Paradoxical Reaction to Gabapentin

[Rebel Maven]

Sorry I don’t have time for a proper introduction. I will as soon I can get more “straightened out”. Short story is I was misdiagnosed and now am addicted to several drugs that are contraindicating each other, one I am having a huge paradoxical reaction to, and two I am having rebound effects from. Planning to taper off them all, one at a time, over who knows how long.

I’ve been on 900mg of gabapentin once a day for a few years. I only took it at night and took it along with along with 2mg of alprazolam for sleep which I’ve been on for many years. Recently I increased the dose of gabapentin to 1,200mg per day and split it up to twice daily because I was "sundowning" and getting in to a horrible funk in the late afternoons and early evenings. I was taking 600mg of gabapentin in the morning by itself and 600mg of gabapentin in the evening with all of my other meds including 2mg of alprazolam and had to add 100mg of trazodone for sleep. Alprazolam and trazodone of course, are both hypnotic.

Once I started taking gabapentin in the day without the sedative effects of the alprazolam and the trazodone I get at night I discovered that gabapentin makes me incredibly wired. I mean like, “manic-and-I-want-off-this-drug-right-this-instant” wired.

How stupid is this? I can’t sleep because I’m taking a drug that makes me manic so now I have to take two hypnotics at night to counteract the mania from the gabapentin. Then I suffer from the hypnotic effects of the alprazolam and trazodone in the morning until the gabapentin kicks in and gets me all wired up again around mid afternoon and then I suffer from the symptoms of the gabapentin.

Not to mention the physical side effects of being on gabapentin while you are actually awake are horrible. I’m on fire everywhere, especially my mouth, upper back, and neck are burning and I feel like I am being electrocuted. The tremors are horrible and my brain feels fried.

So I cut to 300mg of gabapentin every eight hours to try to “level off”. It's time to take my 2:00PM dose of gabapentin and I'm afraid to take it because I don't want to be more manic and I'm afraid to not take it for fear of withdrawals. It's day 4 and it's not working.

I would appreciate hearing from others regarding their experiences and how to cut and taper off of the gabapentin or any other comments.

Thanks.

 

[laCster]

some people just experience allergic reactions certain drugs. i myself love gabapentin, and lyrica even more. however, tolerance comes quick, i mean quicker than any drug i've ever done.

 

[Swimmingdancer]

Are you getting the gabapentin legitimately prescribed? If so, the best thing to do would be to talk to your doctor about the effects you are getting and have him/her help you come up with a plan to gradually taper your dose. They may adjust the dosages of the other drugs you are taking as well.

Gapapentin is known to cause such side effects in some people as mood swings, hostility, concentration problems, hyperactivity, depression and suicidal thoughts, so although your reaction may not be common, it's certainly not unheard of. These type of side effects are believed to be more prevalent in young people, I'm not sure how old you are...

Gabapentin withdrawals include symptoms such as insomnia, restlessness, agitation, anxiety, disorientation, confusion, light sensitivity, diaphoresis, headaches, palpitations, hypertension, chest pain, and flu-like symptoms. So you want to be very careful with reducing your dose and do it gradually. Just to check, are you certain that what you are experiencing is side effects of the gabapentin as opposed to withdrawals?

What do you mean by "it's Day 4 and it's not working?"

Splitting your dose to take it multiple times a day is actually believed to increase the effects of gabapentin. People on here who use gabapentin recreationally take it in multiple doses throughout the day in an attempt to make it stronger by maximizing its saturation along its main transporter. From another thread:

Gabapentin is weird in that the bioavailability goes down almost linearly with increasing dose - so whether you're taking 150mg (about when it starts to decline) or 600mg, nearly the same amount of the drug is absorbed.

So if you are attempting to taper your dose on your own, taking 300mg 3x a day - instead of 1200mg 1x a day or 600mg 2x a day - is actually likely to give you stronger effects from the gabapentin, not weaker. You really should discuss this with your doctor, but if you are set on tapering it yourself I can give you some tips if you like.

 

[Rebel Maven]

It was my doctor who increased my dose to 1,200mg and had me split it to 600mg every 12 hours. I only did this for two weeks and I was so manic I could not stand it. Then he suggested I taper to 300mg every 8 hours to try to "level off" and be more stable. I am on day four of that and I'm still manic and on fire. He wants me to taper every 4-5 days but had no opinion on the amount of the cut.

When I took the gabapentin at night with alprazolam and trazodone I did not have all these horrible side effects. But I would "sun down" every day between 4:00PM-8:00PM which could be rebound anxiety or withdrawl from the 2mg of alprazolam I take every night and not the gabapentin(?).

I'm having all the symptoms of both side effects and some of the symptoms of withdrawal. I feel like I'm going to incinerate. I'm not young. I understand the bioavailability thing with increased dosing.

I've heard of staggering but more like every 45 minutes. So am I potentiating it by doing it every eight hours? He split the dose to stabilize me because he thought the gabapentin was wearing off too soon because of it's short half life and causing me to crash in the late afternoon/early evening. Maybe it was the alprazolam rebound or withdrawl and not the gabapentin? Do I need to split the alprazolam dose to twice daily to avoid rebound or withdrawl? I've been on alprazolam for many years.

I've been on gabapentin for a few years and I want off. I think his suggestion to taper every 4-5 days may be too fast. I have no idea how much to taper. Should I go to 900mg twice a day first before I start to cut? How much should I cut and how long should I hold?

If you could give me any advice I would be so grateful. My doctor really doesn't know what to do but experiment at this point or switch to Depakote and I am concerned the results may be disasterous.

Thank you so much.

 

[Rebel Maven]

I got so wired today from the gabapentin and the physical pain was unbearable so I took 0.5mg of alprazolam and I felt better in about an hour.

So much for using gabapentin to get off benzos in the future.

I was previously taking 900mg of gabapentin only once a day at night and taking 2mg of alprazolam and 150mg of trazodone with it for sleep so I never knew what it did to me (making me manic). So what was the gabapentin doing for me anyway in the first place if it has such a short half life?

More importantly how do I cut and taper off gabapentin now, especially with out having to increase my alprazolam?

 

[Swimmingdancer]

Ah, I see, sometimes doctors aren't sure what to do either. I'm sorry about what you're going through, it sounds awful and frustrating.

Alprazolam is a short-acting benzo; the effects usually last from 2 to 6 hours with lingering after-effects of several more hours, so it could be causing withdrawal symptoms/rebound anxiety if you only take it once a day.

Are you using the trazodone as a sleep aid or an anti-depressant or both?

Taking your gabapentin in 300mg 3x a day should give you more effects from the gabapentin than your previous doses of 600mg 2x a day or 900mg 1x a day. Probably not stronger per se, since you're spacing them out by 8 hrs, but it will not be like you are taking less, it will be like taking the same dose more frequently. You can only absorb a certain amount of gabapentin at once before you reach saturation levels, so say if that amount is somewhere around 150mg, then taking 300mg 3x a day would give you a total of 450mg/day, while taking 600mg 2x would give you 300mg/day, and 900mg 1x would give you 150mg/day. Of course the exact amounts would vary from person to person, but hopefully this illustrates what I'm trying to explain.

Gabapentin should last for around 8hrs or so, so taking it every 8hrs will help to keep the levels more stable, but you may not need to take as much, especially since you are trying to reduce the side effects.

I would suggest you talk to your doctor about lowering the gabapentin dose and maybe taking the alprazolam more often or switching to a longer-acting benzo. If it is you intention to lower your benzo intake or get off benzos altogether, I think I would try to taper the gabapentin before you start tapering the benzo.

 

[Rebel Maven]

Trazodone at low doses is a depressant. It works against serotonin. Only at higher doses does it become an antidepressant (SNRI). I'm taking it for sleep. It was added to the alprazolam at night because I was going through serotonin withdrawal and could not sleep.

I understand what you are saying about the effects. I am going off the gabapentin first, then the trazodone, then the benzos, etc.

What would be your recommendation for How many milligrams I should I cut by, how many times a day should I take it, and how long should I hold between? Do I need to go back to 900mg at night and cut from there by how much or cut to 300mg twice a day or, or, or....?

Thank you so much.

 

[Swimmingdancer]

Hmm.. I asked because I read that the trazodone dosage for depression is 150mg and the dosage for sleep is 25-50mg. What do you mean by "serotonin withdrawal"?

Again, discuss this with your doctor, but I would say for the gabapentin maybe stay on the dosing regimen you are currently on - 3x a day - and gradually lower the doses. A good rule of thumb is to make dose reductions by about 10%. Depending on how quickly you want to taper and how you feel you could drop about 10% about every 10 days. But you can probably get away with larger cuts in the beginning, since you're on such a high dose and your body is not likely to be absorbing it all. If you are currently taking 300mg every 8 hrs, you may be able to jump down to 200mg every 8 hrs without much withdrawal symptoms. But of course it varies from person to person. If you taper too fast and find you are getting strong withdrawal symptoms you can always raise the dose back up a little bit and stabilize for a time, as that should relieve the withdrawal symptoms quickly. Talk to your doctor about the benzo situation, because you really don't need to be going through benzo withdrawals while you're trying to taper the gabapentin. Just be careful not to increase your benzo intake too much, since you don't need a higher dependence to benzos either. I know some doctors will taper people off gabapentin over a period of just 10 days but I really do not advise that or think it is gradual enough.

Also what are you taking the gabapentin for? If you are prone to seizures then you need to be extra-careful with your taper.

How are you feeling now by the way?

 

[Rebel Maven]

http://en.wikipedia.org/wiki/SSRI_discontinuation_syndrome

I was on massive doses of serotinin for many years and went CT. The withdrawals were horrendous. Very similar to benzo withdrawals and lasted for months.

I'm borderline inbetween the trazodone dose for depression and insomnia. I was on 50mg of trazodone for sleep but had to increase it to 100mg during the serotonin withdrawls.

I'm taking the gabapentin for a wrong diagnosis that lead to multiple drugs being prescribed that I was on for many years and trying to counteract their effects. Gabapentin was supposed to "fix" that but it has made it worse. Long story.

After the 0.5 mg of alprazolam at 5:30PM I was still too manic so I took another 0.5mg at 8:30PM. It did not settle me down as much as I had hoped. Now I have taken my evening dose of alprazolam but ut it to 1mg as I already had 1mg in the last few hours and took the trazodone. I'm stoned out of my mind now.

When people say 10% do they mean 10% of the original dose you were on or 10% of the current taper? I think I know the answer to that one but I want to be sure.

Also, I'll have to mix the gabapentin with something to cut as I only have 300mg capsules. I'm thinking milk with vanilla protien powder to keep it in supension and make it palatable.

This is exhausting.

Thank you so much for your input.

 

[Swimmingdancer]

Oh you mean SSRI withdrawal. You were not taking serotonin, you were taking an SSRI, correct? I cold turkey-ed from an SSRI before too. Very weird, crazy and scary withdrawal symptoms.

10% means 10% of whatever dose you are currently on, not 10% of the original dose. So, as an example, if you were taking, say, 300mg, you would lower it to 270mg, then stabilize for 10 days, then lower it from 270mg to 243mg, then lower to 219mg and so on. Of course in reality you would just round it to the closest round number that you were able to measure fairly accurately. And as I said, at higher doses you can probably cut by more than 10% at once. Everyone is different but if it were me I would probably start by lowering it by increments of 50mg (if you can do that), then I would do the 10% thing once I got below around 150mg every 8 hrs. But see what your doctor thinks, see how you feel and play it by ear. You can also take longer amounts of time in between each drop if you feel you need to.

If you can't get smaller gabapentin pills/capsules or won't be able to get them for a while, then you can make a solution. Gabapentin is water-soluble. The inactive ingredients in the powder might not dissolve easily, but once you get the powder to disperse in water, the drug itself should dissolve into the water completely. So stir it well and let it sit in the water for a while. I have no idea whether or not it's milk-soluble though. Maybe dissolve in water, measure, and then mix the dose you are going to take in with the milk?

You will probably have to work out what works for you by trial and error unfortunately. You can't really tell by your immediate reaction how a dose cut is going to affect you, it can take over a week to feel the full brunt of the withdrawal symptoms. So be careful not to make too many big drops too close together as they can add up and feel like they're hitting you almost all at once. You might even want to wait 2 or 3 weeks after your first cut if you are going to drop by a lot, just to make sure you're ok before the next cut.

Sorry if my posts are excessively long, I just know I'd want lots of details if I were in your situation

EDIT: You might also want to consider split-dosing for the trazodone as well (like take it 2x a day, unless that makes you too sleepy in the daytime?), something you might ask your doctor about.

 

[Rebel Maven]

I appreciate that your posts are so detailed and thorough. You are very understanding and an excellent teacher. Our communications styles are very similar although mine are somewhat erratic under my present condition.

Technically, it was not SSRI’s that I was withdrawing from. I was taking prescribed medications for migraines way above the legal limit as advised by my neurologist that affect serotonin levels and other neurotransmitters (sumatriptans, drugs that affect norephinephrine and dopamine, etc.), and OTC supplements that were increasing my free serotonin for weight loss and mood enhancement (chromium, 5HTP), in addition to an SSRI which were all stopped abruptly. Withdrawal lasted for months. The first one was sheer hell, the second hell and by the third month a low dose SSRI was reintroduced. This too is on the list to be cut after the gabapentin and the trazodone.

We are in agreement about the way the 10% cut works. I couldn’t believe how fast the other way I asked about was but conversely I couldn’t believe how long the correct way was.

I understand the water solubility. I’m going to dissolve it in water in a concentration and add a specific amount to the protein shake before I blend it. If it tastes anything like alprazolam it’s going to take a lot of flavor to get it down. I have GERD from all these drugs so I don’t want it to hit on an empty stomach. I also have a very sensitive perception to taste and a highly overactive gag reflex so I think this may be the way to go.

I am going to do a spreadsheet to calculate the taper based on the ratio of dose to bioavailability. So for example, knowing that gabapentin when taken three times daily has a bioavailability of:

900mg/60%
1,200mg/47%
2,400mg/34%
3,600mg/33%
4,800mg/27%

one could calculate the amount of cut based on this information and not just cut literally by 10% but on the ratio of dose to bioavailability. This would make larger cuts available earlier in the protocol possible and smaller and more precise tapering would have to be done as the dose is lowered.

My question would be should I stay on it three times a day though, which would render the above information useless but lower the bioavailability by some number as the increased frequency of the dose appears to have a potentiating effect as you mentioned. I’m already trying to lower the bioavailability be not taking it with food which should lower it by 14% according to what I’ve read.

A big concern for me is the hold time because I am concerned about the accumulating effects of the cuts and the potential to crash. A agree that it should be a few weeks, not 4-5 days per cut as my doctor said.

Regarding the trazodone, it was only given to me for sleep during my months of withdrawal from the serotonin crash. When I take it I literally “turn off” in about an hour. When I wake up in the morning I have a hangover from it that lasts until the early afternoon. I’ve only been on it for a few months and I’ll be tapering off trazodone by cutting it at night by some other protocol which I’ll figure out when the gabapentin thing is over and I’m more stable.

Prior to that I’ve been on alprazolam for occasional panic attacks and insomnia caused by the other drugs I was on. I’ve been on it for about 15 years starting with as needed (0.25mg a few times a month for panic) and then going up to 0.5mg-1mg per night for sleep to replace Ambien because it was cheaper, with the occasional 0.25mg-.5mg for panic or a 2-3mg once or twice a year if I had to get on an airplane or go to a dentist. I got good, consistent results for sleep on 1mg per night even when I was manic on serotonin until the serotonin crash a few months ago where the dose was increased to 2mg per night for sleep and it did nothing so the 100mg of trazodone was added.

The interesting thing about alprazolam is I never developed much tolerance for it. When I was taking 1mg per night for sleep in the past and increased it to 2mg on occasion (for example if I took it to go to bed and then was forced to stay up longer than the dose was effective I’d take another) I would sleep too hard and have a severe hangover the next day, all day. So I am hopeful that when I finally get to the alprazolam taper it won’t be so long and hard. I’m saving it for second to the last of the 5 drugs I’m going off, the last one being the omeprazole.

Thank you again for your input and I look forward to your comments about the above.

Edit: Theoretically, one could be increasing the bioavailability by lowering the dose. That would make tapering have a paradoxical effect as the bioavailability would be getting higher as you were cutting the dose down. Well, that certainly changes things.

 

[vashier]

Good luck RM, talk to your Dr about switching you to lyrica. I find it a much better drug all around plus it is not metabolized in either the liver or kidneys and there are less tremors. You can also get a really funky drunk from it without the mental impairment. It's hard to expalin the feeling aside from that of being very drunk coordination wise but your fully able to speak and think.

I have a very weird reaction to Diphenhydramine of all things. I will either sleep for 24 hours straight, which isn't that odd, but usually I will be jumping out of my skin manic for the same length of time. Try getting a nurse/dr to believe that one hehehe. So I feel your pain over the paradoxical reaction you're going through.

 

[laCster]

great post from swimmer^^

definitely stack your doses. on my gabapentin days, i pop 300mgs every 30-60 mins and by 5pm am soo fuckked

 

[Swimmingdancer]

My question would be should I stay on it three times a day though, which would render the above information useless but lower the bioavailability by some number as the increased frequency of the dose appears to have a potentiating effect as you mentioned. I’m already trying to lower the bioavailability be not taking it with food which should lower it by 14% according to what I’ve read.

I would stay on 3x a day. It doesn't render the info useless unless you can't find out the BA for smaller amounts. You would base your figures and reductions off the dose you are taking at one time instead of the total daily dose. Are those BAs you posted for taking those amounts all at one time? You said "knowing that gabapentin when taken three times daily has a bioavailability of..." so I'm a little confused. I'm also confused about what you meant about staying on it 3x a day lowering the BA. Taking 900mg has a lower BA then taking 300mg 3 times. Did you mean that taking it once daily would render the BA info useless and lower the BA?

EDIT: I found the info where you got the figures, which says "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." So that means that 300mg taken at once has a BA of 60%. But I haven't been able to find out whether or not the BA continues to increase for smaller amounts but I'll keep looking for you.

I also found this:

The bioavailability of a 300mg dose is around 60%, whereas that of a 600mg dose is around 40%

The benefit of taking it 3x a day instead of 1x a day is that the trough levels will be much higher and the peaks will decrease less with the dose decrease, so you won't feel as much from the dose cuts. Here are some diagrams to illustrate (I just tagged them NSFW to keep the post shorter):
Once a day dosing:

NSFW:

3x a day dosing:

NSFW:

A big concern for me is the hold time because I am concerned about the accumulating effects of the cuts and the potential to crash. A agree that it should be a few weeks, not 4-5 days per cut as my doctor said.

Yeah 4-5 days is not enough. I would go with 10 days as a minimum. After 10 days you should be experiencing the full effects of the withdrawal, so if you're feeling fine after 10 days it should be safe to cut the dose again. If you're not ok, then wait longer until you feel a bit better before your next dose cut. Unfortunately this will take a very long time, but it's the best way I know of to avoid or minimize any withdrawal symptoms.

The interesting thing about alprazolam is I never developed much tolerance for it. When I was taking 1mg per night for sleep in the past and increased it to 2mg on occasion (for example if I took it to go to bed and then was forced to stay up longer than the dose was effective I’d take another) I would sleep too hard and have a severe hangover the next day, all day. So I am hopeful that when I finally get to the alprazolam taper it won’t be so long and hard. I’m saving it for second to the last of the 5 drugs I’m going off, the last one being the omeprazole.

The fact that it's short-acting and you've only been taking it once a day might have helped keep you from developing much of a tolerance. It might also make it easier to taper as your brain/body has not been saturated 24/7 with it and therefore won't have as strong a dependence.

Theoretically, one could be increasing the bioavailability by lowering the dose. That would make tapering have a paradoxical effect as the bioavailability would be getting higher as you were cutting the dose down. Well, that certainly changes things.

Yes, you could increase the bioavailabilty by lowering the dose, but it wouldn't actually be like making the dose higher, just keeping it the same. Like if, say, 325mg had a BA of 56% and 300mg had a BA of 60%, they would be equal.

 

[Rebel Maven]

Swimmingdancer:

The benefit of taking it 3x a day instead of 1x a day is that the trough levels will be much higher and the peaks will decrease less with the dose decrease, so you won't feel as much from the dose cuts. Here are some diagrams to illustrate (I just tagged them NSFW to keep the post shorter):
Once a day dosing:
NSFW:

The chart for this one did not show up.

I can't tell you how much I appreciate all of your input. I really would like to know the BA for doses below 900mg. I searched the internet this morning trying to find where you got that chart but I'm hoping you won't mind sharing that link or the chart with me as I want to start tapering today because of a bad reaction again yesterday. The switch from twice a day to three times a day is on day six and the cumulative effect must be kicking in because I am getting worse.

Yes, you could increase the bioavailabilty by lowering the dose, but it wouldn't actually be like making the dose higher, just keeping it the same. Like if, say, 325mg had a BA of 56% and 300mg had a BA of 60%, they would be equal.

This is exactly my concern. Holding for 10-14 days and then cutting but getting nowhere.

Yes, I think I'm going to be very lucky when it gets to the benzo taper, although I have been on it for many years. I'm saving it for second to last because of that and because I need a rescue drug if something goes wrong with any of the other tapers, particularly the gabapentin.

Thank you so much.

 

[Swimmingdancer]

The chart for this one did not show up.

Weird, I can see it. It's from http://ars.sciencedirect.com/content/image/1-s2.0-S0149291812000033-gr3.jpg
I just posted those to illustrate the difference in blood levels from 1x day dosing compared to 3x a day dosing. I don't know if it will be helpful other than that.

I really would like to know the BA for doses below 900mg.

Me too. I can't seem to find them anywhere I'll keep looking for you. It would be nice to know the point where it stops going up, anecdotal reports have placed that point somewhere around 150mg. So what I would do, if we can't find any more details, is make bigger dose cuts between now and 150mg, then start doing the 10% thing, or maybe 15%, after that point.

The switch from twice a day to three times a day is on day six and the cumulative effect must be kicking in because I am getting worse.

Well what I would do is lower it right now. Since you were taking 600mg 2x a day before and have only been taking 300mg 3x a day for 5 days, you should be able to reduce it without problems. 600mg has a BA of 40%, so 2x that would be roughly equal to 480mg if you were getting a BA of 100%. 300mg has a BA of 60%, so 3x that would roughly equal to 540mg at 100%. So to lower it by what would equal 60mg should be fine. Assuming a BA of 60%, that would be a 100mg cut, so you would lower each dose to 266mg (or thereabouts). Personally I would even lower it more than that, that is just in order to make your total daily levels close to what they was before you switched to 3x daily dosing. And even with a cut like that presumably the BA would rise slightly, so if it were me I would try taking 250mg 3x a day.

 

[Rebel Maven]

BA at 100-150mg goes up to 70%. I'm still looking for what the BA is once you get below 100mg. I need to know if the BA keeps raising or if it drops at some point. Maybe it just has no efficacy at lower doses but they give it to children and dose it by weight so there has to be some data somewhere that shows what the bioavailability of a 25mg or 50mg dose is. I can't find much online if anything about the BA below 100mg either.

I dropped yesterday to 300mg BID so that gives me a BA of ~360. I just cannot be this high. Also, I am going to have to go BID as doing the TID I am not getting enough sleep. My doctor told me he wants me to try the gabapentin only for one more month and then he wants to switch me to Depakote. Not a chance in hell. So this is going to be a fast taper. It is what it is. If I can make it through three months of acute Serotonin Discontinuation Syndrome I can make it through this.

Additionally, I do not need to be on this trazodone for sleep since the SDS withdrawals are long over (6 months-3 in hell-three getting better but, put back on SSRI) and the drug has a half life of 11 hours (total clearance 40 hours). (See correction below in "Edit".) I'm just getting up in the morning when the trazodone is barely half way to its half life.

Thus I am hung over from it and that and the gabapentin making me manic is what is causing me to feel "wired and tired" all day. Basically, these drugs in combination are causing a "mixed episode" to put it in psychiatric terms. My chart is full of huge Vs up and down within minutes of each other. So much for this drug being a mood stabilizer. For me it is a "mood swinger".

I'm willing to bet that if I were not on trazodone the gabapentin would make me even more manic. So if I lower the trazodone and lower the gabapentin simultaneously (I know, I know, too many variables) I might stop feeling like I'm stoned and on speed at the same time and get some cognitive function back.

I need to figure a trazodone taper that could run parallel to the gabapentin so I'm off them at the same time. What's the worst that could happen? I don't sleep? Then I'll reup the trazodone. But with 2mg of alprazolam still for sleep I'm betting I'll still sleep like a rock. Can't wait to get off the alprazolam either.

Gabapentin taper is looking like 33% then down to 25% then to 10% with 5 day holds and when it gets around the part where the BA starts going up and if I still don't have the answer to the BA below 100mg then I'll just try SID during the day only or CT for the rest. The PM gabapentin is just being negated by the trazodone and the alprazolam other than the steady rate from the 72 hour clearance it is leaving behind.

I'm up for thoughts on the trazodone taper. I'm on 100mg SID. I want the two tapers to run parallel if at all possible. I need to get on with this before my adrenal glands give up on me forever or my doctor stops "cooperating" and tries to force me on another drug.

Two things I'm VERY thankful for is that I have you helping me and being able to bounce my ideas off, and, I'm thankful for MS-Excel because I've got spreadsheets on all this everywhere and I'd be lost without both of you.

OK, time to go make another spreadsheet and start the trazodone taper.

Thank you again, and again, and again.....

Edit: Correction to trazodone half life: "The mean blood elimination half-life is biphasic: the first phase's half-life is 3–6 hours, and the following phase's half-life is 5–9 hours."

By the way...."as a consequence of the production of mCPP as a metabolite, patients administered Trazodone may test positive on EMIT II urine tests for the presence of MDMA." Lovely.

 

[Swimmingdancer]

Your plan sounds good to me. It is my guess from anecdotes that after you get down to around 100mg-150mg of gabapentin the BA no longer goes up with lower doses. I found this:

Bioavailability for the ER tablets is approximately 75% (with food) and 42% to 65% (fasting)

So that makes me think that the maximum BA is around 75%. Taking a very low dose should be about the same as taking an ER tablet.

I think the taper you outlined should be good. Although if it were me I think I would just stick to TID dosing to keep my levels more stable - in my experience with tapering drugs more frequent dosing makes the cuts much easier to handle. But that's just me.

A faster taper should be ok especially at the beginning, and if you find it's too fast at some point you can always take longer holds or raise your dose back up a bit temporarily. You might find you want to make the holds longer when you get down lower. Just see how you feel. I know it can be very hard to find a balance between not going down so quickly that you get a lot of withdrawal symptoms and not going so slowly that it takes years to get off.

As for the trazodone, I think you're right that you could probably taper it concurrently, especially if you save the alprazolam for last. Some people get no symptoms at all when they stop trazodone, but some do get serious symptoms like seizures, panic attacks, and rage if they stop abruptly. It seems to really vary from person to person. But if you taper it, the most common symptoms with a fast taper are insomnia, sweating, "brain zaps", and some mental effects like a bit of anxiety, irritability or depression. A good schedule might be something like reducing it by 33% every week or 2. I don't know if I'd try to completely stop the gabapentin and the trazodone at the exact same time though.

I'm glad to be of help You remind me of myself, lol. I know it can sometimes be hard to get sufficient help from a doctor as many of them just want you to stay on the drugs and aren't always that knowledgeable about tapering or withdrawal symptoms, or they just take a one-size fits-all approach and don't really have enough time to spend with you. Many doctors are told to spend just 7 days tapering off gabapentin.

 

[Rebel Maven]

I think the taper you outlined should be good. Although if it were me I think I would just stick to TID dosing to keep my levels more stable - in my experience with tapering drugs more frequent dosing makes the cuts much easier to handle. But that's just me.

I agree but I am having a hard time going every eight hours. If I take 300mg at 6:00AM-2:00PM-10:00PM, then as the day goes on I get more manic and more manic until I take the alprazolam and trazodone and just go to bed. I don't get to sleep until 11:00PM or 12:00AM and then I have to get up again at 6:00AM by alarm clock, in a trazodone fog and take the gabapentin and wait for it to kick in which is hours. If I could take it at 9:00AM and then at 10:00PM then I could get longer sleep and not have to wake up to an alarm clock but just wake up naturally.

I am starting to go in to withdrawal from the gabapentin this morning as it is day three of my first reduction in dose. I feel the same as when I am too manic on it. Mentally I am wired, emotionally I am anxious, psychologically I am stressed and scared, physically I feel like my back and neck are on fire, my legs are tingling, my hands are shaking, my muscles are twitching, I have no appetite, and I'm nauseated. Cognitively my mind is in a fog. This may force me in to TID dosing.

I'm going to try to ride out the first big cut in dose and then I'm wondering when I get to the next cut as I will have to be mixing it myself instead of capsules if I could take it TID but not exactly every eight hours. More like 9:00AM-3:00PM-10:00PM. It's that second dose during the day that is kicking my ass. Way too manic. But now the withdrawals are kicking my ass and I may crash this afternoon. My plan is to ride it out with a small dose of alprazolam. The only catch about still going TID is the potentiation of the dosing of TID vs BID would have to be figured in to the cut.

....but some do get serious symptoms like seizures, panic attacks, and rage if they stop abruptly. It seems to really vary from person to person. But if you taper it, the most common symptoms with a fast taper are insomnia, sweating, "brain zaps", and some mental effects like a bit of anxiety, irritability or depression.

Those were some of the acute symptoms I had when I was experiencing SDS (Serotonin Discontinuation Syndrome) for three months. But I was on massive doses of serotonin enhancing substances and had has stopped abruptly. I had no idea the substances I was on were serotonin enhancing so it was quite a shock. It amazes me I never had SS (Serotonin Syndrome).

I'm not jumpring on the trazodone withdrawal band wagon as fast as I thought I was going to based on the gabapentin withdrwals kicking in today. I've got to keep it one variable at a time and if I'm stoned from the trazodone in the morning I'll just have a little caffine to off set it first thing in the AM before the gabapentin kicks in.

I'm glad to be of help You remind me of myself, lol.

That's funny because yesterday I was thinking how much you reminded me of myself, lol.

What do you think about trying play with the TID? Sometimes I think I should just CT everything and have someone lock me in my barn for a few months and slip food under the door. Nothing could be worse than the three months of SDS, right?

Someday I'm going to tell my story, in fact I want to write a book about how the doctors misdiagnosed me, profiled me, overdosed me, and turned me in to what they were supposed to be treating me for and in to an addict and then abandoned me. I'd like to write about the whole experience over my entire life since I was five years old and through my recovery a few years from now bringing all the physical, psychological, emotional, financial, and other experiences to light. There are so many people going through this who think they are totally alone and it's their fault. I know. I was one of them.

As you can't have signatures on here I'm going to post my signature from other forums so you can get a better picture of my present history. My past history of how I got misdiagnosed is an interesting story but that will have to wait for the book or I can do a brief synopsis of it and post it for anyone who is interested. I'm more focused on moving forward than how I got here right now so I've left all that out.

Out of all the forums I'm on you are the only one who has been maintaining a regular dialogue with me, showed such great interest, and invested time in researching and helping me and for that I am ETERNALLY GREATFUL.

Here is my signature:

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"I will not be medicated to make the unacceptable acceptable to me."

Neurontin/gabapentin:
2010: 900mg SID for mood stabilization
06/04/2012: 1200mg-600mg BID
06/27/2012: 900mg-600mg AM, 300mg PM
07/02/2012: 900mg-300mg TID
07/07/2012 to present: 600mg-300mg BID

Xanax/alprazolam:
Mid 1990's: 0.25mg for sleep
02/28/2002: 1.0mg PRN for panic/sleep
03/05/2012 to present: 2mg SID for sleep, 0.5mg-1.0mg for anxiety PRN

Desyrel/trazodone:
02/28/2012: 50mg SID for sleep
03/05/2012 to present: 100mg for sleep

Prozac/fluoxetine:
02/06/2012: 20mg SID
03/05/2012 to present: 40mg SID

Prilosec(Nexium)/omeprazole magnesium:
Mid 1990's to present: 20mg SID

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Guess I win for longest post in history. Certainly in my history, anyway, lol. Sorry. 8)

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Edit: UPDATE~2:30PM: Withdrawals are getting worse. Official word from the doctor regarding gabapentin taper is to cut by 50% and hold for 7-10 days. TID dosing is preferred. God help me.

Edit: UPDATE~4:16PM: Starting to have seizure like symptoms. I feel pressure behind my eyes, have a wavy visual disturbance, and feel intensely nauseated. Doctor said get some gabapentin in me now. Going to the kitchen to mix up a batch. Took 1mg alprazolam. Then I’ll have to refigure my taper as he said I’ve got to do it TID.

Edit: UPDATE~5:11PM: Took 250mg gabapentin.

Edit: UPDATE~6:30PM: Feeling better.

 

[Swimmingdancer]

Yeah, I have to agree that the TID is probably the best idea, even if it's not precisely every 8 hrs. Your doctor seems to be advising a pretty fast taper. I'm sorry you got bad withdrawal symptoms so soon. How are you feeling now? And how much more gabapentin did you take? I have to go out for a while but I'll check in later and give you some more detailed thoughts.

I like your idea of writing a book.

No need to apologize for long posts, I often write super-long posts as well, as you may have noticed