Starting Pregabalin for Opioid-Induced Insomnia

[jitters62]

This forum moves so fast threads seem to get buried after just a couple of days, so I thought it might be best to ask questions in a new post. If there's a better way to continue a discussion please let me know. To recap, my husband takes Hydrocodone 10 mg for severe refractory RLS, this manages his legs very well but has been causing insomnia for months now, worse by the day. We saw Dr Walters Thursday, and after we shared what we'd learned from the folks here he agreed to try Pregabalin along with the Hydrocodone. He suggested 25 mg for 4 nights, 50 mg for 4 nights and then on to 75 mg nightly. The starter dose of 25 mg the past two nights hasn't helped at all, so I called our pharmacy and they said it would be fine to move to 50 mg tonight and then to 75. Those of you taking this medication, did you move up in the dosing fairly quickly? My husband is exhausted and morale is taking a severe beating, as you all well know based on your own experience. Thanks so much for the support and guidance we've found here.

[Madlegs1]

That's exactly the schedule I've just been given a week ago.

I was going to ask the group if there were known problems with continuous sleepiness with the Pregabalin..

I'm taking 75mg in the evening. It doesn't stop RLS attacks in the night time, and I'm pure sleepy all next day.

Whether from the Pregabalin or exhaustion from interrupted night ,I don't know.

In your husband's case ,one of the side effects of Pregabalin is noted as depression.

Isn't that just dandy!🙃😎💚

[SueJohnson in reply to Madlegs1]

Generally speaking the pregabalin shouldn't make you sleepy the next day. I suspect it's from the interrupted sleep.

[teakabeagle in reply to Madlegs1]

I was a mess on Gabapentin and Oregabalin. Felt in a fog, dizzy, sleepy, difficulty concentrating, depressed, barely functioning ant home and work and no significant improvement in the RLS. I didn’t accommodate after 3 months on each and spent 6 months getting my life back. Never again!

[Madlegs1 in reply to teakabeagle]

Thanks 💚

[Joolsg]

You can add 25mg every night quite safely.The starting dose for RLS is 75mg, so he will be fine.

I really hope it sedates him enough to counter the opioid insomnia.

[Baz33]

I was given 300mg of pregablin for 3 months ,the side effects were awful,I then needed to taper off for 28 weeks until I was no longer taking it, the withdrawal process was awful, not enough is documented about the side effects of this drug and it really needs reclassified from a controlled substance C ..to B grade , I literally spent last year navigating the effects this had on my mental health and work.Please do your research .

[Rayme]

I took pregabalin for 4 months, going up to 400mg but it didnt help my RL or my sleep so I came off the over 4 mths, which didn't cause any bother. Side effects of pregabalin were unpleasant, double vision, memory issues, word/thougt confusion so I was glad to be off it. I hope it works well for your husband.

[jitters62]

Thanks so much to all of you for sharing your experiences and offering suggestions and guidance. He took 50 mg of pregabalin at 8:45 and was awake all night but slept some this morning, he said the best sleep he’s had in weeks. Tonight we’ll try 75 mg earlier in the evening and see how it goes. I’ll be back with a report. In the meantime your thoughts and suggestions are greatly appreciated. Thanks again.

[707twitcher]

You may also want to consider cannabis. It helps me with insomnia. Gummies last longer than vaping - generally 6 hours. So an Indica strain (the relaxing one) gummy right before bed might get you through the night.

[jitters62 in reply to 707twitcher]

Thank you for the suggestion. Yes, he was able to use gummies for many months, but then they began to cause worsening daytime anxiety. He said it was a terrible feeling of dread he couldn't describe, and he felt miserably cold and clammy all over. The anxiety reduced dramatically once he stopped the gummies, so we feel certain they were the cause. Thanks again for the suggestion, and I hope they continue to work well for you.

[Munroist]

I took pregabalin for a year without any significant side-effects. I started at 150 mg a day and went up to 300 mg a day within a week. I was taking it for neuropathic pain and didn’t really notice any difference with the RLS although that was less of an issue at the time. It did give me a slight cognitive fog but it was barely noticeable. More annoying was occasional word confusion and hesitation while talking. It is a strong drug and clearly many people have had issues from taking it. However, I don’t think that everybody reacts in the same way, I certainly didn’t. One good thing about pregabalin is it’s relatively easy to stop and start so if it doesn’t work or the side effects are too much it’s not difficult to stop it.

[jitters62 in reply to Munroist]

We're grateful for the encouraging words, Munroist. My husband augmented on Ropinirole, so we expect he'll continue to need an opioid to manage his legs. We're hoping the pregabalin will address the opioid-induced insomnia. Thank you again.