Switching from Gabapentin to Pregabalin

[magarlick]

Dear all

After months on Gabapentin 1200mg, which was working for my RLS/PLMA, it suddenly became ineffective, even after I upped the dose to 1800mg in three batches. No changes in lifestyle, meds or diet. I am switching to Pregabalin. I have many questions which my GP just couldn't help with.

1. Should I taper off / in?

2. Should I start Pregabalin low, at say 75 mg, then up to the equivalent Gabapentin dose (1200/6 = 200mg), or start straight away on 200mg?

3. Will it work right away?

Not quite related, anybody had any success with the patch Rotigotine?

Thank you.

[Madlegs1]

First off-- don't touch the Rotigotine patch. It is similar to Pramipexol and Ropinerol -- a dopamine agonist.

Doctors will tell you it is less likely to cause augmentation -- but that theory has been rubbished by the experts.

Others will advise on changing from Gabapentin to Pregabalin.

As far as I know ,you can move straight over at the correct equivalent dose. But wait till that is confirmed by others here.

Good luck.

[magarlick in reply to Madlegs1]

Thanks, yes I have heard about dopamine agonists being in the dog house, and I also thought it was because of augmentation. If not, what is the reason?

[SueJohnson in reply to magarlick]

It is because almost everyone will eventually suffer augmentation and it can be hell to come off it.

[Madlegs1 in reply to magarlick]

Yes-- they all cause augmentation.

[SueJohnson]

You can switch directly. Divide the total gabapentin you are taking now by 6 to get the correct pregabalin amount. It will work right away, but if the gabapentin didn't work the equivalent pregabalin won't either so increase it by 25 mg every couple of days until it does work. and if it never does reduce by 25 mg every couple of weeks to come off it without withdrawal effects.

[magarlick in reply to SueJohnson]

Thank you, Sue. So will it work right away or do I need to wait a few weeks as with Gabapentin?

[SueJohnson in reply to magarlick]

see my edited answer

[Joolsg]

I agree with Madlegs and SueJohnson. And the fact your GP couldn't answer those simple questions is VERY worrying but not surprising!Avoid Rotigitone. The new AASM makes it clear ALL dopamine agonists are STRONGLY NOT RECOMMENDED.. because of inevitable drug induced worsening, hellish withdrawal and the risk of permanent damage to dopamine receptors.

They are to be used for end of life scenarios or on a one off basis ( eg long flight).

[Islay9]

My experience has been that the pregabalin works much better than the gaba and it’s amazing not having to take it until late so you get your evenings back!

I’ve ended up at 450mg and it seems to be helping mostly. It’s not perfect but I am getting less wakenings at night sometimes and my sleep feels deeper.

I think I went up the doses too fast and perhaps would have managed a lower dose if I had been more patient so I would advise waiting a few weeks after a dose increase. (After you’ve followed Sue’s advice)

[Westann]

I recently switched from 1800mg gabapentin to 300mg pregabalin. The gabapentin worked to some extent but I couldn't manage splitting the dose into three 600mg chunks, 2 hours apart. Which, by the way, I learned to do from this forum (thank you Sue). My doctor told me to take the 1800 all at once. >sigh< I also take 200mg of trazadone at bedtime. I switched immediately to the full 300mg of pregabalin with no problem. After a few days I started to notice an improvement. It's been a few weeks now and my symptoms are much better. I'm sleeping well, with a CPAP and small weighted blanket. So far I haven't experienced side-effects. People on the forum have reported weight gain but it's probably too soon to tell.

For me, making the switch worked out very well. If you do it, I hope it works for you too.

[magarlick in reply to Westann]

Thanks for the encouraging feedback, Westann. May I ask, what is the Trazodone for? I know it as an antidepressant but I suspect you're using it for something else.

[Westann in reply to magarlick]

The trazodone is mainly for sleep. I do have depression and take limotrigine (Lamictal) for that. It seems to be working well also, although it took awhile to get the dose right. In fact, it took years to get an effective combination of meds (for now at least). The main barrier was finding a doctor who knew anything about RLS. The first one I saw put me on ropinirole, with the usual problems of augmentation and hellish withdrawal. You were smart to ask your questions on this forum before making a switch. The knowledge and resources found here will get you through.