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 have started gabapentin 10 days ago and started at 300mg 1 tablet a day and worked up until today at 1800 so 2 x 300mg tablets - 3 times a day. I am sleeping badly so maybe 4 hours between 600mg doses or 6 hours. I had pain in face for weeks before taking. It is better and not 24 / 7 but still feel pain in teeth ( discocciated pain as dentists say teeth ok) but not constant. It was never terrible for me but it was 24/7 and so unrelenting so it becomes unbearable and lose sanity. I only take this. I have been given a sleeping aid called zopiclone that works but is addictive so I only have it for a 2 weeks. I have co codamol 30mg codiene and 500mg of paracetemol. I can get legal cannabis and I have not decided to use this yet. In summary what would pregabalin do for me ? I have searched this and is does not intereact with any of my other meds. I have chatgpted it - and looked at your docs - has anyone taken opiodes - I know the dangers of addiction but I see some posters have had tramodol and oxycodone or is that the very last resort?
Sounds like you are taking gabapentin for neuropathic pain, right? While that is the most common use for gabapentin, those of us on this portion of HealthUnlocked are taking it for Restless Leg Syndrome.
Are you working with your doctor regarding dose? It sounds like you increased your dosage much faster than is typically recommended. So the effects you are experiencing may be due to that.
Pregabalin is generally considered interchangeable with gabapentin, but at doses of 1/6 of a gabapentin dose. Some people react differently to the two drugs, so that’s why some prefer one vs another.
yes that is right - I realise that about rls and this is where it is mentioned the most - doctor wrote down 300 day one , 600 day two and three 900 day 4 and 5 etc building to 1800 by day 11 - i am now on day 12. I have seen no side effects from gabapentin so far and pain was 24/7 and now a bit less but still there - it has got a little less.
They say it generally takes two weeks or more for gabapentin to fully take effect. That is why most advice is to stick with 300mg for a couple weeks then ramp up slowly. You are lucky to not have any bad side effects. Hang in there at your current dose for a while to see if it improves with a little more time. Do not stop suddenly - there will be withdrawal symptoms. I believe some prescribe up to 4800mg per day for pain or epilepsy. So your doctor may increase your dosage eventually. But give it some more time at this dose first.
doctor said to go to 1800 where I am today and stick to it - i am going to update him. I also have for only 2 weeks zopiclone- this is a sleeping drug and knocks you out. It is addictive and the doctor hates giving it out. I felt less pain on Saturday so I did not use it to sleep and had constant pain on sunday and then last night I took zopiclone and today feel less pain. I think the better sleep makes me less run down and therefore less pain. Note I dont have rls and for me the nueralgia is triggered by fatigue or at least that is a factor. I have heard of the withdrawl. Have you heard of anyone taking opiates if all else fails? or cannabis - I can;t remember if we have had that chat
I, and many here on the RLS portion of the site, use buprenorphine for RLS. Most of us can get by with fairly low doses - around .5 mg taken once in the evening. But I know that when opiates are used for pain, it likely requires larger doses and 24/7 coverage. And that's when the addiction concerns get greater. I believe that buprenorphine and methadone (the 2 long half-life opiates that are most often used for RLS) are less likely to be abused, but I'm not sure if they are commonly used for pain relief. Definitely a question for your doctor. There is a wide assortment of opiates to choose from for pain relief. So you'll need to rely on your doctor. He/she may be reluctant or unable to prescribe any, given the opiate scare hanging over the medical profession. But doctors specializing in pain relief (or RLS) know what an important tool they can be in the right circumstances.
I am a fan of cannabis. For me it helps with sleep, RLS, the occasional headache, and other pain. Vaping is good for quick relief; gummies for longer lasting but longer time to kick in. If you try it, start with really low amount and give it some time to see how you handle it.
thanks 707 and I see you are from the usa - I am in England - cannabis is illegal but i have a medical prescription for oil and it is not legal to give tobacco leaf version. The thc and cbd combo is supposed to be good for pain. CBD is legal as it doesnt impair at all and can be purchased in very low doses legally. The THC in weed is the part that gets you high and in this oil the cbd compounds are supposed to offset the thc part if that makes sense
Some people say CBD helps them, but most seem to say it does nothing for RLS or sleep. But we all react differently - so I'd experiment if you can (within your Rx).
I’ve never tried cannabis and doubt I will for awhile (I don’t want to change more than one thing at a time) But what did you look for when deciding on cannabis? Is there a strain you prefer that helps your RLS and sleep? Thanks
I think the effect on RLS is minimal, but the overall buzz might help distract from mild RLS symptoms. Helping with sleep is the main thing. For me, it makes me tired plus seems to reduce the amount of dreaming that leaves me otherwise exchausted when I wake up. It also helps with minor pain, including nausea. So I wouldn't worry about it being an extra variable to figure out in your RLS medication regimen. You'll notice the effect fairly quickly. Just take it easy to start with. If you're one of those people (like my wife) who hates the feeling of being a little "out-of-it", it may not be for you.
Definitely get the Indica strain. It's the relaxing one, as opposed to Sativa that energizes you some. Some products are hybrid (both strains), and some don't say anything - meaning it's likely both. Gummies are good for long-lasting effects - about 6 hours. But it takes around an hour to kick in. Vaping has an immediate effect, but only lasts 2 hours or so. CBD does nothing for me, and most people on this site say the same. It's the THC that makes you sleepy (and high) and helps more with pain. When I use gummies, I usually take 5 or 10 mg (most packages come as either 5mg each, or 10 each). You'd want to start with half a 5 mg gummy at most to see how you handle it. If I take one long vape, it seems to be the equivalent of 20mg or more of gummy. So just a short puff does it for me. (I don't understand how people can handle this when you see them on TV taking drag after drag and still acting coherently 😱.) Kanha is a good gummy brand; Jetty is a good vaping one. With either one, ask for help at a dispensary and tell them what you want it for to see what they recommend.
One last point - constipation is a suboxone side effect for me, and the gummies seem to make it a bit worse than vaping does. But both seem to play some part. Relaxing your body means the GI tract doesn't work as fast, I guess...
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 every 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.
Hi 707twitcher Just flew back to CO from seeing Dr. Buchfuhrer yesterday. I was on a super high dose of Sinemet and Dr. B put me on Suboxone last August, 2024. I'm currently taking 1.25mg of Suboxone a day. I'm also taking 900 mg of gabapentin, In our meeting yesterday, I told him I'd like to try pregabalin instead of gabapentin. I feel like my whole RLS treatment has been so mis-managed. Didn't even start medicine for RLS until two years ago and neurologist put me on Sinemet. I was a fool for not doing any research and now I'm suffering from her ignorance. Anyhow, I told him I wanted to at least try pregabalin and see how I do on it. I, too, would love to reduce my Suboxone dose. I doubt I'll ever get off it but if any alpha2 ligand can help, I want to try it. So Dr. B was very open to try whatever I wanted. So he prescribed stopping the gabapentin and starting pregabalin at 75mg twice a day and going up by 1 capsule until I either get side effects (too much sedation) or the medication works. From your experience and others, I doubt it will change things much for me but I want to at least try. I, too, suffer from insomnia. So maybe the pregabalin will help.
Good luck. Why are you taking the pregab twice a day vs. just in the evening? Are you also splitting the suboxone dose? I know some people get mini-withdrawals, so twice a day would remedy that - but that's rare, given buprenorphine's long half life. I take all my meds in the evening/night. But on those days when I need a nap, I have to take some buprenorphine then to be able to do so.
I like your handle - I'm from CO, now living in northern CA.
It's just what he proposed for pregab. At 5pm and 10pm. And yes, I'm splitting my Suboxone dose. I get symptoms throughout the day so take it 3 x day. It's becoming too much to handle, though. I get nauseous from my daytime suboxone doses so would love to take all my meds in the evening. Maybe because I don't eat much during the day, the daytime doses bother me more. I just don't have much of an appetite during the day.
Suboxone should be effective for 12 hours or close to it. You might try switching to twice a day? But there does seem to be a small carryover effect from earlier doses. So if you have been taking .4 mg three times a day, cutting back to twice a day might necessitate using .5mg each time. Something to experiment with….
Loss of appetite is a buprenorphine side effect for me also. Gabapentin/pregabalin I think has the opposite effect.
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