Can gabapentin intensify RLS?

[Indigirl99]

I’ve been phasing on to gabapentin since the summer whilst I came off ropinerole (been off ropinerole for 2 months). My gabapentin dose has been at 1800mg for 3 weeks (2pm, 5pm & 8pm on Doc’s suggestion) and during the night I invariably am awake for 2-4 hours with the most intense RLS, worse than before the gabapentin, and it seems to be getting worse as the weeks go on. I take Codeine Phosphate 15mg, either 1 or 2 tablets depending on how bad it is. I don’t take any other meds, and no change in diet or lifestyle. I’m not sure whether to increase the gabapentin or try something else. Any thoughts? Thanks.

[SueJohnson]

Try changing the way you take gabapentin to the preferred and normal method. Take 600 mg 1 to 2 hours before bed, 600 mg 4 hour before bed and 600 mg 6 hours before bed. Taking them as early as you do means they are not optimally helping you at night. How long were you on ropinirole? If you were on it for many many years it is possible your dopamine receptors were damaged and gabapentin won't work. If this is not the case you may need to increase the gabapentin, but at that point switch to pregabalin at 300 mg since it doesn't have to be taken in divided doses and add 25 mg every couple of days until you find the dose that works for you. Take it 1 to 2 hours before bed. If later you decide to come off gabapentin, do so very slowly or you will have withdrawal symptoms. If you do so slowly enough you wont have any. Then the best medicine is opioids. Codeine is not as strong as others although you are taking a low dose. 60 to 180 mg is the usual effective dose. Have you had your ferritin checked? Improving it to 100 or more helps 60% of people with RLS. Are you sure you have had no change? Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, estrogen, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise.

[Indigirl99 in reply to SueJohnson]

Thanks Sue. I’ll try changing it to 4pm, 6pm and 8pm and see how that goes. I kept a diary last year so know my triggers and had a full iron/ferritin check before going on to gabapentin. All levels were above what’s been recommended here. I was on ropinerole for 5 years, no meds prior to that, and it was a very gradual thing. By the end I was on one plus a third of the 0.25mg tablets. I hate taking tablets so it was always just enough to get me some relief, but this is why I’m in dispair that I’m up to the upper level of the range for gabapentin and not only is it not working, I’m getting worse RLS for a period of the night. Do you think I need to try pregabalin maybe?

[SueJohnson in reply to Indigirl99]

Wait to find out if the change in time taken works, and if not then I would suggest to switch to pregabalin and try increasing it.