I've been on Gabapentin for the past few months, at a present dose of 600 mg 4x a day. I started at a low dose & as I've worked my way up, and it hasn't taken too long to where my pain relief seems to dwindle down (developing tolerance), at any level. The relief was very good for the short time it lasted.

The other day I asked my Neuro to switch me to Nortriptyline, and he gave me a script for 1 or 2 - 25mg caps per day. He said if 1 capsule per day doesn't do it for me after a few days, to go to 2 capsules a day. A buddy of mine was started out at 10 mg per day & was bumped up by 10 mg per day & he is presently at 40 mg per day & having good results. I mentioned to my Neuro about me starting at 25mg per day vs my buddy starting at 10mg per day, and that starting at 25mg the side effects might be worse & he said I would be fine. As a footnote, Gabapentin put my buddy onto the floor & he was removed from it completely prior to starting Nortriptyline.

Since patients often take both of these drugs at the same time, he said I could start right away, but I'm preferring to cut back slightly first & more pain is slipping back already.

Anyone with initial dosage experience (good or bad) & perhaps some who may have divided capsules into 2 portions to take a smaller dose (Nortriptyline or Amitriptyline)?

25mg will knock you off your feet IMO. start with 10mg

I dumped approximately half of the powder out of 6 of the 25mg capsules, and have taken the 5th capsule last nite. One more nite & I am moving up to the (full) 25mg caps. The only thing I've felt so far is a touch of anxiety, which may be related from withdrawal from the Gabapentin, as I'm down to 1/4 the daily dose that I was on before beginning my taper. I'm also am having trouble sleeping, now. Slept good on 2400mg of Gabapentin daily, but the brain fog wasn't really worth it & it wasn't doing much of anything for my pain, anymore. I built tolerance to it really fast. Too soon for any relief by Nortriptyline.

Groucho,

I am sorry but I dont remember now your history. When were you diagnosed? Do you have SFN? Is your pain limited to your feet and legs?

It seems that you developed a fairly quick tolerance in Gabapentin. I started at 900mg a day in October 2011 and work my way up to 1800mg a day (this is my current dosage). I was trying to hold as long as possible my 1500mg a day because I had a strong suspicion that my neuropathy will be for a long haul. But, the discomforts making me nuts. So, I agreed to increase it to 1800mg a day. Also, my neuro was telling that most patients once they find the right dosage that works for them, they stay in the same dosage for a long long time. Anyway, this was last December. WHen I upped it to 1800mg the pain became tolerable, in fact, I can walk for more than 30mins , walk in the treadmill at speed 3 and an incline of 7. Then, lately, my feet starts to hurt again. I stopped the treadmill and just walk slowly at 30mins. Do my epsom salt soakinng at night but the degree of pain now is more than before I increased to 1800mg! :-(

My GP first offered me Gabapentin in 2011. I resisted and in the spring of 2012 I asked to be referred to a Neurologist. I June last year, he diagnosed me with early stage PN. If he was more specific, I didn't pay attention. He initially suggested a Tens Unit, but that didn't appeal to me & opted for the Gabapentin, at which he started me at 400mg daily, which didn't do anything for me. We quickly worked up to 400mg x3 daily. 2 months later to 600mg 3x daily then to 4x daily a couple of months later. I now have started the Nortryptyline. I have a really bothersome & uncomfortable "folded sock" behind my toes & prior to any treatment, I had pains going up my lower legs, especially when climbing or going down stairs. Numbness is maily in my center 3 toes of each feet, but am noticing it more right now in the big toes. My Navy buddy has had some really good results with the Nortryp, and wasn't able to tolerate the Gaba at all, hence my asking the Neuro for it.

The Fog has lifted.

UPDATE:
I have been off the Gabapentin completely for about 2 weeks. I started 25 mg of Nortriptyline about 3 weeks (I did cheat by emptying out part of the 25 mg caps to titrate myself up to the 25mg after 6 days). It really took about 10 days from day one, to feel the first glimmer that the drug was working. I now have some decent relief, but it lasts maybe 2/3rds of a day. He gave me a script for 1 or 2 - 25 mg caps to take at bedtime, as he mentioned they would make me sleepy. They don't make me sleepy, and in fact, I don't sleep the whole nite through. I've been taking them 3 hrs before bedtime & have no trouble watching tv for the next 3 hours. I have had some anxiety issues for many years & think it has increased them somewhat, but not enough to stop treatment.

I'm thinking of doing my meds twice daily. Has anyone found that once daily on the Nortriptyline is enough for all day relief? Maybe I'm just too much in a hurry? I'd like to keep my dosage low, if possible. Anyone with their own experience to share?

ANOTHER UPDATE:

I'm still somewhat jittery on the 25mg of Nortriptyline, which makes be a bit wary of my doubling the dose to 50mg daily, but I was also "jumpy" for awhile after starting Gabapentin (which I'm still off of). The number of hours that I have good pain relief, also seems to be slipping. Has anyone had a similar experience? I'm wondering if when I increase my dose, the length of relief expands, or I'll need to do twice daily.

I just took one pill, the "N" one, last night, smallest dose I suppose. Today I am at work and was dying of thrist. For all the drinking, not may bathroom trips. I had to take an anxiety pill because the dying of thirst seem to make me panicky. Now I am not panicky, not dying of thirst and greatly relieved. I took a half 200 mg tegretol, which I get because I'm also bp. Also, when I got to work, I shoved five cookies in my mouth like a shotgun, that I didn't even like, suspected something was up and went and looked up the "N" drug - and it said it was a weight gainer - this after the doc told me to get as skinny as possible.

PS. I am new - once the leg cramps and pain in feet started, I started looking on the net and found out what I had before the doc told me. I walked around in cold state of fear for three weeks. I was afraid to look at these kinds of sites because I was afraid seeing any more horror stories would make me loose my mind - I was looking for helpful things but they all seem to have horror stories to start with. Then I went around just cussing under my breath for a while... now I'm finally looking at what others say. Found the Stickies at top very helpful and relieving.

The smallest dose of Nortriptyline is 10 mg. I'm taking 25 mg+ and don't find much difference in my thirst. The first day or 2, I did feel a bit hungry, as I often do when feeling anxious. The hungry feeling went away, and the nervousness calms down a bit after a few days, so you may find that happen for you.