Does anyone combine gabapentin and pregabalin? I’ve seen lots of posts about switching between the two, but none with someone taking both.
It seems like a possible approach, assuming you don’t get awful side effects from either, but may want to reduce side effects of one of them. For example, pregabalin seems more likely to cause weight gain (that has been my experience). But taking more than 1200 mgs of gabapentin is a royal pain, given the need to leave two or three hours between doses. (Dr Buchfurher recommends 3 - 4 hours between doses.)
Pregabalin is much faster acting - one hour vs three. So I’m considering taking 600mg of gabapentin early, and pregabalin an hour before bed.
Any thoughts about this?
Thanks
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Interestingly, Dr B is the second name among the Mayo algorithm contributors. In his defense, the Mayo algorithm says at least two hours between doses. He told me that with 2 hours between, one only gets about 60% efficiency. My guess is that anything more than two hours becomes very impractical, so 60% is better than nothing. Especially since its effective life is about 12 hours, from what I’ve read.
Interesting article on both meds. It does mention gabapentin has 4 to 5 hours 'onset of action' which probably explains why Dr Buchfuhrer mentions dosing 3 hours apart.
He has previously stated that the Mayo algorithm was a 'compromise' because of the very strong, different views of the 'experts' compiling it.
Great article - thanks. I really wonder how anyone taking 3 or more doses of gabapentin gets relief? It has a 5-7 hour half life, and that 5-7 hour figure is also shown as how long its effects last (presumably after the 3-5 hours it takes for it to begin working??). So the first dose would lose effectiveness long before 7am. Maybe you are handling your symptoms for the first part of the night with the early doses, and for the later hours with the last dose? In which case, one could take a dose in the middle of the night, rather than try to cram them all in before bedtime?
Also interesting that 60% bioavailability is the best case scenario for gabapentin, even without dosing a couple hours apart. (I assume that doesn't really matter - it just means that whatever dose works for you is working while your body is only absorbing 60% of the drug.)
So on average a RLS sufferer takes 1800mg Gabapentin, or 350mg Pregabalin.What amount of which one were you taking, and what amount of the combination have you decided on ?
But since it can cause some dizziness which wears off and also makes one sleepy, it is better not to take them in the middle of the night unless one finds it works better for them.
I started a combination last night - 600mg gab @ 6pm & 300mg gab with 75mg pregab @ 8:30 pm. I was previously on 1200 mg gab, but intended to keep increasing as I try to keep decreasing my buprenorphine. Last night didn't go well as RLS symptoms broke through a couple times, even after taking more bup. This leads me to believe the pregab had zero effect or was even a trigger (which doesn't make sense).
So I think I will abandon the pregab experiment for now, and stick with just gab until I have worked out what dose of it is optimal for me. Then I'll experiment switching in some pregab. I intend to increase the gab to 1800 and see what that does to my bup dosage.
The below comments dive a bit deeply into the details about gabapentin dosing, and it is confusing. So don't bother with it unless you are cursed with a scientific curiosity (without a scientific background to make sense of it) like me.
I did a lot of reading yesterday about the two gabapentoids (3 if you count enacarbil). I could not find any really solid info about optimal timing of gab doses. The Mayo algorithm is definitive about no more than 600mg at a time, and at least 2 hours between doses. But I don't see where this definitive recommendation comes from, as all the underlying studies I saw were based on 3x or 4x per day dosing for neuropathic pain. They talk in terms of total dosage per day, typically 1800 - 3600mg per day split into 3 doses (so those higher doses would be 1200mg ea.). They all say that bioavailability decreases dramatically at total daily dosage above 300-900mg (60% availability for 300mg, 40% for 600mg, 35% for 1600 in one study. Others are similar but use the 60% as the starting point but for 900mg daily, going down from there. (pmc.ncbi.nlm.nih.gov/articl...
Basically this means there are diminishing returns the more medication you take. But they say there is a lot of person-to-person variability. And I saw no studies looking at dosing just for RLS where the recommendation is to take it before bed, not throughout the day for 24-hour pain relief. But unless you have bad side effects from gab, there is no harm in taking more than you can absorb - it just gets excreted.
I'd love to see a study that shows on an hourly basis what gab's effectiveness is from the time of dosing until it stops having any significant effect. I've seen that for buprenorphine sublinguals, but nothing for gab - pain relief nor RLS. My guess from reading the neuropathic pain studies is that it takes 4 hours or so after dosing for it to take effect. (Perhaps it takes effect sooner for RLS than the 4 hours or so the studies show for pain relief, because the Mayo algorithm and lots of discussions on HealthUnlocked talk about it taking effect in 2 hours.) Then it is effective for about 6 hours. So if one is taking, say, three doses of 600mg before bedtime, timing would be something like 4pm, 6pm and 8pm - assuming you leave 2 hours between doses (the minimum recommended spacing). So the first dose would start to take effect around 8pm and would lose effectiveness by 2am; second dose would be 10pm - 4am; third would be midnight - 6am. Thus the amount of gab being effective at any one time would be: 8pm - 10pm 600mg; 10pm - midnight 1200mg; midnight - 2am 1800mg; 2am - 4am 1200mg; 4am - 6am 600mg. But the wide variability by person makes this all very speculative.
Please chime in, anyone, if you can ease my confusion. 😃 For now, I'm going to try 500mg at 2, 5 & 8 pm, then bump up to 600mg each, and see what happens.
I"M curious about your experience with Buprenorphine, since many of us are considering it. For me Gabipentin 1800mg was not working. Switched to 350mg Pregabilin and not having positive results with it either.🤷
I’d definitely recommend it. It enabled me to wean off Pramipexole fairly fast and easily. And it completely controls my RLS symptoms. Even if I have break through symptoms, taking a little more buprenorphine will handle it within 30 minutes. I prefer the sublinguals to the patch. A lot of people here get by with a dose of .5mg or less, even though the recommended maximum dose is 6mg.
Everyone has different side effects that bother them. Mine are constipation, insomnia, sweats, fatigue, and loss of appetite. I can handle most of these reasonably well with prunes, cannabis, etc. But these are the reasons I’m seeking to eliminate or drastically reduce my buprenorphine dosage.
Were you on a DA? If so how long have you been off it?
If it helped at all and my memory is it did, then you might want to increase it by 25 mg evry couple of days as 450 is the usual max, but you can take up to 600 Mg. It can be hard to get a doctor to prescribe an opioid and they can have side effects you may not like.
If you decide to come off the pregabalin reduce by 25 mg every couple of weeks.
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