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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 SLS on May 22, 2000, at 9:36:24
Hi All.
I have been diagnosed with bipolar depression.I am just starting to take Neurontin (gabapentin) in combination with the Lamictal 300mg/day that I have been taking for the last six months.
I would like to get an idea of what dosages to take and what side effects to expect.
I once tried Neurontin by itself. When I took more than 1200mg, I began to feel very foggy and spacey. I felt pretty weird. I stopped taking it because of this, even though it initially helped a bit.
What dosages of Neurontin seem to work for bipolar disorder or depression?
Do people respond to as little as 600 - 900 mg. ?
What happens if you increase the dosage of Neurontin too quickly?
What is a good schedule to increase the dosage?
Has anyone with bipolar depression responded well to it?
If so, what other drugs were you taking at the same time?
Thank-you for any input. I really appreciate it.
Sincerely,
Scott
Posted by Cam W. on May 22, 2000, at 11:36:17
In reply to Neurontin - Dosages and Side Effects ???, posted by SLS on May 22, 2000, at 9:36:24
> What dosages of Neurontin seem to work for bipolar disorder or depression?
> Do people respond to as little as 600 - 900 mg. ?I have seen doses from 100mg daily to 2400mg daily (have heard of 3600mg daily). Larry Ereshefsky says that gabapentin has a saturable absorption and that single doses of more than 600mg at a time are not appreciably absorbed (the transporter mechanism from the small intestine to the bloodstream becomes saturated). Gabapentin also has a short half-life (6h), therefore it must be taken about 3 to 4 times daily to maintain adequate blood levels (3 times daily usually okay). Avoid antacids with magnesium and aluminum (eg Maalox), as they can decrease gabapentin absorption by about 25%.
> What happens if you increase the dosage of Neurontin too quickly?Quick titration can lead to more pronounced side effects and interupt your daily routine (eg somnolence, dizziness, ataxia, fatigue, tremor and nystagmus).
>
> What is a good schedule to increase the dosage?Neurontin can be titrated rather quickly (eg Day 1 - 300mg one dose, Day 2 - 300mg twice daily, Day 3 - 300mg three times daily). I have seen it done quicker and slower. Let the side effects be your guide.
>
> Has anyone with bipolar depression responded well to it?I have seen it work in combination with other mood stabilizers (esp. Depakote, lithium and Lamictal). Neurontin is not appreciably metabolized so there is little chance of pharmacokinetic interactions. It does not work well on it's own, but I have seen people respond to monotherapy in biolar disorder.
>
> Thank-you for any input. I really appreciate it.
>
Scott dude, you'd do the same for us. - Cam
Posted by Susan the Crone on May 22, 2000, at 14:10:51
In reply to Re: Neurontin - Dosages and Side Effects ???, posted by Cam W. on May 22, 2000, at 11:36:17
Was just prescribed Nerontin and Effexor-XR today
and am feeling *very* cautious. I had a miserable
experience with Prozac about ??6 years ago (sweating
like 6 hogs... plus anorgasmia...) and I'm hoping that
this will be substantially better experience. Does
anyone have any experience with this combo?Thanks!
Susan the Crone, who just found this group
Posted by Noa on May 22, 2000, at 18:33:53
In reply to Re: Neurontin - Dosages and Side Effects ???, posted by Susan the Crone on May 22, 2000, at 14:10:51
Susan, welcome.
Important advice about effexor xr: start slow, increase slow. Does the scrip call for 37.5 mg pills? I hope so. If not, ask your pdoc to change it. Starting at the smallest dose helps.
As for starting both together, I am not that familiar with this particular combo, but I do wonder if it is a good idea to initiate both at the same time. Cam, what do you think?
Posted by Cam W. on May 22, 2000, at 21:24:28
In reply to Re: Neurontin - Dosages and Side Effects ???, posted by Noa on May 22, 2000, at 18:33:53
Noa & Susan - Susan should follow what the doctor says. I usually like to start one med at a time (it's easier to figure out which one is giving you problems, if they should occur). In this case, because Neurotonin doesn't interact with the Effexor, it shouldn't make a difference. There may be a pharmacodynamic interaction of extra sedation, but this is only a guess.Starting both together will give a faster overall response that the doc is probably looking for. The doc must have his/her reasons for starting an antidepressant and mood stabilizer/pain killer/antiepileptic, at the same time.
Noa is right, a start low and go slow is the way to begin any medication, unless there are life-threatening reasons to reach an effective concentration in a hurry.
Hope this helps - Cam
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