become immediately dependent upon and must micro taper. If I were to use an opioid I would become immediately dependent upon that and would not be able to get off that without a great deal of agony.

Most people, for example who take an MAOI, can simply taper by one pill at a time. I used to be able to do that when I first was diagnosed with unipolar disease but a few years ago when I tried to reduce that drug, my psychiatrist realized that I was totally screwed and I had to micro taper even from that drug. So, the last thing I would ever want to do would be to add another neurotoxin to my CNS. Moreover, with micro tapering you don’t need any drug to ameliorate the withdrawal syndrome because the entire purpose of the micro taper is to avoid those symptoms.

[SueJohnson in reply to tagaxel]

That is terrible!

[tagaxel in reply to SueJohnson]

PS my RLS always occurs at the instant of sleep whether at night or any other time.

[Madlegs1]

Are you taking any form of magnesium?

[tagaxel in reply to Madlegs1]

Yes I take a calcium and magnesium supplement twice daily.

[Madlegs1 in reply to tagaxel]

Then know that magnesium interferes with the absorption of Gabapentin unless kept 3 hours apart.

[ChrisColumbus]

*IF* you're taking a combined calcium/magnesium supplement, rather than the two separately, some of those contain magnesium oxide which is high in elemental magnesium but low in bioavailability. Others do contain magnesium citrate or malate, which are much better, but generally the magnesium content is comparatively low.

To aid sleep you might do better with straight magnesium glycinate if you're not already taking this.