Gabapentin or Pregabalin?

[Embroiderer]

I have been taking codeine 30mg for a couple of years for RLS, but I know it’s too low a dose, and not the first line choice, and doesn’t do the job for me anyway, so I want to change. I’ve never tried any treatment other than codeine. I am talking to my GP tomorrow about the possibility of taking Pregabalin or Gabapentin. Any thoughts on which one is best tolerated? I also take Thyroxine and Omeprazole 10mg. I know the latter is not advised but I can’t do without it, and didn’t notice much of an improvement in my RLS when I stopped it for a while. Thank you in advance!

[Madlegs1]

Are you going to continue with the codeine?

Otherwise the side effects of each of those two differs for each individual.

It's really a case of sucking it and seeing.

Can you get Horizant where you are. It's worth checking out , depending on cost.

I presume you have checked out all Sue's advice in other posts re iron ,triggers etc?

Good luck.

[Embroiderer in reply to Madlegs1]

Yes, I follow the forum daily; I take iron as advised and should have satisfactory levels now, haven’t spotted any specific triggers other than eating an evening meal (with or without sugar or alcohol!) I have done a bit of research myself which seemed to suggest Horizant/gabapentin enalapril is a good first choice but so far can’t find it on UK websites.

[SueJohnson in reply to Embroiderer]

It's not available in the UK and unless you have RLS in the daytime you don't need it.

I usually advise you start with gabapentin as you can increase in smaller doses and is less likely to cause weight gain. You can always switch directly later if you want.

Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). It will take 3 weeks before it is fully effective. After that increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you. 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. (You don't need to split the doses with pregabalin)

Most of the side effects will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms.

According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)." If you take magnesium even in a multivitamin, don't take it within 3 hours of taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and don't take calcium within 2 hours for the same reason (not sure about pregabalin).

[Embroiderer in reply to SueJohnson]

Thank you Sue. I’m anxious they will only give me 100mg as I’m approaching 68. But pretty healthy otherwise, so we’ll see.

[SueJohnson in reply to Embroiderer]

Show them the Mayo Algorithm. The only age restriction is to start with 100 if older than 65 but even that is not necessary and is really meant if you are unsteady on your feet. I am 84 and was started a few years ago on 300 mg with no problems and now take 1800 mg although only 1200 of that is for RLS.

[SueJohnson in reply to Embroiderer]

Also don't take your antacid within 2 hours of taking gabapentin. I forgot to include it above.

Did I ever suggest to you that you could take Gaviscon Advance (just the advance one unless aspertame bothers you - the tablets or saccharin bothers you - the liquids) and it doesn't make RLS worse.

[Embroiderer in reply to SueJohnson]

Yes I tried Gaviscon Advance for a couple of months or more, was fine for symptom control but I was still getting some nighttime reflux which affected my voice, and as I’m a keen choral singer that was too much. Thank you for your advice re Gabapentin dosage too.

[Embroiderer in reply to Embroiderer]

I wasn’t planning to continue with the codeine.

[purple-flowers]

I’m afraid Gabapentin didn’t help me at all. My sister is on it and she also says it doesn’t help. Am now on OxyContin morning and evening slow release. 5. Morning 10mg at night

[Embroiderer]

Thank you all for advice; I had a good discussion with my GP this morning and she has started me on Gabapentin according to the Mayo clinic algorithm so fingers crossed.

[Princegwyn]

I've been on pregabalin for several months now. My GP won't give me more than 275mg. It makes me feel drowsy but it does not stop my RLS. I've also put 1.5 stone on.

I'm pretty upset that a drug that's not worked well has made me gain so much weight. I know it's the pregabalin as I've watched what I've eaten for decades and kept a food diary on Myfitnesspal for 7 years without a day's break.

I have MS and am unsteady on my feet at the best of times. A trip to the bathroom between midnight and midday is pretty hazardous for me these days!

I took a few co-codamol for pain for a few days (out of date from when I was taken off them and dumped on tramadol years ago) about a year ago. They did the job on the pain and the restless legs. I wasn't enamoured with the constipation that followed but at least I slept.

SueJohnson, I hope you don't mind but I am about to pay you a heartfelt compliment. I read many posts here and you're almost always the first to reply. Your advice has helped so many here and would have helped me enormously if my GP was as helpful in following it! I was floored (in the best way) when I just read your age. I know quite a few people your age. My sister is 82, my partner's mother is 81. My sister is fairly computer savvy, my "MIL" can barely manage a non-smartphone. You deserve an award for the work you put in here.

[Embroiderer in reply to Princegwyn]

I’m so sorry you’re struggling so much. The risk of weight gain was the reason I wasn’t keen on Pregabalin. I wish you well- people (including GPs) don’t realise what a nightmare RLS can be.

[Princegwyn]

Thank you. I hope you find relief through the right medication, too.