How long does it take for Lyrica to start working?

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QyX
Posts: 346
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Location: Berlin / Germany

Re: How long does it take for Lyrica to start working?

Postby QyX » Thu Sep 20, 2018 6:17 pm

Okay, I see.

Here are some more basic infos for you:

When you increase the Lyrica dose too fast, you will feel horrible. That is normal and would be expected. If you increase the dose, only do it slowly ... like 50 mg every 2-3 days. I also would not be surprised if you develop a tolerance to the new dose fast. That's just how Lyrica works but most patients will reach a stable dose between 300 and 600 mg where the drug is efficient and no further dose increase is necessary.

HOWEVER: you could run in the situation where Lyrica is not effective enough, you need to increase the dose but then you start developing side effects who won't disappear, where you simply feel horrible and it doesn't get any better. When this happens, reduce the dose until you reached a dose where you are fine.

But then you could be in a situation where Lyrica alone is not effective enough. But before you start adding Gabapentin again, I would evaluate if you have the option to take opioids on a daily basis. Pure Hydrocodon in combination with Lyrica could be a very effective treatment ... and if you develop a tolerance towards Lyrica, you can simply switch it with Gabapentin.

I don't know your doctors policy in terms of opioids and if taking Hydrocodone daily is even an option but it would be a much better opioid for RLS then Tramadol since Tramadol can lead to paradox effects and augmentation because it is also a potent SNRI.

Lyrica has potent analgesic effects and in combination with a drug like Hydrocodone, they would amplify each other analgesic effects. This may allow for the possibility that you can keep Lyrica and Hydrocodone on relative low doses and prolong the development of tolerance.

And again: pure opioids like Hydrocodone (or Morphine, Oxycodone etc.) are way better suited to treat RLS then Tramadol. Some doctors love Tramadol because it max dose is pretty limited while most other opioids dose can be increased forever.

However: if Tramadol works for you at the moment, you can keep it but you should know that Tramadol has the potential to worsen RLS over time. That is something many doctors don't seem to know or don't consider when using Tramadol for RLS. Tramadol is also so often used because prescribers think (and there is some evidence to support this) that Tramadol has less additice potential. But when you already have severe RLS and already use drugs like Lyrica and Hydrocodne ... then using Tramadol is just some additional risk that could be eliminated ... and should (in my opinion).

But when your access to opioids is limited taking Tramadol is still much better then not taking opioids at all when you have symptoms that require the use of opioids.

And please understand: I don't wanna convince you doing anything but I want to provide you with scientific, evidence based information so that you can make better decision yourself.

In terms of tolerance and antiepileptics: Lyrica's tendency for tolerance is well known but since Gabapentin is way less potent and its effects seem to take more time to work, you might not develop tolerance on Gabapentin at all or it will take much longer.

In the end you have to do what feels best for you ... just using two antiepileptics at once is often associated with increased, sometimes problematic side effects ... so most guidelines advise not do this unless it is absolutely necessary. It is a bit of a complicated topic ...

And it is the same with the opioids, not as problematic but Tramadol is just kinda shitty for RLS ... but at least you don't have to worry about seizures from Tramadol when you already take antiepileptics xD

curqlink
Posts: 61
Joined: Sat Jul 21, 2018 6:38 am

Re: How long does it take for Lyrica to start working?

Postby curqlink » Thu Sep 20, 2018 11:30 pm

A few months ago my Dr jumped on the opioid hysteria bandwagon any took away all opioids from me. He talked said he was taking as many people off opioids and putting them on Lyrica or Gabapentin as he could. So i had to give them a shot. I have never took Hydocodone on a daily basis. Just Tramadol and ropinerole. I talked him into giving back Tramadol after trying Gabapentin and Ropinirole for a few days. Which wasn't cutting it. I had a pretty good stash of Hydrocodone so i wasn't too worried about running out of it. I normally didn't have to take it very often. I was at the time taking a 1mg dose of Ropinirole which i had over a period of a couple years brought down from 3 mg. I thought i was doing ok when all of the sudden everything just quit working. I was not getting much sleep without taking Hydrocodone every night. So i decided to go cold turkey off the DA and reset my dopamine receptors. I now know what people are talking about when they talk about augmentation hell. I never could of got thru the first 5 days without my Hydrocodone stash. After 4 weeks i started back on a .25mg dose of Ropinirole along with Tramadol and Lyrica. But i still couldn't completly get away from occasionally needing Hydrocodone. So i went back to my Dr and pleaded my case. Much to my relief he gave me back a script but made it perfectly clear it wasn't for daily use. Hydrocodone by itself really isn't a perfect solution even if i could get all i want due to it's short half life. I love how it makes me feel and can certainly understand how people can get addicted to it. But it only controls my symptoms for around 3 or 4 hours. Much longer if i take it with Tramadol tho. If i take 5mg Hydrocodone and 50 mg Tramadol and my small dose of ropinirole and it will work for 7 to 8 hours without fail. If i could take it daily and could get some THC edibles to help with sleep. I certainly wouldn't need Lyrica or Gabapentin...which i do not like taking.

QyX
Posts: 346
Joined: Wed Mar 13, 2013 12:53 pm
Location: Berlin / Germany

Re: How long does it take for Lyrica to start working?

Postby QyX » Fri Sep 21, 2018 2:15 pm

Okay, I see.

Here is the thing: short acting high potent opioids like Hydrocodone (Hydrocodone is just as potent as Morphine!) are not that good for RLS since you want coverage for the hole night.

I heard they approved an XR (extended release) version of Hydrocodone this year. But you also would have the option of using XR Morphine, Oxycontine (the XR version of regular Oxycodone) or maybe you even have Targin (a XR version of Oxycodone mixed with Naloxone to reduce the potential of abuse) or you get the got old extended release version of Morphine.

Short acting high potent opioids for a chronic disorder also increase the risk of developing a tolerance and in the eyes of most physicians the potential of abuse (even though the XR versions can be abused just like the short acting versions, it just works in a different way).

Maybe you can talk your doctor into getting one of those XR versions.

If this is not working, there is also a XR version of Dihydrocodeine. For some reason it is not very popular, most likely it is old and cheap and therefore was not really advertised compared to the new versions of Oxycodone or Hydromorphone.

Morphine has a potency of 1 since it is the standard opioid drug, just like Hydrocodone has a potency of 1. Tramadol has a potency of 0,1 as has Codeine. So when you get Tramadol, you maybe can try and get Codeine which would be a way cleaner drug for RLS then Tramadol.

Dihydrocodeine has a potency of 0,2 ... so even though it is twice as potent as Tramadol, compared to all the other opioids it is still not that strong.

I get that with that horrible opioid addiction problem in the U.S. doctors want to avoid prescribing opioid as much as they can. But as far as they know they can prescribe opioids until a dose of 90 mg Moprhine /Hydrocodone daily which would equivalent to 45 Oxycodone or 450 mg Dihydrocodeine.

So I guess you have some room here to talk your doctor into giving you a long acting opioid other then Tramadol.

Here in Germany we have XR version of Oxycodone in a strengh of 5 mg or Morphine in 10 mg etc. and I know you have that all in the U.S. too.

So I would try to make the argument that long acting opioids will reduce the risk of addiction and that you can use Lyrica and Gabapentin as a co-analgetikum to keep the dose of the opioid low and avoid developing tolerance and addiction.

Oh, and it could be that he is not even aware that XR versions of Morphine and Dihydrocodeine exists. The XR version of Hydrocodon is pretty new, therefore expensive and might not be covered by your insurance.

THC has its own problems. Maybe you tolerate it well but I always was dizzy the next day and not productive at all. Just lazy with low energy.

curqlink
Posts: 61
Joined: Sat Jul 21, 2018 6:38 am

Re: How long does it take for Lyrica to start working?

Postby curqlink » Fri Sep 21, 2018 3:04 pm

Thanks for all the info. I'm going to look into that Dihydrocodeine. If it gets into my system as fast as Hydrocodone then it may work as a replacement for both of my opioids. And if the Morphine equivalent is that low...my Dr just might go along with that.

I totally understand about the THC. It affects me somewhat that way too. There just doesn't seem to be a perfect answer. We just have to figure out what works and choose the lesser of the evils sometimes.

QyX
Posts: 346
Joined: Wed Mar 13, 2013 12:53 pm
Location: Berlin / Germany

Re: How long does it take for Lyrica to start working?

Postby QyX » Fri Sep 21, 2018 6:08 pm

When you take long action opioids, you take the medication 30 to 60 minutes before any symptoms appear to make sure there is already enough of the drug in the system.

There also should be a short action version of Dihydrocodeine available, however it is not a very popular drug and in Germany they only sell a XR version of it.

For XR Morphine, many doctors seem to think of Morphine as a super potent, super strong opioid but it is only half as strong as Oxycodone and just as potent as Hydrocodone ... but for whatever reason, it seems that in the U.S. Hydrocodone has a relative good image while almost nobody seems to use Morphine anymore.

But when you have the choice, I would go for 10 mg Morphine XR pills ... if this is not an option try Dihydrocodeine XR pills and if they are not available (I am pretty sure they are!) go for XR Hydrocodone ... however your insurance might not cover it since this is a new drug in the U.S.

Morphine will most likely be the cheapests of all the drugs I mentioned and Dihydrocodeine will be a bit more expensive but still way cheaper then XR Oxycodone 5 mg or 10 mg.

Generic Morphine would do just fine.

curqlink
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Joined: Sat Jul 21, 2018 6:38 am

Re: How long does it take for Lyrica to start working?

Postby curqlink » Fri Sep 21, 2018 8:51 pm

I will most likely not even mention giving up Hydrocodone. The nice thing about that it is fast acting and powerful enough to take away symptoms even after they are full blown. Perfect for when driving or when you happen to wake up in the middle of the night. But i may bring up replacing tramadol with Dihydrocodeine ER and see what he says. He told me that he is under a lot of pressure to cut back on opioid prescriptions. So i have my doubts about him giving me something stronger for everyday use. But it's worth a try. Your absolutely correct about Morphine. Even before the recent hysteria..You hardly ever heard of any Dr giving out a script for it. But they would hand out Oxycontin and Hydrocodone like candy.

curqlink
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Joined: Sat Jul 21, 2018 6:38 am

Re: How long does it take for Lyrica to start working?

Postby curqlink » Sat Sep 22, 2018 3:40 am

I just was thinking...maybe Tramadol and Lyrica are really a good combination. If Lyrica helps with any seizure issues from Tramadol. And Tramadol helps with any depression issues from Lyrica. Sounds like they are made for each other. I have been taking Tramadol for years with no issues. So I'm not too concerned because i'm only taking 100 mg a day. I believe the max dose is 400. But considering how much Lyrica messes with my head. I do worry about what the long term affects will be. So i'm thinking that's something i need to discuss with my Dr when i talk to him about trying Dihydrocodeine. It does seem the brain fog thing has been improving the last few days tho. So maybe it will eventually go away. I hope so...i dislike the prospect of being a zombie the rest of my life.

QyX
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Location: Berlin / Germany

Re: How long does it take for Lyrica to start working?

Postby QyX » Sun Sep 23, 2018 12:41 am

curqlink wrote:I just was thinking...maybe Tramadol and Lyrica are really a good combination. If Lyrica helps with any seizure issues from Tramadol. And Tramadol helps with any depression issues from Lyrica. Sounds like they are made for each other. I have been taking Tramadol for years with no issues. So I'm not too concerned because i'm only taking 100 mg a day. I believe the max dose is 400. But considering how much Lyrica messes with my head. I do worry about what the long term affects will be. So i'm thinking that's something i need to discuss with my Dr when i talk to him about trying Dihydrocodeine. It does seem the brain fog thing has been improving the last few days tho. So maybe it will eventually go away. I hope so...i dislike the prospect of being a zombie the rest of my life.



Maybe the "brain fog thing" you experience from Lyrica will go away, maybe not. Nobody knows. You have to wait and see.

If you function well and your mood is good, then there is no reason to not use a combination of Tramadol and Lyrica.

Also 100 mg of Tramadol is a low dose. This means you would only need 50 mg of Dihydrocodeine.

In Germany we have Dihydrocodeine ER Tablets in 60 / 90 and 120 mg.

See, in the end is all up to you. I would not like to take any medication that creates some kind of brain fog. It is just ugly, I know this side effect from Lyrica and other drugs well and personally I just hate it, even when it is weak.

Antiepileptics are also great co-analgetika for RLS because they make it easy to keep the opioid dose low.

Ask yourself: are you happy with your current situation or would you feel better if the side effects would be less? Do you suffer from symptoms like low energy, lack of motivation or being dizzy or being limited in your activities during the evening and night due to side effects from Lyrica?

I know about the new regulations in the U.S. and they basically say for no cancer pain the upper limit for opioids is a equivalent dose of 90 mg Morphine (or 45 mg Oxycodone, or 450 mg Dihydrocodeine etc.) ... so when argues being being under pressure, asking for 60 mg Dihydrocodeine ER daily is not that big of ask ... and then having this together with quick release Hydrocodone would be pretty nice to have. For sure better then Tramadol (I think).

But overall your opioid dose is very low ... that gives you lots of options. The doctor is probably more worried that you might develop a tolerance and then you need more and more and more and more ... and he wants to avoid the risk of having one more of these complicated patients in his clinic.

Still, I would ask for the Dihydrocodeine just because pure opioids are more effective then stuff like Tramadol (as you can tell with Hydrocodone being so effective and offering fast relief).

But to be completely honest with you: when you take Tramadol for 10 years without any problems, then there is no pressing medical reason to change anything. And when you stop Tramadol and replace it with some other opioid, you wont suffer from opioid withdraw symptoms, however since Tramadol also is a potent SNRI, you might have withdraw symptoms similar to stopping a SNRI or SSRi antidepressant.

Which way to go, in the end this depends on how you want to deal with the Lyrica. If you want to give it more time, if the foggy head is a problem for you or not.

I made the experience that I often only can tell afterwards how much a certain medication was affecting me (positive or negative). So if you are in a mood to play around and you can afford a few days or feeling weird and not 100% functional, I would look for a way to get rid of Tramadol and Lyrica and only take Dihydrocodeine and Hydrocodone when needed. When you realise that you will need more and more opioids, you can make a deal with your doctor that you then will get back on Lyrica or some other antiepileptic.

And about Morhpine ... it is really crazy what kind of image this drug has ... like it is craziest opioid pain killer ever ... but stuff like Oxycodone or Hydromorphone or Oxymorphone is way stronger and just as addictive, if not even more.

In the end the dose and delivery method (oral ER tablets, oral fast acting tablets, IV infusion, intramuscular infusion, subuctan infusion, etc.) determine the potential for addiction just as much as the substance itself.

The things that happened with Oxycodone in the U.S. were just crazy. But in their heads Morphine is still the bad boy. So weird and really not based on any evidence.

If you are looking for an easy to understand list of the potency and effects of the most commonly used opioids, check this page:

https://en.wikipedia.org/wiki/Equianalgesic (every drug is compared to analgesic effect of 10 mg Morphine)

It lists all the opioids and even compares them to drugs like Ibuprofen, Aspirin and other common non-opioid analgesics. The analgesic effects is also strongly determined by the delivery method.

For example Morphine IV infusion is more effective then Oxycodone IV infusion while Oxycodone orally is way more effective than Morphine.

Polar Bear
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Re: How long does it take for Lyrica to start working?

Postby Polar Bear » Sun Sep 23, 2018 10:53 am

An interesting read, thank you for that.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

curqlink
Posts: 61
Joined: Sat Jul 21, 2018 6:38 am

Re: How long does it take for Lyrica to start working?

Postby curqlink » Sun Sep 23, 2018 5:56 pm

Yes..Thank you for all the information.

peanut1
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Joined: Sat Jun 04, 2011 8:06 am

Re: How long does it take for Lyrica to start working?

Postby peanut1 » Thu Sep 27, 2018 2:40 am

I take lyrica. I'd say probably around 30 minutes it really starts working.

Kathy


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