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NWGuy

NWGuy: Need help with Gabapentin taper plan

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NWGuy

Hello,

 

I've been reading posts on this site for a while but am reaching out for support in initiating a Gabapentin taper.  I am currently taking both Ativan and Gabapentin, with the Gabapentin having been prescribed to me to aid in Ativan withdrawal and sleep. I was originally taking 600-700 mg at bedtime and another 100-200 mg in the middle of the night to extend my sleep.  I had no doctor advising me on how best to take the medicine, so I wasn't totally consistent.

 

Back in late January, I forgot to take my bedtime dose and woke up at 5:00 am and decided against taking the full 700 mg at that point. Instead I took 100 mg and thought I would resume dosing again that night.  I had very bad withdrawals by early afternoon and decided to take 500 mg to get through the day.  At that point I decided moving forward I would only take the 700 mg at bedtime, since I was not needing the middle of the night dose any more.  I made it almost two weeks before reinstating the 100 mg in the middle of the night due to extreme anxiety symptoms.  Another 10 days later, and more afternoon anxiety, I decided to reinstate 200 mg in the early morning.

 

I'm now at 150 mg between 4:00 - 5:00 am and 700 mg at bedtime and still struggling to get stable.  My Ativan taper has been on hold for almost a month while I try to stabilize, and I'm now seriously considering tapering the Gabapentin before the Ativan. 

 

I know that I need to be very consistent with my Gabapentin doses and timing in order to stabilize, and I'm reaching out for advice both on whether I need to ultimately consider adding an afternoon dose of Gabapentin to avoid afternoon anxiety, and whether I should consider tapering Gabapentin first.  I really don't like this drug, and am concerned about continuing at this high amount for another year or more of an Ativan taper.

 

Thanks in advance for your thoughts and advice.

 

NW Guy

Edited by scallywag
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NWGuy

I'm looking forward to hearing from some moderators as I am feeling at a loss right now of what to do.  I know that both the Ativan and Gabapentin tapers are going to be difficult, and I really want to set myself up for success as much as possible.  Since I'm struggling to get stable right now, it's very challenging for me to go about my day with a foggy brain and cortisol/anxiety spikes in the mornings and afternoon.

 

Thanks in advance for your responses.

 

Sincerely,

 

NW Guy

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scallywag

Hey NWGuy -- Welcome to Surviving Antidepressants (SA)

 

Sorry you found out the hard way that your CNS (central nervous system) didn't like skipping that middle-of-the-night or early-morning 150 mg gabapentin dose. It can take some weeks after a "bounce" like that for your CNS to settle down. Right now you're doing the smart sensible thing -- staying at a dose and waiting it out.

 

Thanks for posting a clear, simple signature. Would you add the dates that you didn't take the morning dose of gabapentin? That will be helpful to have below your posts as your introduction topic gets longer.

 

For your symptoms:

Brain fog; blank mind; comprehension, cognitive and memory problems.

Managing Cortisol Spikes

The Dr. Claire Weekes Method of Recovering from a Sensitized Nervous System, an "oldie" but still very helpful

Although the cortisol discussion starts with a focus on middle of the night waking, people have found the tips helpful for surges at other times of day.

 

Let's give you time to get stable first, then we'll start working out what's next.

 

Some people find supplementing with omega 3 fatty acids (EPA & DHA) and/or magnesium helpful. Start with one at a low dose and increase slowly.

Omega-3 fatty acids (fish oil).

Magnesium, nature's calcium channel blocker.

We say to start with one and to increase that until you reach the max recommended or your tolerance so that if you have a negative reaction you know what's causing it. If you start taking several supplements or a multi-/complex supplement, it's hard to identify what's the cause of the problem.

 

For future reference,

Before you begin tapering -- what you need to know.

Why taper by 10% of my dosage?.

Tips for tapering off Neurontin (gabapentin)

Members-only benzo forum

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

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NWGuy

Scallywag,

 

Thanks so much for the response. I've been reading posts here on Surviving Antidepressants for a little while now, and you are always so helpful and encouraging to those of us who show up scared and overwhelmed. 

 

Just to clarify, I missed my bedtime dose over a month ago - 700 mg - and then made up for it with an afternoon dose of 500 mg.  Following that I decided to just stick with 700 at bedtime only, and then have updosed since then back to my current dose of 850 total.  I also am now taking the morning dose later than I used to, at around 5:00 AM, instead of 2:00 or 3:00.  This is because I no longer need the middle of the night dose to keep sleeping as I did during my acute days last fall.  Removing this dose entirely was not working, so I moved it to later in the morning.  I will insert the timing of this snafu in my signature.

 

Not sure if I made the right choices when reinstating, but that's where I am right now.  A couple follow up questions for you as I work to get stable:

 

- Should I consider adding an afternoon dose at some point, since I'm consistently experiencing afternoon anxiety symptoms?  And/or moving my 5:00 am dose out a little later (say 6:00 or 6:30)?

- When starting magnesium, does it matter what time of day you start?

- Some people in benzo withdrawal claim mag and fish oil rev them up.  I'll give them a try and see how it goes.

- Do those of you on the volunteer staff have an opinion of whether to taper Gabapentin or a Benzo first?

 

Thanks again!

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scallywag

I don't know about adding an afternoon dose, that's getting into medical professional territory. I'd say keep doing what you're doing. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

Most people find magnesium relaxing or calming and therefore find it better to take in the evenings.

 

For people taking multiple medications: Taking multiple drugs? Which to taper first.

It's premature for you to consider which med to taper. You want to taper from stability not from having moderate to severe symptoms.

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NWGuy

Thanks Scallywag,

 

I appreciate the response. Sadly I can't get a medical professional to offer me advice on whether to add an afternoon dose either.  I will continue to focus on stabilizing and hold on deciding when to resume my taper.  It is extremely frustrating to be on both of these meds simultaneously.  I don't think there is a right or wrong answer on whether to taper Gabapentin or Ativan first.

 

NW Guy

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NWGuy

Quick request for advice.  When looking for a provider to help with a Gabapentin taper, would you recommend I reach out to a psychiatry or neurology professional?

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scallywag

The doctor's specialization isn't that relevant. What you're looking for is a doctor who either understands that people have difficulty discontinuing these medications or is willing to trust your reports of your symptoms and to prescribe what you need. 
How do you talk to your doctor about tapering and withdrawal.
What to expect from your doctor about withdrawal symptoms.

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NWGuy

Thanks for the response.  I see in your list of doctors that there is no one recommended in the Seattle area, which is amazing to me.  If you've heard of any recommendations here, please let me know.

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ChessieCat

"I see in your list of doctors that there is no one recommended in the Seattle area, which is amazing to me."

 

Doctors are informed about the drugs they prescribe by the pharmaceutical companies, so it's not surprising to me.

 

Gwen Olsen was a drug rep for 15 years.

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

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NWGuy

Thanks, Chessiecat,

 

I have a question for the moderators or anyone else who stops by.  I have seen on some people's profiles that certain individuals appear to be tapering off of 2 or more meds simultaneously, going very slowly.  I'm curious if you could point me to any threads where this is being discussed, or specific individuals who can offer insight?  I know that this is generally not recommended, but perhaps alternating which med is tapered could work?  Just looking around for ideas at this point in my Ativan taper.

 

Thanks in advance,

 

NW Guy

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NWGuy

Thanks so much.  This is exactly what I was looking for!

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NWGuy

I enjoyed reading this post.  Thanks again for sending this my way. 

 

Does Rhiannon visit the site these days?  I'd love to ask her a question about her experience reinstating and ultimately tapering off of Gabapentin.  I know she had an interesting and eventful time of it.

 

Thanks - NW Guy

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amitabha

Hi NWGuy,

 

How is your taper going? You may benefit from dividing your daily dose to 3 times a day.  

 

I recently went to stop gabapentin after using it off and on for the last several months for insomnia. I would stop using it when sleep efficacy wained and then starting up again; my prescriber was aware of this and I had only been told to titrate up when starting.  I was taking 900mg at 4pm and then again at 11pm.  When I stopped taking it at the end of March, I went into horrible withdrawals: 102 degree fever, diarrhea, shortness of breath, heart pain, chest pressure, muscle contractions, teeth aching, and worst of all - extreme emotional instability w/uncontrollable crying, anger, agitation. 

 

When it occurred to me it could be the gabapentin, I researched it online and immediately took a dose and was fine within 2 - 3 hours.  I got sick again the following days though, even though i was back to my full dose.  The first helpful thing I did was to divide my daily dose into 3x a day instead of 2x a day.  This smoothed the withdrawal symptoms completely within a few days. 

 

I then tried to reduce one dose by 100mg, and then the next dose, and then the next. It was way too fast and I was miserable again, physically and emotionally. I asked my doctor for the pediatric liquid form, and have tapered down 8% so far and currently have no withdrawal symptoms. Before getting the oral solution, i was have withdrawals due to dividing 100mg caps inaccurately, so it seems I'm very sensitive.

 

I've been researching and using magnesium with very good benefit after reading others' experience with it.  Taking a bath with magnesium chloride flakes and supplementing with magnesium glycinate (both available on Amazon) allows me to sleep through the night without any other sleep meds on board.  I'm really shocked by its effectiveness in restoring sleep. This is huge for me, as I haven't been able to sleep without medication for many years. 

 

I hope you'll keep posting.

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