Gabapentin for WED and Sciatica

[crl363]

He went from 28mg to 4mg in ~ 8 weeks. He has been on 4mg for ~6 weeks. The last 2 weeks he has been on gabapentin (slowly increased to 1200mg) but he had severe nausea and dizziness so he had to come off it. It had no impact at all when he was on it. Although I know it works chronically so it takes almost two weeks for it to become effective.

Bob

[crl363]

I forgot to ask a question which happened to my brother, although, I’m sure it also happens to a lot of people. Here are the circumstances. Person is on a high dose of a dopamine agonist (D/A) (~10mg+/-) and the person gets 2-3 hrs of broken sleep/night because RLS symptoms keep waking the person up. Insomnia is not a factor. I know that people can be on a much lower dose of D/A and still augment but we can just use this as an example. Once on an opioid, the individual slowly starts to get tapered off the D/A. At some point the individual should start getting some sleep between the opioid and the D/A? At this point what is the best approach?

1) Do you wait until that time comes when the person starts getting some sleep? For example, maybe 10mg of the opioid and 6mg of the D/A and the person is getting sleep because the RLS symptoms no longer have an impact. At this point you continue to taper down the D/A until the person is off the drug or...?

2) Do you not wait to see if the individual can get some sleep but instead just keep dropping the D/A until they are no longer on the drug?

Bob

[QyX]

I would say in general there is no "best approach". It depends on the individual what is the best approach.

When you play this scenario you also have to keep in mind that everyone has a different response to opioids. Opioids can cause activation and therefore cause insomnia.

Let's say the individual get's some sleep on the opioid. Then I would reduce the DA as fast as possible and see if the individual still is able to sleep.

If the person is able to sleep I would forget the DA and live happily ever after. If not I would maybe restart the DA on the lowest dose possible and cycle between a DA and Benzodiazepine.

[Polar Bear]

My understanding is that It has been suggested it is easier to just stop a DA cold turkey. Withdrawal symptoms will last for say .... 2, 3, 4 weeks.. ?? .. until all DA has left the body.

To taper off is thought to just prolong this procedure. i.e. Withdrawal while tapering, and then further withdrawal time after DA ceases.

[QyX]

The DA leaves the body quickly. The real problem is that the receptors in the brain need to adapt and this process is causing the withdraw symptoms. This will take some time. Depending how long the DA has been taken.

Stopping a DA cold turkey is not so hard if you have potent opioids and Benzodiazepines to cover the withdraw symptoms.

[Polar Bear]

Thanks for that QyX, about it being receptors resetting

Stopping the DAs cold turkey may be harder or easier also, because we are all different.
And perhaps, not so hard if you have sufficient potent medication to cover the withdrawal = given that you have a Doctor who is willing to prescribe sufficient potent medication.

[ViewsAskew]

The difficulty of the receptors resetting is complicated by augmentation. If you are not augmented, this is usually relatively quick. The more augmented you are, the harder it is. Without sufficient medications to assist, some doctors are now saying it can take many, many weeks, if not months and you're likely not going to be able to tough it out.

The Clinical Management of Restless Legs Syndrome says that anticonvulsants, "may mitigate some of the symptoms but usually are not effective enough for this situation. Most patients will need a potent opioids (methadone, oxycodone) to treat the drmatically worsened RLS symptoms created by the withdrawal of their dopamine agonist. Physicians who are unwilling or unable to prescribe potent opioids for these patients when other options fail should refer them to another physician."

[QyX]

When I augment on Pramipexole which happens here and now I use Clonazepam and L-Dopa. I always stop the DA cold turkey and avoid taking them too long.

[ViewsAskew]

When I augment on Pramipexole which happens here and now I use Clonazepam and L-Dopa. I always stop the DA cold turkey and avoid taking them too long.

That wouldn't have helped me at all when augmented. L-dopa is more of a dopaminergic - that was what my doc tried first when I had augmentation. I ended up with constant symptoms and NO sleep for about 36 hours - the worst 36 WED hours I've ever experienced. And, Clonazepam has never made my sensations stop - augmented or not. I tried it, too, when augmented. I also tried Valium, gabapentin, ropinerole, and a few others....all fails or they made it worse.

After many months of it, several doctors, and several medications, the only thing that allowed me to stop the DA was an opioid. It works so well - I would hope that all people who go through augmentation would be lucky enough to have a doctor who will try this first. Unless allergic or you have side effects that are unmanageable, it seems to always work. I surely wish my doc would have known that - it would have saved me the worst 6 months of my life.

[QyX]

When I augment on Pramipexole which happens here and now I use Clonazepam and L-Dopa. I always stop the DA cold turkey and avoid taking them too long.

That wouldn't have helped me at all when augmented. L-dopa is more of a dopaminergic - that was what my doc tried first when I had augmentation. I ended up with constant symptoms and NO sleep for about 36 hours - the worst 36 WED hours I've ever experienced. And, Clonazepam has never made my sensations stop - augmented or not. I tried it, too, when augmented. I also tried Valium, gabapentin, ropinerole, and a few others....all fails or they made it worse.

After many months of it, several doctors, and several medications, the only thing that allowed me to stop the DA was an opioid. It works so well - I would hope that all people who go through augmentation would be lucky enough to have a doctor who will try this first. Unless allergic or you have side effects that are unmanageable, it seems to always work. I surely wish my doc would have known that - it would have saved me the worst 6 months of my life.

Wah! It is fascinating how different we all are. I take Morphine but it doesn't cover 100% of my symptoms and, this is the biggest of all problems: I always have severe trouble falling asleep and need extra medication. I don't augment on L-Dopa but it can cause a depressive mood and I do not tolerate doses over 200 mg.

Benzodiazepines were working better in the past. Now I have trouble finding a working Benzo. A Benzo alone normally doesn't make me sleep. I'm always rotating and on the search for a working drug I can use for sleeping.

[crl363]

Thanks a lot for everyone's help. I continue to learn every day!

Bob

[badnights]

Stopping a DA cold turkey is not so hard if you have potent opioids and Benzodiazepines to cover the withdraw symptoms.

The Z-drugs (non-benzodiazepene sedative/hypnotics) for most people are a preferable alternative to benzos, since they have shorter half lives, don't disrupt sleep architecture like benzo's do, and have lower documented risk of dependence and addiction. They do have a number of potential side effects, though. You've mentioned before that they don't work for you, I forget if it was evil side effects? But anyway, they're a good option for those of us fortunate enough to not have that kind of reaction to them.

[julez74]

I was recently put on Gabapentin for Sciatica. It seemed to help but it made me sick and I had severe constipation. I also take requip before bed. It works most of the time.