USADosing Up on Lyrica & Neurontin
Reaping the greatest reduction in symptoms with a minimal amount of side effects is the goal for any medication. Prior reports on Lyrica implied that the
beneficial target dose was between 450 mg and 600 mg per day. Yet, at the International MYOPAIN meeting, investigators stated that the 600 mg daily dose was no
better than the lower 450 mg dose, and there were more side effects with the higher dosage. In fact, you may achieve significant pain relief at total daily
doses of 300 mg or less because the side effects of Lyrica are dose-related.
How should you dose up on Lyrica or its less expensive cousin, Neurontin? For either drug, neurologist Benjamin Natelson, M.D., recommends that you begin with a small nightly dose because of the sedating side effects, and that you stay at that level for four nights before increasing the dose. Lyrica has been documented to enhance deep level sleep and both meds reduce nighttime pain, which may also assist with your sleep. However, patients must take more Neurontin (approximately 1,800 to 3,000 mg daily) because less of it enters the central nervous system where it is needed to relieve pain and aid sleep.
If your insurance company pays for Lyrica, you may start out on a bedtime dose of 50 or 100 mg. After you are at 100 mg for four nights, you may try a small morning dose of Lyrica, preferably on a day you do not have to drive to work in case it is too sedating at first. Lyrica lasts longer in the system so it only needs to be taken twice a day, while Neurontin must be taken four times a day. Regardless of which medication you try, you may discover that it is easier to take a larger portion at bedtime to minimize daytime sedation.
Allow 12-20 days to reach your target dose of Lyrica, while Natelson says that dosing up on Neurontin could take 28 days. Once his patients reach 300 mg of Neurontin at bedtime, he adds 100 mg in the morning. Four days later he adds another 100 mg, then another 100 mg of Neurontin until the person is taking it at four daily intervals. Then 100 mg is added every four days to one of the four daily doses until the patient is taking 300 mg four times per day (1,200 mg per day). Then he increases the bedtime dose to 600 mg, and if needed, he has his patients slowly add to their daytime doses until significant pain relief is achieved.
Natelson understands that patients want to feel better, but cautions them not to rush dosing up on these medications. Rapid dosing can lead to intolerable side effects and cause you to discontinue a medication that might have worked.
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This is another article from my e-alert email I got this week from the Fibromyalgia Network .
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