Pregabalin or Gabapentin?

[CookieandCJ]

Hi all. Thank you for all the useful help and support you give.

I’ve been on Pregabalin for several years now. Works at 300mgs BD. Attempted to reduce without success. Pain clinic recommended Amitriptyline recently for Osteoarthritis pain and stopped it after 2 days (as advised by group but also because my RLS went into overdrive).

My question is, how effective is Gabapentin compared to Pregabalin? I’ve struggled with my weight for years so never attested that Pregabalin added to weight gain, but I’m now wondering if it contributes to inability (even to a small degree) to losing weight?

I’m meeting with my neurologist soon and not sure whether to ask him to switch. Also going to ask if there is an amitriptyline alternative that helps control neuropathic pain without triggering my RLS.

As always, I’d very much appreciate the wise wisdom of this group. Many thanks. Xx

[SueJohnson]

they are equally effective but pregabalin is more likely to result in weight gain. To switch you would want 1800 mg of gabapentin but that doesn't leave you any room to increase it as you will see from what I am about to say.

Take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. Since you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. Since you need more than 1200 mg, take the extra 600 mg 6 hours before bedtime. So if you needed more it would need to be taken 8 hours before bedtime.

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 nor calcium-rich foods within 2 hours for the same reason .

[CookieandCJ in reply to SueJohnson]

Thanks so much Sue for your prompt and comprehensive reply. I was anxious about switching (if it ain’t broke, don’t fix it) but am now reassured both drugs are equally effective so ready to consider it now in discussion with Neurologist

Best wishes. Cxx

[userotc]

Re your weight issues, could you commit to Nutritional Therapy? As is often the case, it may alleviate or resolve other health issues as it did for my mum and dad.

[CookieandCJ in reply to userotc]

Thank you. Unable to be physically active due to pain and deconditioning. Under going DBT for past 8 months. No gain but no loss hence wondering if Pregabalin may be a factor.

[userotc in reply to CookieandCJ]

If no further weight gain, I cant understand how Pregabalin is a factor. I realise no loss, but what are you doing to expect to lose weight anyhow? Its not easy to lose weight although easier with Nutritional Therapy, despite inactivity limiting its effect or timeline.

[CookieandCJ in reply to userotc]

Weight loss is complex. I’m just here to ask about potential Pregabalin influence but I appreciate your wider advice. Thank you

[Joolsg]

Nerve pain usually responds to gabapentin or pregabalin. Amitriptyline is ' the neurologists' dirty little secret' according to top MS neurologist Dr Gavin Giovanonni.

Most doctors are trained to give anti depressants for nerve pain but all anti depressants worsen RLS.

I use medical cannabis ( oil with 20% THC) for my MS nerve pain. I don't need it all the time, just when I have the nerve pain. It works much better than anything else I've ever been prescribed. But it's expensive. The NHS refuse to prescribe it. It also helps many on here with their RLS.

You can use Curaleaf or Releaf clinics.

[restlegs1 in reply to Joolsg]

Joolsg, what do you mean when you say the amitriptyline is the neurologists' dirty little secret?

[Joolsg in reply to restlegs1]

Professor Gavin Giovanonni says that phrase regularly in his MS blogs.

gavingiovannoni.substack.co...

As you can see, Amitriptyline can cause dementia, severe constipation, cognitive impairment and falls.

So it's probably a good thing that it makes RLS 1000% worse!

[CookieandCJ]

That’s something I might have to consider Joolsg. Between severe OA and Sciatica, the pain is hellish despite being on Tramadol and Pregabalin. I’m on way to see neurologist just now so I’ll ask if any alternative pain relief he can think of that doesn’t trigger my RLS. It was the pain specialists who recommended the Amitriptyline.

I also have to watch what medication I take to ensure it doesn’t interact with warfarin. Nothing is simple!

Really appreciate your input. Xx

[Marymill]

Hi, I am taking Gabapentin as I'm coming of ropinirole due to augmentation, I have found Gabapentin has helped with the pain and had no weight gain. I also have Osteoarthritis, I started a low carb diet around 3 years ago which helped a lot with the pain for that. I am struggling with the RLS pain at the moment and have contacted the Curaleaf for medical cannabis for nerve pain and just had my consultation, you have to pay for it but I have heard really good things about it so willing to give a go now I have been accepted. I too was prescribed Amitriptyline which sent my RLS through the roof!

Hope you find a solution x

[joepublic]

No idea sorry.