How much is too much? neurotin and lyrica
 

Hi, I've been dealing with foot numbness and pain after a knee replacement surgery for the last 2 months. I had a EMG and it was determined that I had post tibal nerve damage. I have been using neurotin and it was being increased weekly because it wasn't helping enough. I am now on 800mg 3x a day and taking lycric 50mg at bedtime. I am feeling so much better. I still have the numbness and burning but it is not to a degree that I can't bear it most of the time.

I was wondering what kind of side effects I should be looking for with taking this amout of meds or is it not that much at all? I recall the doc saying that it was major dosage amount but I wasn't maxed out yet. What would be maxed out?

It has been a week since they added the lyrica and it was the turning point in making life so much more bearable. Will I reach tolerance with the lyrica and have to have that increased too?

I know, I might be rambling, but thanks for listening and any offers of advise or info will be appreciated.

Thanks Brenda

Hi ~ You can go higher on Neurontin ~ I'm surprised you haven't had any side effects from it. Most people notice some weight gain, water retention, and feeling a little "loopy" from it. ;) I'm glad you don't. You would by now if you were going to. The Lyrica has quite a few side effects too - if you look at the top of this page, and click on where it says "Drugs" you can look up ALL the drugs you take and it will tell you all about them and the side effects. No, you're not maxed out on Lyrica either.

I'm SO glad that these are working so well for you. I just wish they had taken away all the burning. I take Topamax and that DOES take away ALL THE BURNING and tingling. Every bit of it!! At least it does for me!!! I hated the Neurontin -- I didn't like the weight gain or feeling loopy. Topamax works the same as Neurontin but for me it works better!

Best of luck to you and God bless! Hugs, Lee

There is a guy on another forum whos doctor has him on 1500mg of lyrica hes also a SCI.

600mg is max for lyrica
4800 for Neurontin (i think)

they were effective for me sort of , or so I thought. Coming down off 300mg Lyrica has actually improved my Pain however I had issues with water retention and swelling so I spent a year in more Pain and paid for the pleasure :rolleyes:

great they are working for you, thats the biggest battle

pain relief = sanity :)

Zorro is pretty much on the mark--
 

--for the maximums that most doctors will prescribe regarding Neurontin (gabapentin) and Lyrica (pregabalin).

Nevertheless, I know of exceptions, among them people with Central Pain/Thalamic Syndrome (common among MS and stroke patients) who've gone higher--one I know of went to 7200mg Neurontin and was still getting slightly increased pain relief after ramping up to that point and was still functional.

For most people, the effect of these meds has a downward slope after about 2400-3000mg of Neurontin, 350-400mg Lyrica or so, in that increasing dosage after these levels by a set amount has less of a therapeutic effect than it did at lower dosages--for example, more effect is felt in going from 1800 to 2400mg Neurontin than in going from 3600-4200mg. There seems to be a diminishing returns curve in absorption ability for most.

Everyone is an experiment of one, though.

"For most people, the effect of these meds has a downward slope after about 2400-3000mg of Neurontin, 350-400mg Lyrica or so"

Agree
Glenn can the same pain relief be expected after remaining med free?
lets say I start lyrica again in 6 months. 100mg gave me super pain relief first up. Im thinking my brain may be hardwired to expect it so may not be as effective next time around?

I was told the exact opposite by the ortho-cutter who put us on the low "as needed" dose. He said that since we'd been on it at higher dosages previously (and come back down off it), the lower dose [might/would - don't recall the exact] work. Between himself and the both of us, he's batting 3 for 3, but no guarantees. I've also heard people report alternating between gab & Lyr as each reached tolerance, so there may be something to the tolerance dissipating in time (or not).

Doc

Side effects can include: incoherent rambling, yadda, yadda, yadda.... :rolleyes:

(Seriously, though - I did recently hear of someone who got more "talky" on it, but who knows....?)

For the real side efects, see:
http://www.drugs.com/sfx/gabapentin-side-effects.html
http://www.drugs.com/sfx/lyrica-side-effects.html

Doc

yeah makes sense Doc. When i gave up drinking once for a whole month :rolleyes: I found the first few when I started again were almost euphoric in initial effect. but tolerance rose quickly after that. The taste was an extra sensation that you wont get from a pill. maybe liquid Lyrica that tastes like beer?........
Nah!

The dose as you need makes a lot of sense when you think about it. One needs to get off the meds first though and that is extremely difficult since the brain sends compounding signals. Is it withdrawals or is it the P/N

In my case it took several attempts to break through.

I also got extremely chatty when peaking / upping dose of Lyrica I went to 450 one week , wow is all i can say :eek:

Neurontin has a very terrible side effect in high doses, in some people. Fecal incontinence! No one wants THAT one!

That would be a strong signal to discontinue IMO.

Its the opposite for me (constipation) taking Lyrica
(was neurontin) & tramadol.
I have to take fiber supplements (rather than laxatives) 2-3x/day,
or I'm backed up and have cramps. Extra pain I don't need!
This PN is just one grand, old, experience!

I hear that. I was getting what seemed like rebound after taking the gabapentin.

Have you tried/considered the R-Lipoic? It's made a believer out of me, and I'd put it more in the "supplements" than "meds" category.

Doc

Bob, I think the Tramadol is countering the Lyrica.

Tramadol is constipating for me, even at the low dose I use.

I could be wrong but I was thinking the OP meant long term issue with taking the med at a high dose for a long time?
When I first started neurontin I thought it really helped and as I increased I felt less so. I am thinking though it may have just been a better time so often I wonder if it is hard to tell if meds are working or not. My pain seems like a rollercoaster and sometimes for no reason.

[QUOTE=Dr. Smith;747845]Side effects can include: incoherent rambling, yadda, yadda, yadda.... :rolleyes:

(Seriously, though - I did recently hear of someone who got more "talky" on it, but who knows....?)

:p You make me laugh, really. I went out to lunch today with a friend and I had to smile and think of you, when I couldn't seem to shut up and kept rambling and rambling. eventually, I let her talk too.

Brenda

There have been a number of people--
 

--who've reported that for Lyrica, Neurontin, Topomax, and a whole lot of other anti-seizure drugs, that they worked well early on as the dose was being ramped up, but some degree of tolerance occurred after having been a on a stable dose for some time.

This is not unusual--it happens with many meds, as the body "upregulates" its responses to adjust to the drug action. It's also the reason why quitting meds "cold turkey" is generally not advised--that upregulated body action often results in withdrawal symptoms as the body is forced to "downregulate" too rapidly for easy adjustment.

Some people have said, though, that when they experienced this tolerance, switching to a related med helped, or adding a new med while slowly ramping down the original one helped, and then, after a period of "rest", starting the original med back up at a lower dose gave them a greater effect than the one they had gotten used to. Some people even go on med "holidays" for this effect, though they have to get through the period of reduced med levels and, often, symptom increase for a while.

But hey, we're all experiments of one. (I know I say that a lot, but no two people seem to have the exact same reaction to anything. Except, maybe, cute kittens and puppies.)

Hello,
The only medication that did not require increased dosage was Methadone, I started at 10mg 3times a day, but found 10mg 2 times a day worked the best, this was over a three year period. The only side effect was severe constipation, no buzzes, no brain fog. Its very cheap and has been around a long time.

I think there are some cultures that would consider these a gastronomic specialty:cool::eek: :(.

Mmmmm.... Pass the barbecue sauce! :p

That's interesting, stagger. Methadone was suggested by one of my docs recently, and I don't feel like I know enough about it to have an informed opinion. I've wondered if I would build up a tolerance to it. Tramadol became pretty much useless to me within a few weeks, so I always figured it would be the same with anything else that is an analgesic. Maybe it's worth trying.

And Dr. Smith, I am apalled! How could you? The very idea of puppies and kitties done in anything but a Bourguignon is unthinkable!

Hi JoanB,
Have your doctor check heart and you should maybe start at 5mg twice a day. In Virginia you have to see a Dr. to get a refill, the VA is not very high on Tramadol usage (was on it with Lyrica) and at max dosage fell a lot and cut off a finger in my wood shop. Quit neurotin when on high dosage 3600 didn't work that well. I'm only taking amitriptyline 12mg at night its great for sleeping, but might go back to 5mg Methadone in am as the pain is in the 4 to 5 range. Thought about dying a lot when on Tramadol-Lyrica and had breathing problems. One does sweat more while taking Methadone. Also take Mythl B-12, R-lipoic acid, L-Carnitine, Benfotiamine, plus other basic vitiams. There is a web site Askapatient.com that patients comment on the meds they take, I suggest this site for those seeking info on medicines. Just type in the name and read the reviews. Methadone is rated very high for pain. Tramadol gets a poor rating. Hope this helps.

Total agreement :cool:;):wink::winky:

Thanks stagger. I'm so sorry about your finger!:(

Actually, at this point, I'm having trouble getting anyone from my doc's office to respond to my calls for anything...in another thread I was talking about following up on the idea of a calcium channel blocker, but it seems like nobody's home there.

Back to the methadone: I'm always very sheepish about asking for anything that's a DRUG drug. I'm so afraid of getting labeled as "drug seeking", even if the doc suggested it first. Just seems like they have absolutely everything about you in their database, and once something gets put in there, it's there forever.

And Bob, you can have dinner at my place any time.:p

Watch out you two........
 

I don't want to have to flash my Animal Rights badge!

Don't like this humor!!!!

Sorry invisable...we were bad...but Dr. Smith started it. Next time we want to whip up a culinary delight, we'll see if we have a big enough pot to fit him (her?) into. Or maybe Bob. Nobody will be tempted to cook me...I'm too bitter an old woman.

Joan remind me never to rob a bank with you

Glenn set me up. :Dunno: That's my story and I'm stickin' to it! :hissyfit:

Doc

Bwahahahahahahahahaha!!! :ROTFLMAO:
:Good-Luck: They don't make 'em that big!

Doc

Boy am I glad that y'all forgot about me in that pot.
Talk about a BIG pot! I'm on my way to hit 300 lbs if this
stopping smoking/eating, doesn't settle down soon.
As soon as I get back from my dream fantasy vacation next week (a cruise to Nassau & Freeport - an Xmas gift)
I HAVE to start on a serious diet! I want to drop 50-60lbs, if I can, but diets, for me are equivalent to Nazi concentration camp torture. And they are so lonely & depressing.
I'm not one to join a dieter's self - help type club, tho. When I went on Weight Watchers the last time (about 6-7 yrs ago), all I did was follow the directions.
No meetings or any thing like that. I checked it out, & it was all really fat women, talking about female problems
I'll have to check out this new 'WW' on-line thing for men.

I didn't, but if they don't make 'em big enough for me, there's no way you're going to fit too.

I'm doing the intractable pain diet, and while it looks difficult at first glance, it really hasn't been at all, and it's the only one that's worked for me (and it is working) in a decade.

Doc

New WW program: not so effective for me....I always had good results with the old program, but I went on the new one for a month and gained two pounds. When I stop thinking about the best way to cook Dr. Smith and/or Bob, I'm gonna try that one again.

What?!? It's them, not me!

I am such an animal lover......
 

I would gladly let you cook me, even a slow simmer, it you promise to leave my 4 legged friends out of the pot!!

Nah, we wouldn't do that. I'm all talk. If I were left alone by meat eaters, I would probably be a vegetarian without even trying.

'intractable pain diet'

What the heck is that? :mad:
A joke? :confused:
Reality ? :o
(altho from many of your posts,
I'm not sure you have a firm grip there. fella :winky::rolleyes::cool:)

http://pain-topics.org/pdf/IntractablePainSurvival.pdf
Page 34 of the book; page 35 of the PDF

My doctors are, as are family, friends, and enough others that I'm secure with my idiosyncrasies.

Doc

Apparently, that goes both ways. Invisable (and anyone else easily offended/grossed-out) DO NOT read this link:
http://tinyurl.com/6gqcczq

Ironically, it IS on-topic (PN).