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Calprof54

Gabapentin for Sleep

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I'm 63y.o. woman with PD dx just 9 months ago.  Currently taking Azilect w/ mild benefits, so dr. added amantadine, 100mg 2x/day.  This really helps with tremor but has caused dry mouth and severe insomnia, resulting in zero hours of sleep.  Even decreasing  amantadine to 100mg 1x/day doesn't help.  I've tried OTC meds like Advil PM, benadryl, and melatonin, all are of no help. Now she's added gabapentin at night for sleep.  Is this a typical way to address the insomnia problem?  What, if anything, do I need to know about gabapentin?  Thanks for your feedback.

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Calprof54,

I have not heard of the practice of using Gabapentin for sleep unless the lack of sleep is associated with some sort of nerve pain issue. Some of the side effects may be drowsiness, unsteadyness, dizziness, dry mouth, fatigue,  and confusion.

More commonly I have seen certain antidepressants, Seroquel or Trazadone, used to help with sleep. there are very few side effects, other than drowsiness, at the low dose when it used for sleep issues. I personally used the Trazadone and have had great success with it and have had very little, if any, drug hangover in the morning.

I hope this helps and please keep me posted.

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Thanks, Mark.  For the Trazadone, what dosage do you suggest to help with sleep?  Also, I just looked up this drug and it says not to take it if you take an MAO inhibitor.  I take Azilect.  Is this contraindicated?

Edited by Calprof54

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Calprof,

When starting Trazadone, and most PD medications,  I go with my "Start low and go slow" theory. This means you usually should start at the lowest dose and increase the strength over time if needed. The starting dose is usually 25mg and can be increased by 25mg after about 7 days on the medication. The maximum dosage of Trazadone is 150mg at bedtime.

As for the interaction, there is a Major interaction between Azilect and Trazadone. The interaction can cause Serotonin Syndrom which is serious but very rare. Many of the Neurologist's and Movement Disorder Specialist I have spoken with say they have never seen this reaction when these two types of medications are used together. Some of the symptoms, stated by Drugs.com of Serotonin Syndrome include:

Mental changes can be irritability, altered consciousness, confusion, hallucinations, and coma.

Some autonomic changes that can occur are increased heart rate, hyperthermia, severe sweating, shivering, and dilated puples.

Some neuromuscular changes that can be stiffness, tremor, rigidity, and loss of control of arms and/or legs.

 Lastly,  some gastrointestinal symptoms that can occur are abdominal cramping, nausea, vomiting, and diarrhea.

In this case you may want to try Seroquel instead of Trazadone. It does not cause Serotonin Syndrome and is also dosed as 25mg and can be increased in increments of 25mg over time.

I hope this helps and please keep me posted. 

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