Alternatives to Gabapentin

[Patrick_W]

Dear All,

Having weaned myself off Pramipexole last year and gone on to Gabapentin, my RLS has - by and large - been OK. I take 2 x 300mg in the evening, and that's usually enough to stop my legs bouncing.

So far, so good...

The problem I have is that I am desperately tired most of the time. I've never been a good sleeper, so have often felt tired - but this is horrible!

A Google search lists 'extreme sleepiness' as a serious side effect, saying I should contact my doctor. Whilst my doctor is very helpful, he - like, apparently, so many in the UK - isn't an expert in RLS.

What alternatives are there to Gabapentin which might not have the same side effect?

Thanks in anticipation.

Patrick

[SueJohnson]

Congratulations on off weaning off Pramipexole. I know that wasn't easy.

If you have just started gabapentin you might give it at least a month as your body gets used to it it may go away.

Or you might want to try switching to pregabalin. Although it is basically the same drug except you don't need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. Divide the gabapentin amount by 6 to get the correct dose.

Or you might want to ask for adderall or ritalin and take it in the morning as it will ware off before night.

If these don't work, the answer is a low dose opioid although they come with their own set of side effects.

I would recommend buprenorphine or methadone as they are long lasting. Most of the others last only 4 to 6 hours and need to be taken that often or you will have mini withdrawals. If you are prescribed one of the others be sure you are given enough to take them that often.

Don't let your doctor prescribe ropinirole or Neupro (rotigotine).

[Patrick_W in reply to SueJohnson]

Sue,

Many thanks for the quick reply.

I've now been on Gabapentin for around 8 months, so would hopefully be used it by now.

I find it difficult to work out why sometimes my legs are fine, and other times - like last night - they were awful. Admittedly yesterday I didn't go anywhere, so I'm going to try to get a bit of exercise each day and see if that reduces the problem.

I'm now waiting to hear about a doctor's appointment, and will print out your message to take with me.

Thanks again, Patrick

[Munroist in reply to Patrick_W]

Daily moderate exercise helps most people with RLS. I try to get something like 5-10k brisk steps a day, morning is usually better than evening - if you walk to work or go shopping you often get that just from your daily activities. Intense exercise e.f. running does tend to make RSL a bit worse but it's something I live with as I want to stay fit but even here you can help yourself by not pushing to the max - 85% is enough for fitness and limits how twitchy your legs are later.

[Karma-]

Hi Patrick. Great to hear that you made it out of pramioexol and so sorry for the sleepiness side effect. I also transitioned from pramipexole to Gabapentina, a year ago or so. While taking pramipexole, it was horrible. Gabapentina has been great and I’m taking the same dosis as you, two 300mg pills before bed and some times (rarely though) I take one more. So, so far so good. However, fortunately I have not felt any side effect, so not much I could say about your sleepiness feeling. In my case, I used to take medicine for a mild level of depression that I suffer, and I had to stop doing that years ago, because it would worsen my RLS. According to what I’ve been said by my psichiatrist, depression medicine do not go well with Gabapentina. I don’t know why exactly but for now I’m managing my depression with therapy only.

Best,

Andres

[joker826]

Hi Patric,

Unfortunately, gabapenten does make one tired. I take Tarzan one and 100 mg of gabapenten at bedtime. The trazadone helps me sleep through the night without leg movement.

[Operaqueen]

Well done Patrick for getting off Pramipexole - a really horrible medication. I too am on Gabapentin and have had terrible problems with sleep - or lack of it. I would try to wean yourself off gabapentin slowly - I am down to 300mg a day now (just before bed) and sleep is better. But I guess you'll have to be led by the doctors (who of course are not experts in RLS). Good luck.

[SueJohnson in reply to Operaqueen]

You might want to try switching to pregabalin. Although it is basically the same drug except you don't need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. Divide the gabapentin amount by 6 to get the correct dose.

And pregabalin tends to make one sleepy and is used for insomnia.

[Patrick_W]

Dear All,

An update on things: I had a nice chat with my doctor, who said that Sue's suggestion of trying Pregabalin was worth trying, so I've now been on that for 11 days.

He's prescribed me 100 mg hard capsules (I was on 2 x 300mg Gabapentin), but I'm finding that they aren't working as well as the Gabapentin - I'm generally waking up a couple of times per night with bouncy legs.

I'm also feeling even more tired during the day, though whether that's because of the Pregabalin or the lack of sleep, I don't know!

I'm not sure whether to ask the doctor for some 50mg Pregabalin tablets so I can try increasing the dosage a little - but am worried that it'll make me even more tired during the day.

Any thoughts?

Thanks, as always.

Patrick