Gabapentin dosage

[Sunri]

Hi I'm currently on 400mg gabapentin which I take at 8.30pm. I have been on this dose for 4 weeks and up until this week it has been ok. This week my rls is back,not nearly as bad as it was just starting to feel that sensation again. I am in my bed early relaxing by 7.30pm, and wondered if perhaps I took it earlier that may help,or should I see GP about increasing my dose. I usually don't settle to sleep till about 1111pm

[SueJohnson]

400 mg is almost a starting dose. According to the Mayo Algorithm the usual effective dose is 1200 to 1800 mg.

Ask for a prescription for 100 mg capsules and increase your dose by 100 mg every couple of days until your RLS is under control.

[SueJohnson]

And yes take it 1 to 2 hours before you go to bed, as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime.

[Sunri in reply to SueJohnson]

thanks Sue,so I could try taking it earlier perhaps 6pm , I will try that till I can get to speak to GP re increasing dose. This last week I've been having a bit of a spaced out feeling at times too during the daytime, which I am putting down to side effects of the medication.

[Joolsg]

I agree with SueJohnson. As you're in the UK- ask your GP to look at RLS-UK website. It sets out the doses of gabapentin under Medical Treatments.Are you on other meds? Many can cause/worsen RLS.

And has your GP taken iron panel blood tests?

[Sunri in reply to Joolsg]

I'm on Amlopidine 5mg once daily, folic acid and B12, I also take Vit D supplement. Not had any bloods done before being prescribed Gabapentin. Last ones done about 4 months ago for my B12 levels.

[SueJohnson in reply to Sunri]

Amlopidine is a calcium channel blocker that makes RLS worse for most.

Some medicines that are safe for high blood pressure are propranolol (Inderal, Hemangeol, InnoPran) a beta blocker that may help RLS, Isosorbide Mononitrate (Monoket, Imdur) which is not a beta blocker nor calcium channel blocker. Other possibilities are: Clonidine (Catapres) an Alpha-2-Agonist used to treat high blood pressure which may help RLS and which also treats insomnia, tenex (Guanfacine, Intuniv), prazosin (Minipress) an alpha-adrenergic blocker that is also useful in managing sleep-related problems caused by PTSD and Tadalafil a vasodilator that in one study completely eliminated RLS. Clonidine can actually help RLS. Discuss these with your doctor. And then there is reducing salt by 1 teaspoon a day nih.gov/news-events/nih-res....

[Sunri in reply to SueJohnson]

thanks, that's very interesting and certainly something I can discuss with my GP

[Joolsg in reply to Sunri]

See SueJohnson reply about this.Many meds trigger/worsen RLS.

And your doctor should have done full iron panel blood tests for RLS.

Raising serum ferritin above 200ųg. ideally, resolves the majority of RLS cases.

[marigold60]

I'm also taking 400mg gabapentin daily, I have been since 2020. I take it with an Ibuprofen after evening meal. I'm usually fine then. However sometimes I do wake in the night feeling a bit twitchy. I then take a 100mg gabapentin and that usually does the trick. Occasionally I take another later in night but not often. This also has the benefit of helping me sleep

[Sunri in reply to marigold60]

Thank you, that gives me hope that my dose will work for me if I take it earlier. Does the ibuprofen help with the rls when taken with gabapentin?

[marigold60 in reply to Sunri]

It seems to, (it's the 400mg Ibuprofen) I've tried different combinations over the years as I didn't want to increase the gabapentin if I didn't have to.

[Sunri in reply to marigold60]

Thank you, I feel the same don't want to increase gabapentin unless I have to. Going to try taking current dose earlier to start with.

[Cobobay in reply to marigold60]

I found taking 100 after my earlier doses took about an hour to kick in and as you say sometimes had to take another 100 around couple later. I took extra on my earlier doses as suggested by Sue and this seems to have helped, or even solved the problem and works better for me anyway.

[marigold60 in reply to Cobobay]

It just shows we are all different. When I take a gabapentin in the night it doesn't take that long to kick in and I can feel it relaxing me

[Cobobay in reply to marigold60]

I'm glad your coping and that your lucky enough you don't have to take more gabapentin.

[Cobobay]

Hi, I am in bed around that time and take my 1st dose of 300 at 5.30pm I then take 600 at 7.30 and 600 again at 9.30. I think Sue or Jules will tell you 400 is quite a low dose and you will have to increase maybe 100 every couple of days till you find the right dose for you. I hope you find the right dose and it settles down for you.

[Sunri in reply to Cobobay]

thanks, I feel a bit stuck really I want the rls controlled but also have concerns the more I take the worse the side effects will be.

[Cobobay in reply to Sunri]

I haven't had any side effects apart from a slight weight gain. Mine seems to be under control atm, but at least I know I can increase my 1st dose up to 600 which I have done a couple of times if I've had a bad night, the next night I up to 400 instead of 300. I have taken brufen at times but it doesn't seem to help me at all.

[Sqlguy]

400 mg Gabapentinn is a pretty low dose; I take 2400, 800 3 times a day. If the 400 is working for you, I would ask to increase the dosage. I don't think the time of day that you take it matters.

[SueJohnson in reply to Sqlguy]

Unless you have neuropathy or PLMD during the daytime you don't need to take gabapentin 3 times a day as RLS symptoms are generally only at night. Doctors will prescribe it that way because it used to be only prescribed for neuropathy.

Also - take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime.

I suspect you will find you won't need 2400 mg when you take it correctly. My suggestion is you first switch so you are taking 1800 mg at night and 600 mg during the day. If you find that controls your RLS then reduce your daytime dose by 100 to 200 mg every 2 weeks so you don't have withdrawal symptoms. When you are through with that you can also try reducing your night time dose.

Have you had your ferritin checked? If so what was it? If not this is the first thing that should be done for RLS. When you see your doctor ask for a full iron panel. Stop taking any iron supplements 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. Have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your ferritin to be over 100 as improving it to that helps 60% of people with RLS and in some cases completely eliminates their RLS and you want your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice.

Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium(salt), foods that cause inflammation, ice cream, eating late at night, estrogen including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, eating late at night, stress and vigorous exercise. It is a good idea to keep a food diary to see if any food make your RLS worse.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga.

Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[SueJohnson in reply to Sqlguy]

Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment at Https://mayoclinicproceedings.org/a... It says the usual effective dose is 1200 to 1800 mg.

[SueJohnson in reply to Sqlguy]

In looking over your replies I see you are taking Parnate for your depression. It is known to make RLS worse. Safe anti depressants are Wellbutrin and trazodone.