It has been a long battle for me getting the most effective medication for my neuropathy, (SFN, and long fiber, sensory motor and autnomic neuropathy) and the battle is not won yet.
I started out with Gabapentin a year ago, and had to increase the dose constantly until I was on such a high dose. I had side effects with dizziness and sometimes difficulties with certain coordinations and orientation.
I was switched to Lyrica. The same here, I needed high doses. I was up to 500 mg daily. This med has some similar effects, but not as severe. I can tolerate it better. But now, my neurologist suggested a combination of Amitriptyline and Lyrica. I think he feels this is the best med for the neuropathy.
I started slowly to introduse Amitriptyline in a low dose. And then, after this was getting tolerated in the body, they (neuro and rheumy) slowly verry slowly started to reduse the Lyrica. Then we increased the Amitriptyline at regular intervals.
But then, with Amitriptyline up to 50 mg daily, I got severe side effects with dry eyes and mouth. so we decrease again with Amitriptyline and increased Lyrica a little

The neurologist said that the Amitriptyline should be increased very slowly, so I will try. He said with very slow increase the body will tolerate it. I hope I will be able to tolerate the Amitriptyline and some Lyrica ( but low dose)