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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by iforgotmypassword on February 25, 2008, at 23:43:08
i read it on some seemingly surprisingly coherent CFS website (they collect jay a. goldstein articles, tho this idea wasn't from one of his articles.)
Mg bypasses gabapentin's (Neurontin) effect?
dubious to me, but i know so little, so is this true?
Posted by iforgotmypassword on February 26, 2008, at 0:07:03
In reply to Lar, SLS, Link: Magnesium blocks Neurontin?, posted by iforgotmypassword on February 25, 2008, at 23:43:08
Posted by SLS on February 26, 2008, at 7:04:20
In reply to Lar, SLS, Link: Magnesium blocks Neurontin?, posted by iforgotmypassword on February 25, 2008, at 23:43:08
Hi.
This is the sort of thing that seems more hypothetical than clinical. Try the Mg and see how it affects you once you have established a stable response to the Neurontin. You know that Neurontin and Lyrica both attach to the alpha2delta subunit of the calcium channel. This is a very depressogenic property for me. Mg might actually stabilize the feedback loop and help establish a further reduction in excessive neurotransmitter vesicular release for those neurons affected by Ca2+ influx. If the bulk of the neurons affected by Neurontin and Lyrica are GABA, this can produce an activating effect rather than a sedating one.
That is pure conjecture on my part, and a rather simplistic one at that. One thing that Neurontin does not do is to block Mg receptors. I don't see how they can be competitive for the same membrane receptor sites. It is interesting that both drugs can be sedating at first.
- Scott
Posted by iforgotmypassword on February 26, 2008, at 17:05:12
In reply to Re: Lar, SLS, Link: Magnesium blocks Neurontin?, posted by SLS on February 26, 2008, at 7:04:20
> Hi.
>
> This is the sort of thing that seems more hypothetical than clinical. Try the Mg and see how it affects you once you have established a stable response to the Neurontin. You know that Neurontin and Lyrica both attach to the alpha2delta subunit of the calcium channel. This is a very depressogenic property for me. Mg might actually stabilize the feedback loop and help establish a further reduction in excessive neurotransmitter vesicular release for those neurons affected by Ca2+ influx. If the bulk of the neurons affected by Neurontin and Lyrica are GABA, this can produce an activating effect rather than a sedating one.>It is interesting that both drugs can be sedating at first.
at first? so you need to wait and they stop being sedating... even activating? how long would that process be?
my current med situation is lamotrigine 200mg, deplin 7.5mg, and at least 2mg lorazepam a day.
i find lorazepam activating in the sense that it eases my paralysis a bit, and helps me do things. not miraculously but it's noticable. i don't know if i'd consider it activating in the energizing sense, but it isn't sedating at least, i don't think. i often take it with caffeine, maybe this only adds to the paralysis tho, for some reason i am suspicious that the caffeine does that.
i am hoping that the neurontin will get my lorazepam use under control, and in the end have a better effect for me.
akathisia and social anxiety killing, temper my anger and disorganized social feelings and instead give some peace, and most importantly cure my executive paralysis.
this has to be done without sedating me and especially, no cognitive (or emotional) dulling!
i need to be able to wake up. i already have trouble with this, but then again i also have bad anxiety-driven insomnia.
so if i do get sedating effects, they go away in time, and how long?
my dosing titration plan:
100 4x/day for 3 days, then,
200 4x/dayshould i go higher?
i am already on 200mg of lamotrigine.
(also the gabapentin will be generic, as is the lamotrigine; is this potentially problematic?)
(sorry this is long. thanks for your input!!)
Posted by Larry Hoover on February 26, 2008, at 21:26:11
In reply to Re: Lar, SLS, Link: Magnesium blocks Neurontin?, posted by SLS on February 26, 2008, at 7:04:20
> Hi.
>
> This is the sort of thing that seems more hypothetical than clinical. Try the Mg and see how it affects you once you have established a stable response to the Neurontin. You know that Neurontin and Lyrica both attach to the alpha2delta subunit of the calcium channel.Yes, and apparently, magnesium allosterically inhibits gabapentin binding to said subunit of said channel. An allosteric inhibitor changes the shape of the receptor/binding site, without acting in the active site itself.
See:
http://www.ncbi.nlm.nih.gov/pubmed/10760368
http://www.ncbi.nlm.nih.gov/pubmed/12766660Also, coingestion of gabapentin and magnesium salts inhibits uptake of gabapentin from the gut.
Looks the concern is credible, but it's hard to say how significant it may be.
Lar
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