Neurontin answer for Kimmer - Pain Management Message Board

ozzybug · 03-12-2007, 05:31 AM

Kimmer-
Hey, I saw your question about the doses of Neurontin my PM doctor started me on, so instead of answering on someone elses thread, I started a new one.

All doctors will use different starting doses, so what my doctor did may not be what others will do, and so on and so on.

If I remember correctly, my doctor had me start night time doses which was 300 mgs. at dinner and 300 mgs. at bed time. Then, as my body started tolerating that, he moved me to 600 at dinner & 600 at bed, then added daytime doses of 100 mgs., so I actually take 1500 mgs. total per day.

I can't remember a specific time frame, but I think it was about 2 weeks before I started seeing a noticable difference in the nerve pain. He did titrate me up fairly quickly, but my body tolerated it ok. Like I said before, the sleepiness was the main thing I had to deal with. It still sometimes will make me really sleepy, but not always.

It sounds like your doctor is starting you low, which is the "norm" as these kinds of meds usually require dose adjustments before you are able to find the right amount to make a difference. If you aren't seeing some improvement, then your doctor can certainly raise the dose if needed. I'm not positive what is considered the "max" dose, but I do think I've heard of people taking up to 1800 mgs. a day. Don't quote me on that though.

I hope you start to see improvement soon if you aren't already. Again, if you aren't, don't worry just yet as there is still a ways to go with titrating up. Good Luck!

Shoreline · 03-12-2007, 12:12 PM

Hey Ozzy, I've met folks that take as much as 3600 mgs a day, As long as someone can tolerate the side effects "mainly drowsiness/forgetfullness", there really isn't a specific point docs should give up on this particluilar med. It's really no different than titrating any other med. I've seen folks give up on elevil if 100 mgs a day doesn't help when you can safely take 3 times that amount and it may take 300 mgs a day to achieve the desired effect.

There realy is no danger of respirtory supression or any other reason to pick an arbitrary limit other than how the patient manages the side effects. Like you said, 100 mgs 3 times a day is the standard startng dose. Even if a doc agressively increases the dose weekly, it may still take 6 weeks to reach an effective level and then a few weeks of that dose sustained to see a positive result. Unfortunately docs and patients both become impatient and may give up on something that may have worked if given time to reach an effective level and accomadate to the side effects.

The same is true for many drugs. We see docs and patents give up on many meds if they don't repond to what a particular doc thinks should work. The downside is the drug may have been a lifesaver for the patient if given a fair trial.

For Kimmy, try to be patient, I can't tell you how many people I have heard say Neurontin saved their lives or sanity when it came to neuro pain caused by shingles and diebetic neuropothy and many other neurogenic causes of pain that simply don't respond well to opiates. Nerve pain is the toughest to treat and requires the most patience and trial and error to find what works.

Good luck Dave

ozzybug · 03-12-2007, 12:22 PM

I knew you would be able to give more information Dave- thanks!

I am sometimes hesitant to speak in depth about any medication because I don't want to give bad information. I'm glad there are folks here who are able to give concrete, knowledgable information!

My doctor titrated me fairly quickly, because I've been seeing him since October, and am at the 1500 mg daily with the Neurontin. (It seemed like a quick titration anyways) And, like others, I am really glad I didn't give up on it because it really does help. With me it does anyway. I was at the point where if someone told me to hang upside down by my toes and it would help, I would have done so.

And absolutely, there are times we have to be patient and allow the medications and the dose adjustments to really have time to work. It's not always easy to be patient when you are hurting so badly and just want some relief, but unfortunately, each person is different, each treating doctor is different, and therefore, finding the right "fit" isn't a textbook answer. Patience is key, and I have to remind myself on many occassions that sometimes it takes "baby steps" to reach the end of this race.

Thank you Dave for adding to this post!

lorriem · 03-12-2007, 12:24 PM

I only take 100 mg of neurontin three times a day and if needed one extra 100 mg. I also take 25 mg of elival once a day and for several years it has controlled my pain (RSD) it also helps somewhat with migraines along with tylenol.I still have pain at maybe a 5 leval but I can function most of the time.

rayefaye · 03-12-2007, 12:36 PM

Shoreline is correct about people giving up on medication before they give it a chance. I've been on Neurontin for 3 yrs for RSD and I don't know what I would do without it because of the Neurontin I don't have to take a lot of pain medication. It truly has been a life saver for me.