Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).


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Old 08-01-2014, 08:29 PM #11
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Originally Posted by markneil1212 View Post
sorry Mark . maybe the gabapentin really knocks you for a loop when you increase it and it builds up in your system. I felt better a little better but not 30 hours worth!!
Mark. If you increased your gabapentin, yes, it can do that.

It's likely you'll get used to the sedation in a week or so, but it might calm some of the sleep issues.

How much were you taking before, and how much did you increase it by?
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Old 08-01-2014, 08:33 PM #12
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Mark. If you increased your gabapentin, yes, it can do that.

It's likely you'll get used to the sedation in a week or so, but it might calm some of the sleep issues.

How much were you taking before, and how much did you increase it by?
nine hudred to eighteen hundred. it has helped the waking up burning and trembling thing but not the chronic head neck pain. I know it is only good for certain pain. i'll take it
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Old 08-01-2014, 08:54 PM #13
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just fantasizing here, but wouldn't it be great if we could just check ourselves into a swanky hospital, some sorta drug would knock us out and another drug would fix our brain. then we'd wake up with no memory of the horrors of pcs, but we would still be able to walk away with the wisdom gained. or not. f' wisdom.
I dream about this often... I also have said that if I was knocked out right after for a few days then I would have faired better... I would have gotten proper "brain rest" and may be "healed" by now....
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The Start: MVA, t-boned, on 1-12-14 (my sons 5th birthday) and did not think anything of it.. my back hurt on site but everything else seemed ok. Lost about 10-12 hours from about 3 hours after the accident to the next day...Experienced terrible brain fog for over a month, plus intense headaches, nausea, dizziness, cognitive difficulties, disorientation, no short term memory, depression and just an overall hangover feeling daily.

Current Situation: I'm about 7 months in and my local neurologist has waived her white flag and therefore I am headed to Dallas to be seen (I have family there). The headaches are still daily. I have nausea, dizziness as well.

Drugs I have been on- Vicodin (off), Naproxen (off), proanolol (off), topamax (off), cataflam (off), Midrin (off), Flexeril (off) and now Namenda XR (off), Nortrptylin (off), Verapamil (off)

Therapy- Osteopath, Vestibular and balance therapy, fuzion/soft tissue massage, acupuncture

Drs- ER (no help), GP, Chiropractor, Neurologist and Osteopath
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Old 08-01-2014, 09:09 PM #14
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Originally Posted by markneil1212 View Post
nine hudred to eighteen hundred. it has helped the waking up burning and trembling thing but not the chronic head neck pain. I know it is only good for certain pain. i'll take it
Holy guacamole, no wonder you slept 30 hours! Upping 900 at a time is pretty big increase.

Glad it helped with the burning/trembling at least. Sounds like that was keeping you awake and waking you up. Also, you know, gabapentin works only by chronic exposure you dont' see full effect until it stays in the system a while... give it a week and see. Who knows, perhaps it will reduce the head pain some as well.

Increasing above 1800 can be done safely with medical supervision, but it's less likely to be useful. (Response is non-linear above this dosage, i.e. the drug is less and less "efficient").

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Old 08-01-2014, 10:22 PM #15
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wave,

Keep in mind that markneil is 350 pounds. It may be a part of why such a high dose is needed and well tolerated.

I am 150+ pounds and have taken up to 1200 mgs before bed. At first, I needed 1200 or at least 900. Now, I do fine with 600.

It is not know to help with normal pain (that's an off label use), such as skeletal pain but helps some with nerve pain similar to Lyrica.

I've been taking it for 14 years.

I take it to reduce the body jerks and to help my mind let go of thinking. Its half-life is only 8 hours so unless it is taken multiple times during the day, its benefit can be targeted at sleep issues.

markneil, If you are waking up still tired, did you keep your cpap mask on ? Apnea will negate the good sleep benefits.
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Old 08-01-2014, 11:02 PM #16
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Originally Posted by Mark in Idaho View Post
wave,

Keep in mind that markneil is 350 pounds. It may be a part of why such a high dose is needed and well tolerated.

I am 150+ pounds and have taken up to 1200 mgs before bed. At first, I needed 1200 or at least 900. Now, I do fine with 600.
Hi Mark!

Seems to me also that weight would be a factor in overall dosing as this med is heavily distributed in tissues (diffuses out of the blood). But I do know of people over 200 lbs and use only 600-900 successfully.

However, an increase of 900mg at a time is steep even if one is heavy, and could certainly bring on a potent sleepiness.

The thing I was saying about dose is only about absorption. Higher than 1800 studies show that dose/response rate loses linearity. For instance, increases from 1200 to 1800mg, or from 1800 to 2400 mg, are both 600 mg. But in the latter case, a bit less of the med is going to get "delivered" and as you increase further, less and less of it gets "delivered". Not sure if that's clear I'll try to find you a link tomorrow. (I need to get to bed!)

I take gabapentin myself... have on and off for years -- 1200mg for migraine prevention. And sometimes other things.

Quote:
I take it to reduce the body jerks and to help my mind let go of thinking.
Yes, it's good with the letting go of thinking... can be a little "too good" that way. (When I was on another med along with it, I couldn't handle it.... I couldn't think straight to do my job. )

Quote:
Its half-life is only 8 hours so unless it is taken multiple times during the day, its benefit can be targeted at sleep issues.
Interesting. I used to keep it as a sleep aid, but it only worked if I didn't use it with any sort of regularity. In other words, I got used to the sedation quite quickly. I don't know, but I wouldn't want to take a really steep dose on an occasional basis... I'd be afraid of seizures when it leaves the system.

The half-life is misleading becausee this thing has crazy pharmacokinetics.
It takes several hours just to be absorbed (3-5 hours). I notice this when I start taking it... start feeling brainfuzz and sleepiness at about 5 hours after each dose.)

And then, it doesn't stay in the blood it migrates into tissues... body fat.

All in all, the slow absorption means plasma concentration risees very slowly, and then the tissue distribution means it falls off somewhat more rapidly than the half-life suggests as it permeates into body fat.

waves... who will check back tomorrow and try to find you some links that maybe explain better if you like. Or maybe I misunderstood you and you already knew these things. Nite nite for now.
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Old 08-01-2014, 11:08 PM #17
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Waves,
I thought I was a big shot because I read so much about Neurontin and how it works. I didn't know anything you mentioned very interesting. would love the website for further information and to kill time
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Old 08-01-2014, 11:22 PM #18
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I start to get effect from my before bed dose within 90 minutes. It could be that I never take it except before bed.

I don't get any cognitive decrease when I take it. It just sets me up so I can relax my thinking if I want/need to. I still need to practice good sleep hygiene to get to sleep. It does not put me to sleep.

btw, Time for my bedtime dose. I want to sleep tonight.
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Old 08-02-2014, 07:46 PM #19
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Default sources -- and amendments -- re: gabapentin pharmacokinetics

Hi again, Mark & Mark.

Ok, so most of my bookmarks on gabapentin were defunct or too specific and not about dosage considerations... so I had to go to google .... took me a bit.

AND, what turned up this time is little different than what I remember or perhaps found before. Not entirely surprising because every time I google this med something different comes up.

Anyway, I will post a few of the sources/articles.

1. http://www.ncbi.nlm.nih.gov/pubmed/8022536


Quote:
Plasma concentrations are essentially proportional to dosages up to 1,800 mg daily, which is the highest dosage used in double-blind, placebo-controlled clinical trials.
========

2. http://onlinelibrary.wiley.com/doi/1...01.02399.x/pdf

Quote:
Peak plasma levels [...] are achieved 3±3.2 h after ingestion of a single 300-mg capsule [7, 10].
Quote:
As a result of the dose-dependent saturable absorption of gabapentin, C-max increases less than threefold when the dose is tripled from 300 to 900 mg [9]
This tells us something a little more specific... not only the daily dose is significant, but the size of an individual dose is significant in absorption, becausee the transport mechanism (you can research this if you want) gets saturated... only a limited supply of "gabapentin taxi-cabs", lol. This suggests to me that taking a certain daily dosage split into a greater number of smaller doses can deliver slightly more gabapentin than taking fewer larger doses.

Quote:
Its extensive distribution is reflected in a volume of
distribution of ~0.6±0.8 L/kg [7, 9]. Cerebrospinal fluid (CSF) concentrations are 20% of plasma concentrations [11] and have been estimated at between 0.09 and 0.14mcg/ml [12]. Brain tissue concentrations are ~80% the plasma level [13]. In rats, the pancreatic and renal tissue concentrations were found to be eight and four times, respectively, higher than serum concentrations[11]. Pancreatic accumulation of the drug does not occur in humans as it exists in a highly ionised state at physiological pH and concentrations in adipose tissue are low [11].
So, although it distributes outside the blood, it does not accumulate much in adipose tissue. This means weight is unlikely to have much impact on dosing considerations. (Perhaps a little, but would perhaps need more specifics on the albeit low concentration of drug in adipose tissue to believe that.)

========

3. http://www.rxmed.com/b.main/b2.pharm...NEURONTIN.html

Quote:
Pharmacokinetics: Adults: Following oral administration of gabapentin, peak plasma concentrations are observed within 2 to 3 hours.
3 hrs is faster than what I remember/stated... might have been "tainted" by my own experience.

Quote:
Absolute bioavailability of a 300 mg dose of Neurontin capsules is approximately 59%. At doses of 300 and 400 mg, gabapentin bioavailability is unchanged following multiple dose administration.
[...]
Plasma gabapentin concentrations are dose-proportional at doses of 300 to 400 mg q8h, ranging between 1 µg/mL and 10 µg/mL, but are less than dose-proportional above the clinical range (>600 mg q8h).
300-400 mg q8h is 900 to 1200 mg a day -- plasma conc. is dose-proportional.
">600 mg q8h" would be more than 1800/day -- over 1800mg a da plasma conc. is less than dose-proportional.

Quote:
There is no correlation between plasma levels and efficacy.
In other worsds, some people may respond with only a little in their blood, while others need a lot.

========

4. http://www.rxlist.com/neurontin-drug...armacology.htm

This source states something slightly different -- that availability decreases as the dose goes up, even starting at 900 mg/day. These numbers still show a progressive decrease in availability with increasing dose. I do find very interesting though that the rate of decrease slows down as the dose goes up.

Quote:
Gabapentin bioavailability is not dose proportional; i.e., as dose is increased, bioavailability decreases. Bioavailability of gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively. Food has only a slight effect on the rate and extent of absorption of gabapentin (14% increase in AUC and Cmax).
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Old 08-02-2014, 07:48 PM #20
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Quote:
Originally Posted by markneil1212 View Post
Waves,
I thought I was a big shot because I read so much about Neurontin and how it works. I didn't know anything you mentioned very interesting. would love the website for further information and to kill time
What I know on its mechanism of action is murky... the only stuff I could find was either murky or too difficult for me to grasp completely. Many sources still report the mechanism of action as unknown, so if you know how it works you are doing way better than most!
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