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