Gabapentin for WED and Sciatica

[Caitrin]

I have been taking 1200-1800 for my WED together with Sinimet with complete relief. I recently consulted with a neurologist re my severe sciatica pain. I have had lumbar surgery and epidural injections but the pain continues though I walk 3 miles a day most days and am active. This new doctor suggested increasing Gabapentin gradually from 600 mg. 3 x day to 1200 mg. 3 x day over a two-three week period. I am very reluctant to start this regimen albeit I did take an extra 600 mg. tab yesterday a.m. and although my sciatica pains lessened I was in a disoriented state for several hours and had water retention. I wonder if anyone has both conditions and been prescribed what I describe above. Also, I wonder if my WED could worsen were I to follow the regimen and then taper back or the original dosage. Thank you for any input.

[QyX]

I don't have any experience with sciatica pain and not much with Gabapentin but the side effects you describe (being disoriented for several hours) don't sound good. I would be reluctant about this change, too.

Also, I wonder if my WED could worsen were I to follow the regimen and then taper back or the original dosage.

I think it is possible but unlikely.

Personally I wouldn't take a higher dose of Gabapentin then I would tolerate. Maybe what you take now is your personal limit and when you take higher doses you have to deal with the side effects you prescribed I would look for 2nd drug to add to the Gabapentin.

I don't know anything about opioids and sciatica pain but maybe adding an opioid is an option and it will develop synergy effects together with Gabapentin?

Being disoriented for several hours can't be an option, I would say!

We do have lots of other drugs on the market to deal with nerve pain. It is hard to say which one could help here.

I guess one thing is clear: if you don't tolerate higher doses of Gabapentin, you have to look out for a 2nd drug.

[Polar Bear]

Caitrin - with regard to the Gabapentin and Sinimet providing you with complete relief from WED/RLS symptoms, It is wonderful to hear that you are obtaining such good results.
I wonder do you take Sinimet every day and how long have you been taking it. Sinimet is known to provide very good and speedy relief from symptoms but it also has an extremely high % in the augmentation stakes.

I have never taken gabapentin and cannot speak of it from experience but as QyX comments being disoriented isn't a good thing. It may be that such side effects would pass but I'd be very wary.

Hopefully someone with experience and knowledge of gabapentin will be along soon.

[ViewsAskew]

As Polar Bear noted, I'd be concerned about using Sinemet daily (I am making the assumption you take it every day). No one that I no of who posts here takes it daily. It's a GREAT drug when used 4 or fewer days a week, but it almost always eventually makes the WED worse and you have to stop the drug.

Have you had your serum ferritin tested recently?

Per the disorientation - it's possible that you could increase it more slowly than the doc recommended - say 300 mg at a time and take that for a few days, THEN increase another 300. That might prevent issues. But, if you try that and you still have problems, it's a tough decision. Some doctors say that these side effects go away in a week or two. A week of disorientation is a LONG time! And, no guarantee it will work.

If you do try this, I don't see why the WED would be worse if you taper back to your original dose.

[Caitrin]

Thanks to all for your input. Regarding the carbidopa/levodopa I have taken this for 20+ years, 50-200 mg CR tab before bedtime, with no augmentation and half the tab on occasion. I had taken Vicodin 5-500 together with the carb/levodopa for several years but doctor determined I should not take a "narcotic." Too bad because it worked well for me both for WED and sciatica and I never increased the dosage. That's when I began the Gabapentin 1200 mg/day and carb/levodopa regimen. Wish I could locate a doctor who would prescribe the Vicodin or similar opoid!

[QyX]

Why don't you change the doctor?

Treating WED/RLS with opioids is very common.

Maybe seeing a specialist would help?

At the end of December a big study about the positive effects of opioids on RLS/WED was published.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/24140442

If you like I can send you the full text of the study and you can print it out and show it to your doctor.

Do you know which problem your doctor has with opioids?

[ViewsAskew]

You are SO lucky to be successful with the Sinemet - Glad to meet someone for whom it works!

Most of us who take opioids and tolerate them are very happy with the results regarding the WED. I understand the doctors'
concern, but studies show they work and are well-tolerated, with few problems regarding addiction. Too bad that doesn't over ride the doctors' concerns.

[EeFall]

Wish I could locate a doctor who would prescribe the Vicodin or similar opoid!

If you live in New Jersey you live less than 3 hours drive from Baltimore and Johns Hopkins Medicine. There is a doctor there, Dr Christopher J Earley, MBBCh PhD, Professor of Neurology who is one of the best doctors in the country for RLS and sleep disorders in general. How good is he? I live on the West Coast and he is my doctor and well worth the cost of the flight to go see him. I had run out of options until a sleep doctor here referred me to him and my doctor here is a great doctor.

[skn0412]

Totally agree with Eefall.....I just had my first visit with Dr. Earley at John Hopkins, and if you are in New Jersey, you are doing yourself a dis-service by not seeing him; he is by far the best in the field and he will help !!!

[badnights]

Agreed on the opioids - switch doctors if you can.

Re gabapentin, Usually I think sciatica is treated with an anti-inflammatory, and once the inflammation abates you can go off the anti-inflammatory. I would think the gabapentin means your doctor thinks your sciatica is not caused by inflammation but is caused by chronic nerve degeneration?

I took naproxen 375 mg 1 or 2x daily for a year or more, then as it got better switched to daily ibuprofen , and now just ibuprofen sometimes. I also do lots of yoga, I find the poses that stretch the butt muscles really help, also the standing poses that stretch various muscles on alll sides of the lower back.

[Caitrin]

Re my lumbar stenosis I do yoga stretches and certain poses for back and it does help a bit.
Re finding another doctor who might prescribe vicodin I don't think I'll have any luck unless someone could recommend a doc in New Jersey and, yes, I think I may make an appointment with doctor Early at John Hopkins, a 3 hr. drive from my home in northwest NJ.
Re my serotin level I had it checked two yrs ago and it was normal.

Meanwhile I continue the Gabapentin 1200-1800 mg/day and night, the Sinimet and 2 mg. clonazepam/day. Just read Dr. Allen's email re a recent study regarding the FDA approved Mirapex and Requip for WED and Lyrica,Lyrica being the preferred med having no rebound and other adverse side effects. Have not tried Lyrica though it was suggested as an alternative to Gabapentin.

Thanks for all replies to my initial post.

[ViewsAskew]

Caitrin, another option is to try the newest drug in the gaba group - Horizant or gabapentin encarbil. It supposedly uses less to work better. One dose per day. It's expensive, but it might do a better job.

I seem to recall someone posting the name of a NJ doc on here....but I can't remember. There is a doctor list in the General Wed section. You can also try searching on NJ or New Jersey and see what comes up.

If you see Dr Earley, I think you'll not be disappointed, though it is a long drive.

[crl363]

I know there are many people on this board who have really severe RLS/WED and are prescribed two different opioids to keep their symptoms under control. Does anyone know if Dr. Earley will prescribe two opioids for severe RLS? The reason I am asking is my brother was on 28 mg ropinirole. His doctor has him down to 4mg ropinirole and 10mg Methadone and he still only gets ~2-3 hrs broken sleep/night. He can’t go any higher on Methadone because of the side effects. Does Dr. Earley prescribe more than one opioid for severe cases?

Bob

[ViewsAskew]

Given the amount of ropinerole he was on, he is very likely augmented. What side effects does he have with methadone? It could be that other opioids would cause the same issues - or not, depending. It also could be that the side effects could be managed - anti nausea drugs, for example, can resolve nausea, and Zyrtec can resolve itching.

There are many options, however, and Dr Earley would most likely work with him to get it right, whether he needed two opioids or something completely different.

[badnights]

Ann is right, he is most likely augmenting, and needs to get completely off the ropinirole. If his doctor is aware of this, then he is trying to taper him, which is probably necessary from that high a dose, and should have warned him that it will get worse before it gets better.

As the ropinirole drops, the symptoms get worse, on and on until finally the ropinirole is stopped completely, then for another 1 - 4 weeks there are worsened symptoms (usually 2 weeks, but that's for people who were on 4 mg to begin with).

THEN - and this is the important part - the symptoms should drop back to something more normal, and allow more sleep at night. 10 mg methadone might never be enough, but then again it might be - one simply can't tell while he is still augmented.

How long has he been at 4 mg? And how long did the taper from 28 mg take?