[QUOTE=Synnove;1013129]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)


Hi Synnove

How are you doing with the Amitriptyline & Lyrica? Its been and still is a long battle for me too. I take 300 mgs Lyrica for Small fiber Neuropathy. It took 9 months to get here and the Lyrica is not helping as much as it could. My Neuro doesn't want to increase my dose. I recently started Amitriptyline 10 mgs a night. I also started very slowly. I took 5 mg (split pill) for a couple of mos. It helps me sleep, but I do not see a difference in my pain yet. I'm hoping I do not have to go much higher. I see you got up to 50 mgs. Dont think Ill make it that high. How "slowly" was your increase? Are you still feeling better with this medicine combo? Do you have any side effects with the lyrica? I had a lot of dizziness and my stomach was bloated for the first few mos but thats better now, so far no weight gain. But now my hair is falling out, not patches, but a lot of shedding. Needless to say Im very upset about this. The Dermatologist said to wait 2-3 months to see whats happens before I have to stop taking Lyrica. Did you have this problem with your hair? Sorry for the ramble and all the questions. just confused and depressed. Thanks..

I was previously on Neurontin and felt that it helped for a while and over time the effects slowly went away so my dose was increased and increased until I got to 900mg 3 times a day. It got to the point where it wasn't working anymore. Then I was on nortyptiline for migraines, but it didn't help. Do you think it is worth it for me to try the 2 in combo?? Or is it a waste of time and money?

CiCi

Greetings, CiCi. Here's a link to the summary of a study recommending the combination: http://www.ncbi.nlm.nih.gov/pubmed/19796802
The difference between the combo and each drug separately isn't huge, but the researchers regard it as substantial. (And it's worked well for me.) But I haven't been able to find anything about the staging of the two--for instance, does it make a difference which one you start on? And if you're on a high dose of gabapentin (aka neurontin), and you add nortriptyline, can you then cut back on the gabapentin? I hope you can get good advice from a doctor you trust--though that's a struggle in itself for most of us.

Both drugs are available as generics, and on my insurance plan, they're pretty cheap. But I'm lucky to have a good insurance plan through my employer.

Lynn

Do you? Not trying to be a smart*** here; only you know what you're experience has been and what your pain is now.

As with any medication decision, it's about benefit vs. risk. Personally, I think it would at least be worth looking into, and then if you think it worth pursuing, take a copy of the study (and any other documentation/evidence) to your doctor and discuss it.

Doc

FWIW, I took amitriptyline (30 mg/day) and gabapentin (2000 mg/day) for many years. The amitriptyline had a sexual side effect that I didn't care for, so earlier this year I changed it to tramadol (200 mg/day) and am much happier with that. My level of pain relief is about the same, and I am not aware of any side effects from either, except possibly a mild cognitive and memory impairment. Or maybe that's just the real me, who knows.
Ron

hi Marie33
How are you doing with your meds?
Sorry I was away fro this site a few days.
Regarding what you were asking me regarding the combination of Lyrica and Amitriptyline. My neuropathy neuro dr. says he would recoment higher dose of Amitriptyline. But, I tell you, since my last post regarding this( must be a long time ago!) things has changed. I first started with Amitriptyline 10 mg for 2 weeks, then increase to 20 mg. And I am on Lyrica 100 mg in am, 100 mg at 2 pm and 150 mg at bed time. So then they started to increase it to 25 and then up to 50 mg. That was intolerable!! All my glands of any kind of liquid in my body closed up dry mouth, nose, eyes and every thing. So I went down to 30 mg, which I have been on for a while, but dr, sais to try to slowly increase it to 40. I tryed, but my throat closes up with hard mucus plugs at night, it is dangerous. I am down to 30 mg
You asked regarding how slowly I increased the dose, the neuro said verre slowly every 3 weeks or so
Regarding hair loss. Yes I do have a fair amount of hair loss, but I do not know if it is fram Lyrica, could be another symptom of some king of autoimmune condition.
I hope you have gotten answers to your dosing problems by now. I hope the medicine is working for you

I am new to this site so I am sure I must not be looking in the right place but I am DESPERATE for help with BMS. I have suffered for years with BMS and dry eyes (restatsis for years) and only recently have been prescribed gabapentin but I have had NO RELIEF. Tonight is so bad I considered using burn gel in my mouth...the external only warning stopped me but when the pain is this bad I am willing to try anything! The most recent PCP has also prescribed procardia for my hands and feet which is helping but the headache from that medicine is killer.
Is there anyone out there in Pittsburgh, PA who is receiving help from a pcp or dentist?
Thank you and I really appreciate any and all suggestions!

Welcome to NeuroTalk:

Burning mouth can occur with low B12.

Also lipoic acid supplements help some people.

But commonly, toothpaste can be a culprit or mouthwashes.
Check your labels and buy a brand without Triclosan.

These are the 3 most common interventions. Otherwise, it might be a food intolerance or allergy.

I myself cannot tolerate citrus or tomatoes.

This is the very thing I discovered when I was looking around for an answer to my atypical trigeminal neuralgia pain.

However, my stomach is a war zone since I have GERD and went on many meds after developing this very horrible pain after some dental work (didn't have any pain going in).

I DID notice those that were getting improvement were taking some sort of combo of a tricyclic and Gabapentin.

Well...guess what? I take Desipramine (tablet) and a compounded cream and in that cream is Gabapentin.

I also keep my B12 and D levels optimized.

Improvement!

I am being treated by a GP, his name is Geno Pavlick with Premier Medical. He is a very caring and intelligent doctor who listens and take over medication when you are getting no where with other doctors. Unfortunately I have no dentist referrals as most know very little about nerve damage. Currently I have taken gabapentin for 2 months with little improvement 600 mg twice a day is where I am, however, much research has indicated tricyclics antidepressants for mouth pain and I just started this week on Nortriptlyine. I will let you know how it goes. I do not have burning mouth, however, I have suffered with ulcers and burning at times and know it is painful. I found milk helped the burning and there are lidocaine mouthwashes they can prescribe. I also take a complex b vitamin and alpha lipoid acid supplement that they coaim helps heal nerves. I understand the desperation as I go thru it daily. I have had two teeth pulled and several root canals. I currently have a tooth hurting that was root canalled. Please update me on your progress. Maybe we can be some sort of support to one another.