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Gabapentin


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#1 jolo

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Posted 18 February 2011 - 02:57 PM

I would appreciate some help with weaning off Gabapentin, as it is known to cause edema. Over the last four years have gained 30 lbs, making it more difficult to move in general when I least need it. I have tried weaning off several times over periods up to three weeks but when I get down to three to six hundred mg/d from eighteen hundred the tremors increase and will not stop when I go to bed. Is this a withdrawal symptom or is it possible that the med is actually helping my tremors? It was originally prescribed for peripheral neuropathy after testing my feet more than four years ago. I am unsure that it helped as they still feel the same, no pain, just feel like wearing socks when go to bed and soles get hot at times. I know that I still have feeling in my feet as my physician tests them frequently. My Parkinson’s tremor started in 2003 and have just recently started on Sinemet to help with deteriorating movement.
John.

#2 Dr. Okun

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Posted 20 February 2011 - 01:11 PM

John, interesting.

Rarely does Gabapentin help PD but there are cases. I suggest increasing the sinemet dose if tremors re-occur and weaning over 4-6 weeks. You can discuss with your doc, but in most cases simply adjusting sinemet will cover. If you wean slowly it usually is not withdrawal.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#3 gmk

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Posted 22 February 2011 - 04:59 PM

John, interesting.

Rarely does Gabapentin help PD but there are cases. I suggest increasing the sinemet do,se if tremors re-occur and weaning over 4-6 weeks. You can discuss with your doc, but in most cases simply adjusting sinemet will cover. If you wean slowly it usually is not withdrawal.

N.B.:
Gabapentin is at times prescribed in Eurozone for control of resting tremor (as an alternative to another anticonvulsant, which is more commonly used in
Japan: Zonisamide)in addition to long-duration therapy with Sinemet, i.e., if Sinemet after appropriate increase in dosage (dose x frequency/24 hrs.) has failed to stabilise, so called tremorogenic type of parkinsonism.
Supervision of this type of therapeutic endeavor and/or the problem of edemas likely calls for a board certified internist.
gmk

#4 Dr. Okun

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Posted 23 February 2011 - 07:50 AM

Thanks for the comment.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#5 gmk

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Posted 27 February 2011 - 03:58 PM

Thanks for the comment.

The good news is that gabapentin in the higher dose does control your tremor. Resting or resting-postural tremor usually is more difficult to control by
l-dopa-carbidopa (Sinemet).
The bad news is that you have got into the problem.
Appearance of bradykinesia does call for adding or increasing in dosage of Sinemet. However, adding of Sinemet should be done without change in gabapentin
dose in your regimen rather than with it. Then, when your dose of sinemet has controlled bradykinesia, you can try to slowly weaning of gabapentin. If
with the smaller doses of gabapentin your tremor worsens, we have answer to your very question.
gmk

#6 Dr. Okun

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Posted 28 February 2011 - 05:24 PM

The simple solution is to work with your doc to wean gabapentin and then adjust sinemet to try to cover the tremor.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#7 gmk

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Posted 12 March 2011 - 10:04 PM

The simple solution is to work with your doc to wean gabapentin and then adjust sinemet to try to cover the tremor.

Of course, he (the patient asking the question) should NOT try to treat himself alone. He lives in Canada and their health care system is very well organized
and beneficial to participants.
Does gabapentin in the higher doses really control the tremor?
What has been causing the appearance of peripheral edema? Is it in one leg only or is it in both legs? What about the weight gain, is it due to overeating
and/or lack of exertion (sedentary life style) or due to fluid retention as a side effect of the drug or is it also due to varicosity and/or thrombophlebitis?
gmk

#8 jolo

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Posted 19 March 2011 - 01:09 PM

The good news is that gabapentin in the higher dose does control your tremor. Resting or resting-postural tremor usually is more difficult to control by
l-dopa-carbidopa (Sinemet).
The bad news is that you have got into the problem.
Appearance of bradykinesia does call for adding or increasing in dosage of Sinemet. However, adding of Sinemet should be done without change in gabapentin
dose in your regimen rather than with it. Then, when your dose of sinemet has controlled bradykinesia, you can try to slowly weaning of gabapentin. If
with the smaller doses of gabapentin your tremor worsens, we have answer to your very question.
gmk

--------------------------
Dr Okun and gmk.
Thank you for your replies.
I feel that I need to provide additional information so that you are able to advise me more accurately.
I should mention that into my second year after PD diagnosis by a MDO specialist, with the help of my GP we started on Sinemet and gradually increased the dose to 1200mg/d over a period of about fourteen weeks. The purpose was to try and minimize the tremor as at that time I had no problems with slowness of movement, just severe tremor. Instead it had the opposite effect, the tremors became worse, I was having strange jerky movements, my rotary cuff felt like cog wheels and my feet started to tingle and felt numb. Consequently I phoned the head of our Parkinson’s society who happens to be a registered nurse with PD experience and she advised me to immediately start to wean off over a period of two weeks and advised that Sinemet normally will not help tremor.
After I stopped, the tremor was more severe than ever and would not stop at night so I had to place a sandbag on my right leg and lay on top of my right arm to partially control it (tremor was on right side only, and still is except for recent slight tremor in left leg) to try and get some sleep. After about a month of this my GP suggested I try Clonazepam and started 3x.05/d, it was like a miracle, the tremor stopped at night and I was able to sleep again, the Clonazepam helped my essential tremor as well (which had developed in my early teens and only affected my writing or showed up when I became anxious. None the less it was a burden and caused withdrawal, depression and marital problems throughout my life).
My GP sent me to a Neuro to have my feet diagnosed as neuropathy. He started the Gabapentin although it seemed like a minor problem to me, and the Gabapentin did not make any noticeable difference. Later he was not sure about my PD diagnosis because of the lack of rigidity and suggested that I see a Specialist in Vancouver 800 miles west in Vancouver. There was a nine month wait but a very thorough exam and a determination that I had a tremor-intensive form of PD, the good news was that it would progress slower. He prescribed Mirtazapine 30mgx1/d for improved sleep and possibility of help with both tremors. That was March 2010. I can’t say that it helps but am still on it.
I am now seeing a Neuro at our local MDC. Last saw him about four months ago for the first time and he suggested that we try a starting dose of Sinemet CR100/25x3/d for a period of three months. This did not seem to make any difference to my deteriorating movements and there were no on/off periods, so after the period through his associate physician I have increased it to 4/d every six hours (4, 10, 4, 10). I have been on this regimen for two weeks now and really slept well the first two nights but now sleep is deteriorating and the tremor is a more severe during the day. Also the last few days my feet get hot starting with the soles. The alternative was to contact his nurse in a few weeks and switch to regular Sinemet 3/d for a month and take it from there. It seems I should stop the Sinemet now to see if it is causing complications with my feet and increased tremor and then try it again at a later date.
So that rules out increasing the Sinemet in order to wean off the Gabapentin.
I have been on Clonazepam 1mgx3/d for the past year, would increasing this to two or three mg then try slowly weaning off the Gabapentin? (one capsule/week?)
There is no reason to believe that the weight gain is due to a sedentary lifestyle or overeating as I live alone on a 40 acre parcel twenty miles east of the city. There is plenty to keep me busy and it is easy to regulate my diet as it does not vary much from day to day. I have been cutting down the portions over the past six months but it does not help with weight loss. At bedtime my ankles are like tennis balls and there are deep indents from my socks, and are subsided (but not fully) in am, but my waist size has increased. Also my wrist leaves an indent from watch although loose in am. Now 5’11” and weigh 200 lbs. Was always around 170 steady since early 20’s now 72.
Any advice you have to offer is appreciated.
Regards.
John.

#9 Dr. Okun

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Posted 19 March 2011 - 07:48 PM

The information on sinemet not helping tremor is not completely accurate. It helps 80% of patients at least partially with tremor and some completely. The trick is dose. You are on a tiny dose. We usually go up by half tabs each week up to 3 tablets at each interval (3 or 4 intervals to start) and then choose the week that was best. We combine with an agonist (if tolerated) and watch for weight gain on agonist. Finally in some cases we add an anticholinergic (trihexyphenidyl) if tolerated (watch for cognitive issues in particular). If tremor is still bothersome we then discuss DBS.

You may want to print this email and discuss with your doctors.

Hope this helps.

The neuropathy in the feet and edema also need a workup (cardiovascular with your internist remembering dopamine agonists can cause edema; and a neuropathy workup from your neurologist remembering sinemet and PD rarely cause neuropathy).

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#10 gmk

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Posted 20 March 2011 - 06:24 PM

The information on sinemet not helping tremor is not completely accurate. It helps 80% of patients at least partially with tremor and some completely. The trick is dose. You are on a tiny dose. We usually go up by half tabs each week up to 3 tablets at each interval (3 or 4 intervals to start) and then choose the week that was best. We combine with an agonist (if tolerated) and watch for weight gain on agonist. Finally in some cases we add an anticholinergic (trihexyphenidyl) if tolerated (watch for cognitive issues in particular). If tremor is still bothersome we then discuss DBS.

You may want to print this email and discuss with your doctors.

Hope this helps.

The neuropathy in the feet and edema also need a workup (cardiovascular with your internist remembering dopamine agonists can cause edema; and a neuropathy workup from your
neurologist remembering sinemet and PD rarely cause neuropathy).

To Jolo:
Dr. Okun has given to you valuable suggestion. Because you are canadian citizen, go with this email to your GP aneriphd ask him to review your case
including the consultations with the neurologists and all the medicaments as they were prescribed to you. Let him know that the presenting complaints
edemas, weight gain, parkinsonism with rt sided tremor predominant, neuropathy, adverse reaction? to the drugs have persisted /or worsened, ask him
the question if he would take care of you directly in his office or if he can refer you with his Summary to a doctor specializinng in internal medicine

#11 jolo

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Posted 21 March 2011 - 07:35 PM

Dr Okun & gmk
Thank you for information, I will take your advice.




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