Gabapentin vs Horizant

Use this section to discuss your experiences with prescription drugs, iron injections, and other medical interventions that involve the introduction of a drug or medicine into the body. Discuss side effects, successes, failures, published research, information about drug trials, and information about new medications being developed.

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lhoff12085
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Joined: Fri Apr 24, 2015 1:04 pm
Location: Sarasota, FL

Gabapentin vs Horizant

Postby lhoff12085 » Fri Jan 13, 2017 9:22 pm

I'm currently taking Horizant (gabapentin enacarbil) but it is very expensive on my plan ($1300/90 days). It works very well. I asked my doctor if gabapentin would work for RLS which would save me a lot of money. He doesn't think it will but gave me 10 days to try. Is anyone else having luck with gapenpentin? I'm nervous to try something and risk having a terrible night. I'm wondering if it's worth it. I see a few posts in reference to side effects but nothing that defines it as a good drug for RLS.

Thanks for any advice.

Rustsmith
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Re: Gabapentin vs Horizant

Postby Rustsmith » Fri Jan 13, 2017 11:31 pm

My doctor tried to switch me from gabapentin to Horizant and I did not see any difference, so I obviously insisted that I was not willing to make the switch due to the extreme difference in price. Horizant is a modification of gabapentin that allows it to be more easily absorbed into the blood stream. As I understand it, gabapentin is only absorbed into the blood stream by a short length of the small intestine. If you don't absorb it as it passes through this section, it passes out of you unused. This can happen if you adsorb it to slowly or if it moves through this section too quickly due to your last meal. On the other hand, Horizant is absorbed throughout the entire length and so you are more likely to get the benefit of the entire dose.

However, once Horizant passes through into the blood stream, it is converted into the same chemical as gabapentin. So if you take equal doses and manage to absorb all of the gabapentin, you get the exact same benefit (or side effects) with Horizant.

In my case, it appears that I do a good job of absorbing the gabapentin because I can take a high dose and seem to get the benefit of all of it. So taking an equivalent amount of Horizant didn't provide any theraputic benefit and just cost both me and my insurance company a lot more money.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

QyX
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Location: Berlin / Germany

Re: Gabapentin vs Horizant

Postby QyX » Fri Jan 13, 2017 11:40 pm

If you care about money saving trying the regular Gabapentin is worth a shot.

In Germany we just have Gabapentin and no Horianzt because the additional benefit of Horianzt seems to be so low that it is unlikely that insurance companies will pay for it.

You just have to find the right equivalent dose and then everything should be fine.

lhoff12085
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Joined: Fri Apr 24, 2015 1:04 pm
Location: Sarasota, FL

Re: Gabapentin vs Horizant

Postby lhoff12085 » Fri Jan 13, 2017 11:45 pm

I've got 600mg of gabapentin, the same dose as Horizant. Does that sound reasonable? I've got moderate to severe RLS. Thanks so much for the explanation and your responses - very helpful. I'm nervous to try something new since I put my sleep at risk but this sounds like it's worth trying.

Rustsmith
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Re: Gabapentin vs Horizant

Postby Rustsmith » Sat Jan 14, 2017 12:17 am

I don't know that they are 1:1, but it would be worth the try. They only make Horizant in 600 mg tablets, but gabapentin comes in 100, 300 and 400 mg capsules so there are more options with gabapentin and you can go to lower doses if there are side effects.

I currently take 900mg gabapentin each evening. When my doctor tried to switch me to Horizant he had be try both 600 and 1200mg. Thankfully he had samples, so his experiment didn't cost me anything.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

lhoff12085
Posts: 29
Joined: Fri Apr 24, 2015 1:04 pm
Location: Sarasota, FL

Re: Gabapentin vs Horizant

Postby lhoff12085 » Sat Jan 14, 2017 12:20 am

Did you gradually increase to 900 or is that where you started? Do you take the gabapentin right before bed? I'm going to try it tomorrow. Thanks so much. Laura

Rustsmith
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Re: Gabapentin vs Horizant

Postby Rustsmith » Sat Jan 14, 2017 3:35 am

I started taking it for migraine prevention. I switched from a similar drug, so I started at 600mg. It was increased to 1200mg for a while, but I started experiencing an inconvenient side effect and found that dropping back to 900 worked for me. That is quite a bit compared to what some people use, but it is apparently what I need.

As for timing, I take it 30 minutes prior to bedtime. I start to feel sleepy in about 20 minutes and have a hard time staying awake after about 45 minutes, so timing is everything.

Also, the half life of gabapentin ranges from 4 to 6 hrs. I find it difficult to stay asleep after about 6 hrs and cannot go back to sleep once the gabapentin wears off. I use an edible form of marijuana that kicks in after about four hours to stay asleep longer.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

lhoff12085
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Joined: Fri Apr 24, 2015 1:04 pm
Location: Sarasota, FL

Re: Gabapentin vs Horizant

Postby lhoff12085 » Sat Jan 14, 2017 5:06 pm

That's very helpful so thanks for the background. Also about the marijuana. It's not legal in Florida but I may spend a month in CO this summer. I'm worried about the effect of the elevation on my RLS. Last May we spent a weekend in Denver and I had trouble every night while on Horizant. I also found that my vision was fuzzy. Both cleared up when I returned home. I found on the discussion board that that's not unusual. I'm going to see what my doctor will do to prescribe a supplemental medicine to get me through.

Rustsmith
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Re: Gabapentin vs Horizant

Postby Rustsmith » Sat Jan 14, 2017 6:47 pm

As you might have noticed from my into on the right of these columns, I live in CO. I am about 100 miles south of Denver and 500 ft lower. We moved here about a year ago partially so that my wife and I would both have access to medical marijuana. I honestly cannot say whether the elevation change from sea level made my RLS worse. I was so badly augmented when we moved and then completely modified my treatment once here that I don't have a basis for comparison. But the current research does tend to indicate that there is a hypoxia component to the disease, which means that until you probably would notice more problems until you adjust to the altitude. Low ferritin levels could also aggravate that since a part of adjusting to the altitude involves an increase in red blood cells. Also, be aware that Denver is a LOT dryer than FL. That might have been the issue with your vision.

When you come to CO and go to one of the retail marijuana shops, what you need to look for will be one of the edible products. These range from gummy bear type candies to cookies and chocolates. Several of us on the board find that the THC products help us more with sleep while the CBD products help with anxiety. Neither seems to help with needing to move. The warning that you will probably hear at the shop for THC is to go easy with it since THC is the intoxicating part of marijuana. For me, a single 5mg candy helps me sleep and usually doesn't leave me with a stoned feeling before my first coffee. Also, candies take about 2 hrs to kick in where smoking or using one of the tinctures will result in faster effects. But the effects wear off faster with smoking and tinctures. Since I want the THC to help my sleep in the early morning hours after the gabapentin wears off, the delayed effects are just what I need.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

lhoff12085
Posts: 29
Joined: Fri Apr 24, 2015 1:04 pm
Location: Sarasota, FL

Re: Gabapentin vs Horizant

Postby lhoff12085 » Mon Jan 16, 2017 7:00 pm

Thanks so much for all the info. I may try it when I go. I don't even know what a tincture is. I'm wondering if I should take more iron when I go to see if that helps. I'm curious - why did your doctor have you try Horizant when the gabapentin was working? I've had 2 good nights on gabapentin so we'll see if it continues.

Rustsmith
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Re: Gabapentin vs Horizant

Postby Rustsmith » Mon Jan 16, 2017 10:03 pm

The tinctures are simply flavored alcohol based solutions of THC, CBD or a mixture. You put a couple of drops under your tongue and they absorb directly into the blood stream. So they are a quicker way of getting the meds into your system than by edibles and do not require smoking or vaping.

As for taking more iron, it takes a while for you to build your iron levels. So if you are going to try taking more, then you should start before you leave. But be aware of the fact that you can get too much iron.

As for why my doctor was pushing Horizant, I suspect that it had something to do with the fact that he was involved in the clinical trials that resulted in Horizant being approved for the treatment of RLS. So he had seen that it helped others for whom gabapentin was not as effective. When I told him that Horizant wasn't any more effective, his response was simply "okay".
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

yawny
Posts: 138
Joined: Sun Nov 08, 2015 4:20 pm
Location: Washington

Re: Gabapentin vs Horizant

Postby yawny » Tue Jan 17, 2017 9:52 pm

Steve, I noticed you take your Gabapentin 30 minutes before bed and my doctor's (and the prescription bottle) directions are to take it 2 hours before bed...How did you get to 30 minutes? Do you think 2 hours is necessary?

Anyone else with advice/experience on when to take Gabapentin and why?

Rustsmith
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Re: Gabapentin vs Horizant

Postby Rustsmith » Tue Jan 17, 2017 11:23 pm

It's all a question of how fast the gabapentin kicks in. 30 minutes after I take it, I am starting to fall asleep and often have a difficult time keeping my eyes open. If I fight through that first hour or so, then I find that it takes me longer to fall asleep once I get into bed.

Also, my RLS causes two different types of insomnia. The first is the "normal" form where I have a difficult time falling asleep without the gabapentin, so the pills help that. The one that causes me more problems now is that I tend to wake up way too early. Gabapentin has a 4 to 6 hr half life, so I figured that if I take it 2 hrs before bedtime, it is starting to wear off much earlier than I need for the "staying asleep" form of insomnia. So, taking it 30 minutes before bedtime allows me the freedom of not falling asleep too early and also helps me stay asleep a little bit longer into the early AM hours. Of course, I also use an edible marijuana that starts to kick in about the time that the gabapentin is wearing off, so these days I am able to sleep from 7 to near 8 hrs instead of the 3.5 to 4 that I was getting before I worked all of this out. But then again, this is what works for me and everyone else will need to experiment to find out what works for them.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

yawny
Posts: 138
Joined: Sun Nov 08, 2015 4:20 pm
Location: Washington

Re: Gabapentin vs Horizant

Postby yawny » Wed Jan 18, 2017 7:21 pm

An extra hour of sleep...that's what I got by changing when I take my Gabapentin. Thanks Steve, I never would have considered taking it closer to bedtime if I hadn't seen your post. One of the many reasons I so appreciate this forum of awesome people sharing ideas and practices. Instead of taking my 50mg of Gabapentin 2 hours before bedtime, I took it 1 hour before. I plan on continuing the experimentation to find the right time for me.

ViewsAskew
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Re: Gabapentin vs Horizant

Postby ViewsAskew » Thu Jan 19, 2017 4:12 am

I also found it was better to take it and get to bed within 30 minutes. I was getting sleeping and could usually get to sleep quickly. If I waited, I'd move through the initial sleepiness and it would be wasted.

Same with methadone - I do get insomnia from it, but it takes an hour to hit me and goes away in about 3-4 hours. If I can split my dose so that part of it is 3 hours before bed and the last part is immediately before bed, I can avoid the 'it's 3 AM and I am cleaning the kitchen while I watch Netflix and whatever else I feel I need to accomplish."
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.


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