Roses13: gabapentin tapering

[Roses13]

Hello all,

My story is a bit jumbled, I apologize. I am new and plan on doing a signature soon.
 

Back story: 

Zoloft for panic attacks- Severe adverse reaction in 2004 after 10 days. Started on benzos as a result of this reaction.
Klonopin- developed tolerance after 4 weeks. Doctor kept me on for 5 months then rapid tapered in 10 days. Experienced akathisia, disabling brain zaps, intrusive thoughts, phonic tics.
On and off Klonopin- 15 years. Multiple rapid tapers and cold turkeys (Before I knew better).
Off benzos for good June 2020
Currently- Gabapentin 1200mg (got down from highest 6,000mg. On Gabapentin for 10 months) , 20mg Baclofen (On 1 month) 50-100mg Benadryl (on Benadryl over 2 years).

 

I am suffering from severe occipital neuralgia (on the left side of my head), vocal tics, and horrific intrusive thoughts. My pain seems to be somewhat managed by my current medication combo, but my relief is inconsistent at best and at my worst I feel disabled. I am terrified of starting my gabapentin taper. I have gotten down to 800 but I went too fast and went back up to 1200. I would say my intrusive thoughts are my WORST symptom and I have had times where I felt completely psychotic. My hold on reality feels tiny and I pretty much never feel normal or relaxed.

 

My question is, should I even start to try to taper now or do I wait to stabilize? I’ve been on gabapentin almost 10 months so I’m worried there won’t be some magical time that I stabilize and I’m just prolonging my misery. Any insight much appreciated.

 

Rose 

[Gridley]

Welcome to SA, Roses13.  Thanks for doing your signature.

 

Regarding our question about waiting to taper until you stabilize on the Gabapentin, Gabapentin can take up to two months to begin working.  Since you're at ten months, if it's going to work, it's had plenty of time to stabilize in your system.  So this shouldn't be an issue regarding your decision to taper.

 

I have a couple of questions, please.

1.  How are you feeling after going off the Klonopin?  Are you have withdrawal symptoms?

2.  Why do you want to taper the Gabapentin? 

3.  Did your intrusive thoughts get worse when you tapered the Gabapentin, or is this a symptom you have to deal with pretty constantly?

 

As with all psychiatric drugs, we recommend tapering no faster than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Gabapentin.

 

Tips for tapering off gabapentin (Neurontin)

 

Gabapentin comes in an oral solution, and this is the easiest way to taper this drug. If you use the oral solution, you should do a gradual crossover from tablet to liquid to let your system get accustomed to the liquid.

 

There is a moderate interaction between Gabapentin and Baclofen.

 

Interactions between your drugs

Moderate

baclofen  gabapentin

Applies to: baclofen, gabapentin

Using baclofen together with gabapentin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you.

 

There is also a moderate interaction between benadryl and baclofen and between Benadryl and gabapentin.

 

Moderate

diphenhydrAMINE  baclofen

Applies to: Benadryl (diphenhydramine), baclofen

Using diphenhydrAMINE together with baclofen may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. 

Moderate

diphenhydrAMINE  gabapentin

Applies to: Benadryl (diphenhydramine), gabapentin

Using diphenhydrAMINE together with gabapentin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you.

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We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

Edited September 24, 2020 by Gridley

[Roses13]

Hello Gridley!

 

Thank you so much for your reply. I think you’re so right that if I would stabilize, it would have happened by now.

 

So, I cold turkeyed Klonopin over a year ago. My psychiatrist fired me and I couldn’t find someone else to prescribe. This summer I was still feeling miserable so I tried to reinstate on Valium briefly with no positive results. I tried a small amount and stopped after a couple of weeks.

 

i want to taper the gabapentin because I feel like my brain won’t truly heal until I’m off.

 

i have dealt with intrusive thoughts regularly since my setback in withdrawal symptoms 2.5 years ago. They do get much worse once I start going lower on my gabapentin. This is the worst symptom I deal with. 

[Gridley]

 

@Roses13

 

In my previous post I had recommended magnesium.  There's an interaction between Gabapentin and magnesium, as explained below. 

 

IMPORTANT:  There is an interaction between gabapentin and magnesium, see http://www.webmd.com/drugs/2/drug-9845-8217/neurontin-oral/gabapentin-oral/details/list-interaction-details/dmid-1207/dmtitle-gabapentin-aluminum-magnesium-containing-compounds/intrtype-drug.

 

Taking magnesium at the same time as  Neurontin/ gabapentin decreases the absorption of gabapentin.

 

Avoid taking aluminum or magnesium containing products (such as antacids) for 2 hours before your gabapentin.

 

 

 

[Roses13]

Thank you! I had seen that in another post and am happy you all have that base covered. I’ve tried magnesium before and it made me worse... this explains why  

[Roses13]

Hello All,

 

I have been liquid tapering Gabapentin for over 4 months now. I make 5% exponential reductions every 2 weeks. For this time period, dosing three times a day has served me well. Now that I am down to 427mg, my interdose withdrawals in the morning have become horrendous. I have no realized that I will need to wake up much earlier to dose, but that will also mean splitting my dose into 4 vs 3. Is this something that will help my situation? I know the bioavailability of Gabapentin is 5-7 hours. I am roughly following a dosing schedule of every 6 or 7 hours, give or take. Are there others here who have to dose Gabapentin 4 times a day? I honestly can't imagine having to schedule another dose into my day, but I do not see any other alternative to avoid these horrendous morning withdrawals. Thank you.

[ChessieCat]

Please note that your Introduction topic is the best place to ask questions specific to your own situation.  That way your history is all in one place.  SA is a very busy site with a lot of members.  Moderators regularly check the new posts made in the Introduction forum but posts made elsewhere may not get seen.

 

roses13-gabapentin-tapering

 

Please keep daily symptoms notes for the next 3 consecutive days (post in intro topic) so that your symptoms can be assessed.  See:  Keep Notes on Paper

 

Q:  What time do you get up and what time do you go to bed?

 

Q:  What times are you currently ALL of your drugs?

 

Q:  Have you missed any doses or changed the dose of ANY of your drugs or been taking them at irregular times?

 

Drug signature:  CURRENTLY: 30MG s, 20MG Propranolol, 427MG Gabapentin (liquid dosing 3X a day). 7.5-15MG Adderall

 

From https://reference.medscape.com/drug-interactionchecker

 

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  Quote

   

  gabapentin + clorazepate

  gabapentin, clorazepate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

   

   

 

 

 

 

 

[ChessieCat]

Rose has posted elsewhere:

 

  

3 hours ago, Roses13 said:

Hello All,

 

I have been liquid tapering Gabapentin for over 4 months now. I make 5% exponential reductions every 2 weeks. For this time period, dosing three times a day has served me well. Now that I am down to 427mg, my interdose withdrawals in the morning have become horrendous. I have no realized that I will need to wake up much earlier to dose, but that will also mean splitting my dose into 4 vs 3. Is this something that will help my situation? I know the bioavailability of Gabapentin is 5-7 hours. I am roughly following a dosing schedule of every 6 or 7 hours, give or take. Are there others here who have to dose Gabapentin 4 times a day? I honestly can't imagine having to schedule another dose into my day, but I do not see any other alternative to avoid these horrendous morning withdrawals. Thank you.

 

 

I have requested daily symptom notes for assessment.

 

gabapentin-dosing-schedule

 

 

[manymoretodays]

Hi Roses13, @Roses13

And welcome.  I just merged your stand alone topic and question from tapering back here.  So do scan the posts above now, and Ccat has replied as well.

 

This is your Introduction, and the best place for you to ask questions, around your specifics.  That everything is in one place, and we can see what has been replied to, and then you also don't have to repeat yourself over and over.  It keeps things in context too.

 

Would you also plug your current drug(s) into the interaction checker here:  Drugs.com- Interactions

And then link us to the results or copy and paste here.

I'm not seeing the adderall in the one you posted above.

 

Why are you wanting to taper Gabapentin first?

 

And have faith Roses, please.  I just was reading your intial post.  And no reason to believe that you'll have permanent neurological damage from the drugs.

So sorry you've had such a rocky road, to date.  Hugs.

 

And best, L, P, H, and G,

mmt

[Roses13]

Thank you for merging the post. Thank you for your suggestions . Honestly, I’m not in a place to keep a diary of my symptoms. I never go to bed/awaken at the same times but I do set alarms for each gabapentin dose at the same time every day. I don’t set times on my other meds because I haven’t found it has made any difference.
 

I’m really only interested in bioavailability factors of dosing more frequently, which *could* result in eliminating ID withdrawal. The adderall is a new addition (few weeks) and has not changed the outcome of my morning withdrawals or produced any new side effects. I’m tapering gabapentin first because it has elevated my liver enzymes (they went back down after I went low enough) and it also exacerbated my original nerve pain.