Augmentation and pregabalin/gabapentin

[davchar23]

As many of you will have read my earlier posts I have been one of those many grateful people whose life has been positively changed by association with this forum

My journey, briefly, was DAs to augmentation to oxycodone to low dose opioid (buprenorphine) and finally to a personal formula for RLS control going forward.

My question today is this:-

Are the drugs pregabalin and gabapentin really any use to a person whose has severe augmentation? I suspect thar these drugs only help with RLS at a stage in the use of DAs BEFORE augmentation sets in? After augmentation I tried both drugs and in the case of pregabalin I took as much as 500mg/day with out any benefit and bad side effects.

I would appreciate comments on this question

Davchar23

[Madlegs1]

Gabapentin and Pregabalin do not help with withdrawals.

They are best used as a primary medication for RLS, when iron deficiency, and triggers have been eliminated as potential causes..

So--- if one has severe augmentation, then those two will not be of any help until after any withdrawal effects are finished.

(Assuming not too much damage has occurred to any neural pathways etc.)

Good luck.

[Joolsg]

There are studies that show gabapentin does not help many patients after they have been on dopamine agonists.Dr Garcia Borregeurrero also reported that dipyradimole was not effective when patients had previously been on dopamine agonists.

The evidence does seem to be mounting that dopamine agonists cause permanent damage and reduce the effectiveness of other treatments.

Depressing.

And the reason we have to keep campaigning against dopamine agonists.

[davchar23 in reply to Joolsg]

Dear Joolsg,

I agree that is very depressing despite being what I thought. I know that if I decrease the buprenorphine and stand up to the withdrawal symptoms my RLS occurs so after such a long time (ie 18 months since augmentation) I suspect my sensors are permanently damaged.

Davchar

[GaryHB in reply to Joolsg]

Hi Joolsg. I would support what you have said. Since I came of Pramipexole 2 years ago, my mood has been precarious to say the least. It is distressing. Thankfully Tramadol is till keeping the rls out the door.

[707twitcher]

Hi Davchar. I’ve recently started gabapentin again, 13 months post-DAs. My previous attempts were futile, but this time I have been able to halve my buprenorphine dose while taking 1000 mgs of gabapentin. I’m still experimenting, hoping to reduce the buprenorphine dose further. but so far I haven’t been able to do so, even while increasing gabapentin dose to 1500mgs. And yes, I have been spacing the gabapentin doses so that there is 2-3 hours between doses of 600mgs.

Interestingly, I spoke briefly with Dr Buchfurher the other day, as I am in the study that he is managing with Noctrix regarding the use of the Nidra TOMAC bands. He said that most of the dopamine receptor healing that occurs does so in the first month post-DAs. This doesn’t seem to be true in my case. He also said that spacing gabapentin doses out by 3-4 hours is better than 2 hours. He says we’re only getting about 60% effectiveness with 2 hour spacing. Of course, pregabalin eliminates this issue, but my initial trial of pregabalin resulted in significant weight gain, so I’ve been reluctant to try it again. But I will do so after determining what the optimal gabapentin dose is for me.

I have no idea if my experience is unusual or if I can reduce buprenorphine dose further. But you may as well try it to see if you can reduce your dose somewhat. I know the nausea side effect has been awful for you. At this point, I can’t honestly say that my opioid side effects are any better on half my former dose, but that might change with continued use. 🤞 and I have been lucky to have no gabapentin side effects.

[davchar23 in reply to 707twitcher]

Dear 707 Twitcher,

Good to hear from you again and to hear your interesting data on gabapentin vs buprenorphine. I understand where you are coming from and will think about doing some testing on pregabalin to aid bupre reduction. However I am sure that my nausea which as you say was quite severe is now under control was not from a reduction in bupre but by making sure I do not get withdrawal symptoms. I am currently using a 10mcg/hr patch (lasts 5 days) and "topping up" on average twice a day with a quarter of a 200mcg tablet (ie 2x 50mcg). This way I find I keep the level of bupre in my system at a level high enough to block RLS and low enough to avoid nausea and hot/cold sweats.

It took a lot of tests and a long time, to find my personal formula, during which i trialled in vain numerous side effect suggestions from the GPs Ondansetron and other anti-emetics , CBD cannabis oil and several OTC compounds.

I know that Joolsg has in the past used a low level of pregabalin alongside bupre so i will give it another chance although it seems that the DAs have done the damage and I am not going to get much benefit. it is about 18months since augmentation in my case.

Incidentally can you please remind me of the equivalent pregabalin to your 1000mgs of gabapentin?

Best regards

David

[707twitcher in reply to davchar23]

6:1 ratio. So 1000mg gaba = 167mg pregab. Ramp up slowly if you're going to try - to make sure the side effects don't slam you. My only side effect of the gaba was slight dizziness a couple times during the ramp up.

[davchar23 in reply to 707twitcher]

Thanks and yes i will start much lower as I remember having dizzy spells at higher levels of pregabalin

[ID158 in reply to 707twitcher]

707, why do you want to get off of buprenorphine? What kind of side effects have you experienced? You may have mentioned it before but I missed it if so.

[707twitcher in reply to ID158]

In rough order of nastiness (for me):

Constipation, insomnia, sweats, fatigue, lack of appetite. Yes, there are remedies for most. And this beats RLS. But if I can find something different with fewer side effects, I’ll try it.

[ID158 in reply to 707twitcher]

I see! For sure worth trying to switch then.

[SueJohnson]

Gabapentin and pregabalin can definitely work after augmentation if one's dopamine receptors haven't been damaged. I suffered augmentation and am on gabapentin which controls my RLS.