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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by mars on January 16, 2001, at 5:01:54
Hi -
I'm currently taking 1800 mg of Neurontin, was ramped up very quickly (just added 300 mg this morning), and will probably be adding more. My pdoc is very adamant about me staying on it for at least a few months.
I feel terrible today, much worse than yesterday: foggy, disoriented, almost like everything is a dream, and very sluggish (I'm even napping, which is unheard of). I feel like a blob, and it's very discouraging. I have been trying to read the archived posts here so I can try to learn about drug therapies I haven't tried yet, and today I haven't been able to do that at all - I can't think.
Can anyone give me an idea of how long this might last? Or of any alternatives to the gabapentin? I think my pdoc is basically good but, of course, not perfect. I have tried Depakote, Topamax, Tegretol, Lamictal, did not respond to them well.
Thanks for any feedback you can provide.
best,
mary
Posted by Cam W. on January 16, 2001, at 6:40:10
In reply to Having a difficult time with Neurontin, posted by mars on January 16, 2001, at 5:01:54
Mary - Just a note. The maximum amount of Neurontin that the body can absorb in any one dose is approximately 600mg. This is because the Neurontin is "actively transported" from the stomach to the blood stream by a saturable enzyme system. So, to get full effect from the drug you need to be taking the 1800mg in 3 divided doses daily (ie 600mg three times daily). Your small intestine contains a molecule (carrier molecule - usually an enzyme or protein) that transports Neurontin into the bloodstream. This system can be saturated, whereby taking more of the drug does not appreciably increase it's absorption. I cannot remember the actual mechanics of this active transport system, but maybe one of those pharmacy students out there (and I know you're out there) can enlighten us. Anyway, if you do increase the dose past 1800mg, you will need to divide the dose four times a day, for maximal absorption.
Hope this helps - Cam
Posted by mars on January 16, 2001, at 18:36:27
In reply to Re: Having a difficult time with Neurontin » mars, posted by Cam W. on January 16, 2001, at 6:40:10
thanks, Cam. my pdoc had already cautioned me not to take more than 600 mg at one time.
mars
Posted by allisonm on January 17, 2001, at 20:01:20
In reply to Re: Having a difficult time with Neurontin » mars, posted by Cam W. on January 16, 2001, at 6:40:10
> Mary - Just a note. The maximum amount of Neurontin that the body can absorb in any one dose is approximately 600mg.
Cam,
I believe what you say, but how come Neurontin comes in 800 mg tablets?Thanks.
Allison
Posted by Jeff on January 17, 2001, at 20:28:31
In reply to Having a difficult time with Neurontin, posted by mars on January 16, 2001, at 5:01:54
I take 3000 mg/day 2 600mg tabs morning and night and 1 in the afternoon. I used to take 3600, but was too foggy. It helps me with anxiety and a lot of somatic symptoms that I get from both anxiety and depression. It just helps though-no cure by any means. It may actually be pooping out a little and i might go back up. As far as the absorption goes, I am unclear also.
Hi -
>
> I'm currently taking 1800 mg of Neurontin, was ramped up very quickly (just added 300 mg this morning), and will probably be adding more. My pdoc is very adamant about me staying on it for at least a few months.
>
> I feel terrible today, much worse than yesterday: foggy, disoriented, almost like everything is a dream, and very sluggish (I'm even napping, which is unheard of). I feel like a blob, and it's very discouraging. I have been trying to read the archived posts here so I can try to learn about drug therapies I haven't tried yet, and today I haven't been able to do that at all - I can't think.
>
> Can anyone give me an idea of how long this might last? Or of any alternatives to the gabapentin? I think my pdoc is basically good but, of course, not perfect. I have tried Depakote, Topamax, Tegretol, Lamictal, did not respond to them well.
>
> Thanks for any feedback you can provide.
>
> best,
>
> mary
Posted by Cam W. on January 17, 2001, at 21:54:29
In reply to Re: Having a difficult time with Neurontin » Cam W., posted by allisonm on January 17, 2001, at 20:01:20
Allison - Is the 800mg formulation sustained release. This would mean that the Neurontin would absorb slower over a longer period of time, thus not allowing saturation of the active transport system (ie all of the 800mg is not absorbed at once, only a little at a time, allowing the transporter to "ferry" the Neurontin into the blood stream and then come back for more Neurontin in the intestine). Therefore saturation does not take place. I am not sure of this, but it would seem the most plausible explanation.
Either that, or the company does not know the pharmacokinetics of their own drug (which I doubt). A sustained released formulation would theoretically improve medication compliance because you would not have to take the medication as often (eg twice a day dosing, rather than three of four times daily).
Hope this helps - Cam
Posted by mars on January 18, 2001, at 0:43:58
In reply to Re: Having a difficult time with Neurontin, posted by Jeff on January 17, 2001, at 20:28:31
Thanks for the feedback, Jeff. I really appreciate it.
I cut back to 1500 mg today, am a little less frightened. Think I can deal with it now.
best,
mary
Posted by Neal on January 21, 2001, at 16:57:59
In reply to Re: Having a difficult time with Neurontin » mars, posted by Cam W. on January 16, 2001, at 6:40:10
Cam- Is there such a thing as Neurontin SR? And would body weight be a factor in the absorbtion limit you mention?
Posted by allisonm on January 21, 2001, at 17:22:45
In reply to Re: Neurontin 800mg » allisonm, posted by Cam W. on January 17, 2001, at 21:54:29
> Allison - Is the 800mg formulation sustained release. This would mean that the Neurontin would absorb slower over a longer period of time, thus not allowing saturation of the active transport system (ie all of the 800mg is not absorbed at once, only a little at a time, allowing the transporter to "ferry" the Neurontin into the blood stream and then come back for more Neurontin in the intestine). Therefore saturation does not take place. I am not sure of this, but it would seem the most plausible explanation.
>
> Either that, or the company does not know the pharmacokinetics of their own drug (which I doubt).
Cam,Thank you.
I don't see anywhere in the online drug information sites such as RxList that there is a sustained release version. The two sources that I found didn't list all of the available sizes, though, either. I have taken both 600mg and 800mg. Only one of the two listed the 800 and neither mentioned the 600.
On the capsules I have, there is nothing written on the pills or on the vials other than the name Neurontin. (No SR, or anything like that.) Hmmmm. I should look up the Parke Davis site.
Allison
Posted by allisonm on January 21, 2001, at 17:35:39
In reply to Re: Neurontin 800mg » allisonm, posted by Cam W. on January 17, 2001, at 21:54:29
Cam,
http://www.pfizer.com/hml/pi's/neurontinpi.pdf
I couldn't cut and paste the copy and my memory doesn't serve me so well, but this pdf file from the manufacturer says bioavailability from 400mg (I think) up to 600mg doesn't change much and is about 60%, but it doesn't mention 800. I assume it's the same.
Allison
Posted by Cam W. on January 21, 2001, at 18:19:42
In reply to Re: Having a difficult time with Neurontin » Cam W., posted by Neal on January 21, 2001, at 16:57:59
> Cam- Is there such a thing as Neurontin SR? And would body weight be a factor in the absorbtion limit you mention?
Neal - I haven't heard of a long-acting Neurontin, but it would be an advantage for Parke-Davis to make one . Check Allison's link to the PD website & see. MY CPS (similar to the U.S. PDR) doesn't have a sustained-release form, but if memory serves me, I think I received some information regarding Neurontin , but I haven't read that pile on my desk, yet. - Cam
Posted by Cam W. on January 21, 2001, at 18:25:30
In reply to Re: Neurontin 800mg » Cam W., posted by allisonm on January 21, 2001, at 17:35:39
Allison - Parke-Davis makes Neurontin here in the land of snow and poutine. I would help look up more info, but I have 5 lectures (3 are the same), before Feb.1, so, as usual, I am way behind and freaking out on the incredible pile of paper that I am sifting through. Times like this are like continuously hitting yourself with a hammer. It will feel so good when I can stop.
So, I will be of little use here fro the next week or so (Sorry) - Cam
> Cam,
>
> http://www.pfizer.com/hml/pi's/neurontinpi.pdf
>
> I couldn't cut and paste the copy and my memory doesn't serve me so well, but this pdf file from the manufacturer says bioavailability from 400mg (I think) up to 600mg doesn't change much and is about 60%, but it doesn't mention 800. I assume it's the same.
>
> Allison
Posted by allisonm on January 21, 2001, at 21:40:01
In reply to Re: Neurontin 800mg » allisonm, posted by Cam W. on January 21, 2001, at 18:25:30
Yikes!
I mean, Ouch!!
I mean, Good luck!!!Allison
Posted by quilter on January 29, 2001, at 1:09:02
In reply to Re: Having a difficult time with Neurontin » Neal, posted by Cam W. on January 21, 2001, at 18:19:42
Is there a reference for the 600mg thing? My pdoc and or neurologist have me taking 900mg three times/day for mood and neuralgia/migraine.
Quilter
Posted by Cam W. on January 29, 2001, at 6:56:56
In reply to Re: Having a difficult time with Neurontin » Cam W., posted by quilter on January 29, 2001, at 1:09:02
Quilter - I'm sure it's in the literature and perhaps in Dr.Bob's Tips. Dr.Larry Ereshefsky pointed it out at a meeting I was at. Neurontin has a saturable absorption. - Cam
IF THIS GOES THROUGH IT IS MY LAST POST
I HAVE BEEN BANNED FROM THIS SITE!
Posted by Cam W. on January 29, 2001, at 7:13:35
In reply to Re: Having a difficult time with Neurontin » Cam W., posted by quilter on January 29, 2001, at 1:09:02
Quilter - Any good pharmacology book should have the information on saturable absorption of Neurontin. If not check on Medline or Pub-Med for the pharmacokinetics of gabapentin. The transport system of gabapentin from the intestine becomes saturated and any more than 600mg at a time (give or take, depending upon your genetics) will just exit via your feces.
Sorry, I know I said I wasn't going to post anymore, but I hate leaving something only partially answered
Posted by Joy on January 29, 2001, at 16:03:06
In reply to Re: Having a difficult time with Neurontin » quilter, posted by Cam W. on January 29, 2001, at 6:56:56
Cam,
Why would you be banned from this site. You have been so helpful. What's going on?
Joy
> Quilter - I'm sure it's in the literature and perhaps in Dr.Bob's Tips. Dr.Larry Ereshefsky pointed it out at a meeting I was at. Neurontin has a saturable absorption. - Cam
>
> IF THIS GOES THROUGH IT IS MY LAST POST
>
> I HAVE BEEN BANNED FROM THIS SITE!
Posted by PatJ. on January 29, 2001, at 17:28:05
In reply to Why is Cam Banned? What's Going On? » Cam W., posted by Joy on January 29, 2001, at 16:03:06
I don't think he was banned. Go read the admin. section.
Posted by Ron Hill on January 29, 2001, at 17:32:18
In reply to Why is Cam Banned? What's Going On? » Cam W., posted by Joy on January 29, 2001, at 16:03:06
Joy,
I doubt that Cam is actually banned (at least I certainly hope not). Instead, I suspect the "ban" is self-imposed because he has a February 1st deadline (see below). Let's leave Cam alone for a while and I suspect he will return in a week or so. Perhaps Cam will time his return to coincide with the return of Art Bell (for those who listen to Coast-to-Coast on those nights when the meds, or the mania, or the depression, or the whatever is keeping you awake into the wee hours).
-- Ron
Posted by Cam W. on January 21, 2001, at 18:25:30
In reply to Re: Neurontin 800mg » Cam W., posted by allisonm on January 21, 2001, at 17:35:39
Allison - Parke-Davis makes Neurontin here in the land of snow and poutine. I would help look up more info, but I have 5 lectures (3 are the same), before Feb.1, so, as usual, I am way behind and freaking out on the incredible pile of paper that I am sifting through. Times like this are like continuously hitting yourself with a hammer. It will feel so good when I can stop.-------------------------------------------------
> Cam,
> Why would you be banned from this site. You have been so helpful. What's going on?
> Joy
>
>
> > Quilter - I'm sure it's in the literature and perhaps in Dr.Bob's Tips. Dr.Larry Ereshefsky pointed it out at a meeting I was at. Neurontin has a saturable absorption. - Cam
> >
> > IF THIS GOES THROUGH IT IS MY LAST POST
> >
> > I HAVE BEEN BANNED FROM THIS SITE!
Posted by Dr. Bob on January 29, 2001, at 23:51:44
In reply to No, I don't think he was banned » Joy, posted by PatJ. on January 29, 2001, at 17:28:05
> I don't think he was banned. Go read the admin. section.
Yes, please use Psycho-Babble Administration for any discussion of "banning". And stick to Neurontin here. Thanks,
Bob
Posted by quilter on January 30, 2001, at 1:44:24
In reply to Re: Discussion of banning should be at PB Admin, posted by Dr. Bob on January 29, 2001, at 23:51:44
Dear Cam, Thanks for the info. Could not think of the right words to look up. I'll miss you while you are gone. Take care of yourself.
Quilter
Posted by Cam W. on January 30, 2001, at 7:03:04
In reply to Re: Neurontin absorbtion, posted by quilter on January 30, 2001, at 1:44:24
Geez Quilter - Wouldn't your doctor accept, "because Cam said so". You're beginning to sound like some of the pdocs I work with. Try this link and scroll to "Oral Bioavailability"
http://www.rxlist.com/cgi/generic/gabapent_cp.htm
Hope this helps - Cam
> Dear Cam, Thanks for the info. Could not think of the right words to look up. I'll miss you while you are gone. Take care of yourself.
> Quilter
Posted by AnnaBanana on April 11, 2001, at 10:15:25
In reply to Having a difficult time with Neurontin, posted by mars on January 16, 2001, at 5:01:54
I took Neurontin for 3 weeks (for facial pain) and got up to 900mg per day. Then I got sick and was diagnosed with Colitis so I stopped for 3 weeks. I'm back on it at 1200mg per day for the last 2 weeks. I don't feel any better at all. In fact, I'm in a bad phase right now (which is not unusual - my pain fluctuates). My neurologist told me to stay on 1200mg for 4 weeks and then come see him. I'm just wondering if anyone has any experience in determining when it simply isn't going to work. I don't really want to keep upping the dosage if it's not going to make any difference. Personally, I think I should have felt some improvement by now. Any thoughts would be appreciated.
Posted by SalArmy4me on April 12, 2001, at 12:35:49
In reply to Re: Having a difficult time with Neurontin, posted by AnnaBanana on April 11, 2001, at 10:15:25
I say that a trial of Neurontin should be for at least a month, like anything else in this field.
> I took Neurontin for 3 weeks (for facial pain) and got up to 900mg per day. Then I got sick and was diagnosed with Colitis so I stopped for 3 weeks. I'm back on it at 1200mg per day for the last 2 weeks. I don't feel any better at all. In fact, I'm in a bad phase right now (which is not unusual - my pain fluctuates). My neurologist told me to stay on 1200mg for 4 weeks and then come see him. I'm just wondering if anyone has any experience in determining when it simply isn't going to work. I don't really want to keep upping the dosage if it's not going to make any difference. Personally, I think I should have felt some improvement by now. Any thoughts would be appreciated.
Posted by JohnL on April 13, 2001, at 17:51:17
In reply to Re: Having a difficult time with Neurontin, posted by AnnaBanana on April 11, 2001, at 10:15:25
> I took Neurontin for 3 weeks (for facial pain) and got up to 900mg per day. Then I got sick and was diagnosed with Colitis so I stopped for 3 weeks. I'm back on it at 1200mg per day for the last 2 weeks. I don't feel any better at all. In fact, I'm in a bad phase right now (which is not unusual - my pain fluctuates). My neurologist told me to stay on 1200mg for 4 weeks and then come see him. I'm just wondering if anyone has any experience in determining when it simply isn't going to work. I don't really want to keep upping the dosage if it's not going to make any difference. Personally, I think I should have felt some improvement by now. Any thoughts would be appreciated.
I can certainly empathize with you. Been there too many times. But anyway, I tend to agree with you that there should have been some improvement by now, IF Neurontin was a superior match for you.
Conventional practice says to stay with it and give it time. Over the years though I have come to view it a little bit differently. From what I have seen, everybody has a drug that is a superior match for them, chemically and molecularly. There are also inferior matches. Very often an early response within a few days to two weeks indicates a superior match. The majority, but not all, of those patients go on to do the best given more time. On the other hand, a slow or absent response indicates an inferior match. Sure it could go on to work if given more time and suffering, but in the majority of these patients it won't.
Anyway, I feel as you do that perhaps there should have been some kind of hint of some improvement by now. But the doc is likely to let you suffer longer and wait more instead of refocusing on finding a superior med.
John
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