I recently started taking Gapapentin for PN nerve pain. I've read across the web that after one has been on it for a time, that you develop tolerance to the drug, & your dosage must be upped in order to receive the same pain relief. I also have found that when taking it 3x a day, as prescribed, that it wears off between doses. Does anyone have experience on this?

I have a friend on Nortriptyline, and he says his Neuro told him that once he finds a dose that works for him, that's his dose for life.

Can it be with all the folks on this website, and Gabapentin being one of the most prescribed medicines for PN, that there isn't a soul here that can share their experience with the drug with me? It seems that most must be getting relief with vitamins, but that hasn't occurred for me.

Yes gabapentin does create tolerance.
People in whom gabapentin works (about 30% of those who try it), find that over time they may have to increase doses, because the previous dose stops working.

The same effects happen with Lyrica. Some patients therefore end up on very high doses of these two medications.

Things are slow here sometimes, just be patient and people will likely respond. It could be that not many current members here are using gabapentin at the moment.

You might try searching old posts for members in the past who have moved on.

I have been on the same dose, 600 mg 3 times a day, for about three years. It may be decreasing in effectiveness, I am noticing more burning, tingling, and the feeling of things running across my feet lately. It does work for me in that if I skip a dose I have electrical zaps and more burning.
I will probably not increase this dose any time soon because I do not currently have side effects, and I would expect to at a larger dose. I have not gained weight on it, as many do, and with my muscle weakness i definitely want to avoid that. Most of my pain, I have CMT (hereditary neuropathy), comes from my legs, and I take oxycodone for that.

Supplements are not really that helpful in my case, except for maintaining general health- b12, fish oil, d3.

Taking 3 years to feel the need to up your dose doesn't sound too bad. I just started taking the Gabapentin at the end of June, & I had to go up to the same dose you are taking to get relief from the "folded sock" behind the toes, which causes me the greatest pain, when AI walk. I really feel that it's wearing off before the next dose, and that I should be taking it 4x a day. I've had a slight weight gain, a bit of short term memory loss, and I feel a bit tired, but that's about it. In a way I'd like to switch to the Nortriptyline, but worry about new side effects.

I think what we are taking is about the minimum effective dose, if it is going to work at all, as Mrs. D said. A lot of people, especially men, seem to be on 2400-2700 mg. I am 6'2", but women, even big ones, seem more sensitive to meds. I have not heard of Nortriptyline as a substitute for gabapentin, rather in combination with it.

My neurologist seemed to view the primary job of the gabapentin as making sure I could sleep at night. My first dose is when I wake up, but the two later ones are at dinner and bedtime, no more than four hours apart usually, so I have it built up when I go to sleep. It does work. I can't take oxycodone at night as it wires me up. I use it for housework, walking, shopping, etc. I have the feeling of walking on large stones, probably the equivalent of your folded sock feeling. I wanted to take my boots off yesterday and check whether my socks had slipped down and bunched up, but of course they hadn't. My pain med muffles the feeling, but it never goes away.

It doesn't hurt to try different things, in fact you must to have any quality of life. PN is really idiosyncratic and everyone seems to have a different pain protocol. I blame the memory loss on being a 51 year old woman, but I do have slightly blurred vision which may be the gabapentin. I have (had?) a photographic memory so still get by, but am relying more on lists. Then I forget the lst...

Hi Groucho,

I have been on gabapentin for a year now. I initially started last October at 300mg 3x/day and within a month moved up to 4x/day spread evenly throughout the day. (I don't have trouble with pain at night while sleeping.) It works great for me with no side effects, for which I know I am lucky. My pain is exacerbated by too much walking, standing or other stress on my feet. When I am having a flare, I can tell when the doses wear off because I look at the clock and my next dose is usually due within the hour. However, I have also discovered the gabapentin to have a cumulative effect in that it loads up in your system and is more effective. I tried to go off it over the summer and successfully reduced my dosage for awhile, reducing by one pill every two weeks. But, it all caught up with me and after 3 weeks I was in horrible pain, I believe, because my overall system level finally caught up with the lower dosage I was taking daily. My psychiatrist explained to me about the system load and like he said, it took 7-10 days to start feeling better after I went back to 4x/day dosage. (Incidentally, the pharmacist told me it would only take 2-3 days to ramp up.) I will be paying attention to any tolerance build up with this drug, but so far so good. Hope this is helpful for you!

I appreciate everyone's personal experiences. I am presently taking 600mg x3 daily of the gabapentin, and have played with all dosages that these scored pills will allow me, from 900-1800mg daily. My Neuro said to see if I could cut out a half pill daily, when he put me on this dosage, but that's not going to happen. I find that 600mg x3 starts wearing off between doses. I feel I'm really close to "comfort", and I have extra pills, from playing with lower doses. I'm going to try out a 4th dose of a half pill (300mg) in the evening, so I don't have a down time in between the 3x doses.

My Neuro said he would give me either Gabapentin or Nortriptyline or a combination of both, if I felt I needed it. I dislike so many doses with the Gabapentin, but can tell it's working. It's not perfect, but will take what I can get. I really don't want to start over right now, as I live in the Northeast, and snow & the extra activity is just around the corner. I'd rather deal with the devil I know, that experiment right now. I'm strongly considering asking my Neuro to switch me to the Nortriptyline in the Spring, and since there seem to be few that have been on both Gabapentin and Nortriptyline, I will share that experience with you. Pros & cons.

Can someone tell me more about Nortriptyline, please? This is the first I am hearing it being used for nerve pain. I'd like to know the pros and cons, please. My interest was piqued by Mrs. D's comment about it encouraging nerve repair.

Here is the article to copy for your doctor:

http://psychcentral.com/news/2009/06...tors/6761.html

Nortriptyline is the active metabolite of the older drug amitriptyline. So they would both work I would imagine.

http://en.wikipedia.org/wiki/Nortriptyline