marxxx: WD from gabapentin, how much to reinstate

[Marxxx]

Hello all,
I did not realize gabapentin required a taper. I had been taking 300mg twice a day for a couple years. There were times I would miss one and not have any ill effects.  I stopped maybe two weeks ago and didn't realize why I felt so poorly.

I had/have anxiety, insomnia, loss of appetite, increased ringing in the ears, increased palpitations and some light / sound sensitivity.

 

When I figured out what was going on I took one and felt better very quickly.

My question is how much to reinstate. I read the thread about reinstatement but didn't get a clear idea how much I should reinstate.

Do I jump back to normal dosage? 150 in the am 300 pm?

 

Also, I am planning to get off Ativan. I have only been on .5 1-2x daily for less than 3 weeks (total of 20 doses in 19 days). I assume I will have to taper that since I missed a day and felt even worse. Hoping it can be a quicker taper then work on getting of the gabapentin.

Thanks in advance for any advice!
marxxx


 

[tyson]

hi, marxx. 

In my educated opinion from this site and other books, you  should go back were you were stable and stay there till you are stable. Then start to reduce 10% from your meds. But on your Ativan, that is benzo family and hard to get out from once you stay with it longer. I would reduce that first and then your other meds. 

This is my opinion only. good luck. 

[ChessieCat]

Hi Marxxx

 

Welcome to SA.  To enable the mods to best offer suggestions, it would you please include ALL your drug/s, doses, dates and how you reduced/increased them  See How to Put Your History in Your Signature.

 

The mods will move your post and start up an Intro Topic for you.  Once that has been done if you click on Follow This Topic (top right) you will receive an email when someone replies.  You can use your Intro Topic to ask questions regarding your own situation and as a journal of your progress.

 

The mods will be able to offer suggestions about how much to reinstate (DO NOT go back on the dose you were last taking) and which drug to taper first.

 

Here are some things to read:

 

About reinstating and stabilizing to reduce withdrawal symptoms

Why taper by 10% of my dosage?

 

These couple of things should help you to understand what happens to the brain.

 

Video: Healing from Antidepressants: Patterns of Recovery

 

Brain Remodelling

 

Also:

 

Tips for Tapering Gabapentin

 

Which Drug to Taper First?

 

This site has a lot of information and helpful members and volunteer staff.  You've landed in the right place for the help you need.  CC

[Fresh]

Hi marxxx , welcome to the site , very glad you found us.

 

Yes , you'll be feeling poorly because you have withdrawal symptoms from stopping the gagapentin.

 

Please could you clarify - was you regular dose 300mg am and pm or 150mg am and 300mg pm ?

 

As Chessie mentioned , your previous dose may be too much for you now. I'm guessing you have tablets of

150mg and that's what you took today , is that correct?

Please don't take any more than 150mg tonight , until one of the more experienced moderators or Altostrata can advise.

 

You need to get back to stable before thinking about tapering again , and that will take a few weeks.

In the meantime you can get familiar with the links ChessieCat provided , and use this thread to ask any questions that come up.

 

Best wishes , Fresh

 

If you click FOLLOW at the to right , you'll receive an email each time someone posts.

[Marxxx]

Hi, 

 

Thanks for the replies guys! 

I was on 300mg twice daily for a total of 600mg. Most of my symptoms improved in about a week, then the light / sound sensitivity started. The concerning part is the heart palpitations, they are crazy. I have a healthy heart with some palpitations (all checked out less than 6 months ago). But now it's through the roof crazy. 

 

The capsules I have are 300 mg. I'm sure I could get the dr to give me some different ones to use to taper. I see the dr wednesday and will discuss with him. I'm just not confident that he will have a lot of experience with it. 

[ChessieCat]

Hi Marxxx,

 

Many doctors, if they do know about tapering, do it too quickly.  You don't need your doctor's "permission" to taper, but you do need to know what you need and how to get it.  I suggest before you go to the drs you check out these links.

 

How do you talk to a doctor about tapering and withdrawal?

 

What should I expect from my doctor about withdrawal symptoms?

[Marxxx]

Thanks for all the replies.

So the best option would be 150mg 2x a day?

I was hoping my dr could tell me how much to reinstate. I left a message late afternoon and didn't hear anything back.

 

 

Thanks

[Fresh]

Sorry Marxxx , I'm still not clear on how many days you stopped for?

" Stopped less than weeks ago "

 

Please can you clarify , thanks.

[Marxxx]

I don't know the exact date that I stopped taking it. Within the last 2 weeks. I didn't anticipate any problems so I didn't really keep track.

 

Thanks

[Wellness]

Regarding the Ativan, the first step is to reduce to once a day and not twice a day, for a day or two to that the dose is the same every day.  Then if there is interdose withdrawal, spread the dose throughout the day.  Since you have been on for only three weeks, you'll want to reduce as fast as your body will allow.

 

If you want me to follow your progress getting off Ativan, can  you please start a thread in the benzo part of this forum ?  That's where I hang out.

 

See you there.

[Altostrata]

Welcome, Marxxx.

 

How are you feeling now?

 

We suggest a partial reinstatement because if a low dose works, why take more? I might start with 50mg once a day.

 

What do you mean by "Thyroid small changes" in your signature?

[Marxxx]

Alto -

 

Not doing good at all. The anxiety is better than it was, but still gets pretty intense. 
The most worrisome of the symptoms are the heart palpitations. They are really significant. Luckily I was able to get my appt with the cardiologist moved up so I can get that checked out. 

 

The first re instating dose I took, I immediately felt better. After a few doses I am finding when I take an it my tinnitus gets louder about an hour later, then gets quieter after about an hour. I am guessing the brain is getting over excited?

I feel trapped at this point. I know if you stop abruptly tinnitus and sound sensitivity can be bad. I have read some have had it hang around for a long time. On the other hand am I at risk taking any at this point? 

 

I take a compounded thyroid medication, the amount was changed by a small percentage. Changes to the medicine have not affected my senses or anxiety in the past.   

 

I appreciate any and all help! 

 

Thanks,
Mark

[Wellness]

Marxxx,

 

Did you have the anxiety before starting the Ativan?  Some people get symptoms of withdrawal between doses almost immediately, in a matter of days.  Was the Ativan prescribed to "help" you with the symptoms of Gabapentin withdrawal?

[Marxxx]

Wellness,

 

I did have anxiety before I started the ativan. The ativan was added to help with the anxiety. I tried to take it sparingly and planned on stopping at two weeks. I missed one day and could tell I missed it. So I have been taking a little less than a full pill. Figured I would try to taper off that asap. 

 

The big concern I have right now is the neurontin making my tinnitus worse. Seems like a catch 22. Not taking it can cause tinnitus in withdrawal and taking it seems to increase it for a short time. 

[Altostrata]

How much Neurontin are you taking now and how often?

[Marxxx]

When I first figured out what was going on I took 2 doses of 300mg. I found the board and it was suggested to start lower so I went to right around 200mg twice a day (depending on how I cut the capsule). I felt pretty good for a couple days then had the explosion in my ears when I took 200mg gabapentin along with .4 - .5 ativan and 600mg  magnesium. I just took everything before bed to help with sleep. My tinnitus roared (loudest ever) for about an hour. Do you think it was the gabapentin that did this or the combination?

 

I took 3 - 50mg doses yesterday (because I was scared of another flare up of tinitus) and was planning on 3 - 100mg today. I know you are supposed to stay even, but I was afraid of another T spike. It was brutal.

 

What do you recommend?

 

Thanks in advance!

[Altostrata]

These symptoms are because your autonomic nervous system is in an uproar. It's impossible to tell which drug or which drug change caused this. It's probably a culmination of all of them.

 

Your nervous system will do better if you maintain stability instead of jumping around in dosing. If I were you, I'd choose a gabapentin dosage at the low end and take it at the same times each day.

 

I don't know how to fix the tinnitus. It sounds like you get it when a large dose hits your system.

 

Please keep notes on paper about your dosing: the times, amounts, and symptoms before and after. Your daily symptom pattern is very important. Read

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

[Marxxx]

Thanks for the info. Do you think the 100 3x a day is good / low enough?

I was going to try to taper the Ativan. Would it be a good idea to wait a week or two before I do that until the neurontin stabilizes?

I missed one dose of Ativan and could really feel it. I have generally been taking it bedtime and slowly started to cut it back. Should I just stick with 1/2 tab morning and evening for a week or so?

Thank you very much for your time. I really didn't think the ativan would be a problem in less than 3 weeks.
Marxxx

[Altostrata]

I am confused about how you've been dosing the Neurontin. You were taking 300mg twice a day, then you experimented with other dosing?

 

How exactly have you been taking Neurontin over the last week? How often have you taken Ativan? Why do you take it?

 

Are you accustomed to changing your psychiatric drug dosing now and then?

 

If I were you, I would not change the Ativan at all until you get the Neurontin settled. It's very possible you will need to taper the Ativan, too, and that will take quite a while.

 

You need to think in terms of months rather than days or weeks when you make drug changes. See The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

Please keeps notes on paper about your daily symptoms, drugs, their dosages, and when you take them.

[Marxxx]

300mg 2x daily was the dose I was on for a long time. I did not realize it needed to be tapered and I stopped a couple weeks ago. I had terrible anxiety (and tons of other symptoms) after stopping but did not realize it was from the gabapentin. I stumbled upon it being gabapentin withdrawal on line so I took (I think) 2 of my normal doses (300mg. 1 the first night and one the next morning). Then I found out to reinstate at a lower dose, once I saw that I lowered the dose. After a couple doses at 200 (it was between 150 and 200 - trying to cut a 300mg capsule). I had the issue with the tinnitus so I dropped to very small doses just to make sure I could handle it. So far so good.

 

I don't normally make changes. In the past I have not noticed if I missed a dose or a day of gabapentin. I have not had any other ADs for years.

 

I have only been on the ativan 3 weeks which is why I wanted to taper off, but kind of feared that may be bad with the gabapentin issues. I understand the gabapentin is going to be around for a while. I am ok with that. I have been on it for years. I only stopped because I got scared it could affect my ear problems. I wish I had known.

 

Sorry for the confusion and messy situation.

I am very grateful that you have taken the time to help me!

 

Do you think I should take the 100mg 2 or 3 times daily?

[Fresh]

The lower the better Mark.  It takes 4 days to get to a steady state in your bloodstream , so you want to stay on the same dose at least 4 - 7 days to see how your symptoms are.  

We usually suggest people stay on the same dose for another month or two after a hiccup like this , before beginning to taper.

[Marxxx]

Hello again!

 

I have a topic about gabapentin WD here:

http://survivingantidepressants.org/index.php?/topic/11510-marxxx-wd-from-gabapentin-how-much-to-reinstate/?hl=neurontin#entry212536

I updated my signature to reflect current doses.

 

My question is -

I have tmj caused by severe muscle tension. I just started using my bite guard. My dr (oral surgeon) recommended Klonopin (I think he said 1mg for a few months). Apparently it is a good muscle relaxer and helps one stop grinding teeth. He also said it would help me sleep. I declined because I don't want to deal with the WD symptoms (I am trying to et off the meds I am on now). Would I be better off to go on it and stop the other 3 drugs (Ativan, Anbien and Neurontin over next couple months, or will I still have to taper very slowly)? Then just taper off it later this summer?

 

Most of my gabapentin WD symptoms are manageable after reinstating, however I am having a terrible time sleeping.

 

Thanks in advance!

 

marxxx

Edited March 31, 2016 by KarenB
merged intro topics

[KarenB]

Hi Marxxx,

 

I've merged your new intro with your old one, so all your information is in one place.  Any time you want to post just come to this thread and reply here.

 

It's not advisable to add in another drug - it just complicates things.  You'd do better to stick with what you've got, and continue a slow and safe taper. 

 

Sleep is an issue that affects many in w/d, and it is best if you can approach it in non-drug ways.  It does take time to sort out, but it will happen.  Have you seen the sleep threads?  http://survivingantidepressants.org/index.php?/topic/555-tips-to-help-sleep-so-many-of-us-have-withdrawal-insomnia/

 

And the TMJ thread:  http://survivingantidepressants.org/index.php?/topic/7292-face-jaw-tongue-muscle-tension-and-pain/  Personally, I googled exercises for relaxing jaw muscles, and have been learning to relax my jaw.  Not totally cured, but much better now I've incorporated these into my life.

 

All things considered, you're in the better end of things if sleep is your only issue .

[Marxxx]

Hi Karen,

 

Thanks for the input.

I am currently using the bite guard, going to physical therapy for cranio sacral work and trigger point therapy 3x a week (which is quite expensive), have tried 2 different muscle relaxers, use a tens unit several hours a day and heat / ice the head, neck and jaw several hours a day. It is beyond a full time job trying to rehab this.

The oral surgeon was pretty confident in the klonopin. As I said, I declined. My thought after I left was whether or not I could essentially consolidate these 3 drugs into 1 (maybe have less pain and better sleep to) and only have to deal with tapering 1 later on. I am not really expecting an easy way out, but I am dealing with an awful lot right now (as I'm sure most here have). Just trying to ask all the right questions before things get worse.

If I don't start sleeping better I may not have a job for long. I have tried every over the counter answer I can think of and they just don't touch it when things are bad (the TMJ, tinnitus, anxiety or WD).

 

Thanks to all for reading and input!

[Fresh]

Hi Mark ,

 

"My thought after I left was whether or not I could essentially consolidate these 3 drugs into 1 (maybe have less pain and better sleep to) and only have to deal with tapering 1 later on."

 

I think the answer is "not really". You've been taking each for long enough now that you can't just swap them out.

You can't just stop any of them without setting yourself up for w/d symptoms , so that's a huge risk.

 

It hasn't been long since you reinstated neurontin. Hopefully you'll be sleeping much better in a couple of weeks.

 

bw , fresh

[Altostrata]

Marxxx, you're referring to substituting Klonopin for gabapentin, Ativan, and zolpidem?

 

Why was your oral surgeon confident about this? Ativan is a cousin of Klonopin, as is zolpidem, but a little more distant.

 

Why does he think Klonopin is more effective than Ativan? Does he have experience in getting people off psychiatric drugs?

 

This all seems risky to me, and might lead to a dependence on a fairly large dosage of Klonopin.

 

Have you tried acupuncture?

[Marxxx]

I'm sorry, I must have explained it wrong. He seemed confident that klonopin was a good treatment for the TMJ. He said that it helps people who grind their teeth and also acts as a muscle relaxer.

I thought the longer acting benzos were easier to taper (so maybe the klonopin was better than the shorter acting ativan). My thinking was I am almost off ambien now - switch the ativan for klonopin and work on getting off the gabapentin. Have one med that works as a muscle relaxer, anti anxiety and sleep.

The consensus definitely seems to indicate I was wrong - therefor I am glad I declined and came here to ask. I am SO GLAD I finally did something right with all this and didn't further complicate matters:) I do see your point about not increasing the amount of benzo I am taking.

I assume it would be ok to take a muscle relaxer that doesn't act on gaba?

 

Prior to the last 6-7 weeks I didn't need anything mind altering but the gabapentin. Hopefully I can get back to that....

 

Just got a referral for a good acupuncturist in the area. I am hoping to see him asap.

Once again - thanks for all the information!