gabapentin extended release?

[randomdoc1]

Does anyone have experience with this? I find gabapentin a good alternative/adjunct for anxiety but the insert for horizant says as far as dosing is concerned it is not interchangeable with other gabapentin products. They did not recommend doses over 1200mg/day but that is for indications of PHN and RLS. Has anyone found the horizant to be helpful for anxiety and how did you dose it? I just started two patients on it but am curious about other people's experiences. I'm trying horizant because some of my patients c/o fatigue on regular release gabapentin. Thanks!

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[Attending1985]

Does anyone have experience with this? I find gabapentin a good alternative/adjunct for anxiety but the insert for horizant says as far as dosing is concerned it is not interchangeable with other gabapentin products. They did not recommend doses over 1200mg/day but that is for indications of PHN and RLS. Has anyone found the horizant to be helpful for anxiety and how did you dose it? I just started two patients on it but am curious about other people's experiences. I'm trying horizant because some of my patients c/o fatigue on regular release gabapentin. Thanks!

I’ve never used it but on a related note I’m becoming much less inclined to prescribe gabapentin freely as its becoming highly abused

 

[randomdoc1]

I’ve never used it but on a related note I’m becoming much less inclined to prescribe gabapentin freely as its becoming highly abused

Indeed I try to be mindful of that too. Perhaps XR would help decrease some of the abuse potential?

 

[SourceOfDenial]

Indeed I try to be mindful of that too. Perhaps XR would help decrease some of the abuse potential?

OxyContin didn't seem to reduce the abuse potential of oxycodone, so I wouldn't take the 'long acting is ok' approach with gpn either.

 

[randomdoc1]

OxyContin didn't seem to reduce the abuse potential of oxycodone, so I wouldn't take the 'long acting is ok' approach with gpn either.

Well, so far I have not had issues with gabapentin but I've heard about it with other patients. Obviously, we have to be judicious about how we prescribe and to who. I'd rather have mine on 100mg gabapentin tid than xanax 2mg qid or a liter of vodka a day.

 

[Attending1985]

Well, so far I have not had issues with gabapentin but I've heard about it with other patients. Obviously, we have to be judicious about how we prescribe and to who. I'd rather have mine on 100mg gabapentin tid than xanax 2mg qid or a liter of vodka a day.

I was working with a patient in prison and talked to a sherif who told me that he sees inmates asking for it constantly, diverting it and then snorting it. I guess the street name is gabby or gabs. When he picks people up it’s common to have gabapentin on them in a bottle marked something else and sees it sold on the streets all the time.

 

[clausewitz2]

I was working with a patient in prison and talked to a sherif who told me that he sees inmates asking for it constantly, diverting it and then snorting it. I guess the street name is gabby or gabs. When he picks people up it’s common to have gabapentin on them in a bottle marked something else and sees it sold on the streets all the time.

Much like Seroquel or Wellbutrin, deliberate gabapentin misuse like this seems to be much more common in correctional or court-ordered treatment settings. If you can't get access to better drugs, or someone is going to be doing an off-the-shelf UDS on you on a regular basis, you are of course going to seek out what you can get/isn't going to get your probation violated.

I would put money on the fact that literally no one is saying "you know, I can buy Xannies or crack but what really does it for me is Neurontin."

 

[eaglepsych]

Gabapentin is being abused a lot in my area. Persons becoming dependent. Especially popular with opiate dependent patients/patients on suboxone and methadone.

Neurontin/pregabalin lacks any psychiatric indication whatsoever. I personally cannot think of a reason to use this (or lyrica) for the treatment of any psychiatric illness where the potential benefits outweigh the potential risks (including the risk of diversion, etc).

Much like Seroquel or Wellbutrin, deliberate gabapentin misuse like this seems to be much more common in correctional or court-ordered treatment settings. If you can't get access to better drugs, or someone is going to be doing an off-the-shelf UDS on you on a regular basis, you are of course going to seek out what you can get/isn't going to get your probation violated.

I would put money on the fact that literally no one is saying "you know, I can buy Xannies or crack but what really does it for me is Neurontin."

 

[clausewitz2]

Gabapentin is being abused a lot in my area. Persons becoming dependent. Especially popular with opiate dependent patients/patients on suboxone and methadone.

Neurontin/pregabalin lacks any psychiatric indication whatsoever. I personally cannot think of a reason to use this (or lyrica) for the treatment of any psychiatric illness where the potential benefits outweigh the potential risks (including the risk of diversion, etc).

I mean, Lyrica is actually first line for anxiety in some developed countries. The fact that the FDA has not given an approval for that purpose here is a legal fact, not a pharmacological one.

 

[randomdoc1]

Neurontin/pregabalin lacks any psychiatric indication whatsoever. I personally cannot think of a reason to use this (or lyrica) for the treatment of any psychiatric illness where the potential benefits outweigh the potential risks (including the risk of diversion, etc).

There is a body of evidence supporting the use of lyrica and gabapentin for anxiety and for gabapentin in the role of treating alcohol use disorder. I'm not strongly advocating for gabapentin but just sharing some of the data I am aware of.

Mason, B. J., Quello, S., Goodell, V., Shadan, F., Kyle, M., & Begovic, A. (2014). Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA internal medicine, 174(1), 70-77.

Pande, A. C., Pollack, M. H., Crockatt, J., Greiner, M., Chouinard, G., Lydiard, R. B., ... & Shiovitz, T. (2000). Placebo-controlled study of gabapentin treatment of panic disorder. Journal of clinical psychopharmacology, 20(4), 467-471.

Pande, A. C., Davidson, J. R., Jefferson, J. W., Janney, C. A., Katzelnick, D. J., Weisler, R. H., ... & Sutherland, S. M. (1999). Treatment of social phobia with gabapentin: a placebo-controlled study. Journal of clinical psychopharmacology, 19(4), 341-348.

Lavigne, J. E., Heckler, C., Mathews, J. L., Palesh, O., Kirshner, J. J., Lord, R., ... & Mustian, K. (2012). A randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors. Breast cancer research and treatment, 136(2), 479-486.

Pande, A. C., Crockatt, J. G., Feltner, D. E., Janney, C. A., Smith, W. T., Weisler, R., ... & Liu-Dumaw, M. (2003). Pregabalin in generalized anxiety disorder: a placebo-controlled trial. American Journal of Psychiatry, 160(3), 533-540.

Feltner, D. E., Crockatt, J. G., Dubovsky, S. J., Cohn, C. K., Shrivastava, R. K., Targum, S. D., ... & Pande, A. C. (2003). A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. Journal of clinical psychopharmacology, 23(3), 240-249.

Rickels, K., Pollack, M. H., Feltner, D. E., Lydiard, R. B., Zimbroff, D. L., Bielski, R. J., ... & Pande, A. C. (2005). Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Archives of General Psychiatry, 62(9), 1022-1030.

But just like in the case of benzos which have evidence for anxiety, all medications have their place. Like any aspect in medicine, it boils down to risks versus benefits. These medications are helpful when utilized properly in the right cases. After speaking with some addictionologists, as I said earlier, it still beats Xanax or worse yet, things like THC and etoh. Likewise, in my high functioning patients with minimal addiction risk, I do prescribe some prn benzodiazepines. I don't prescribe benzos a ton, just like how I don't prescribe gabapentin a ton, but they can have their utility in the right circumstances. Of course, I always recommend therapy and exposure where warranted as well.

By the way, my cat's vet prescribed him buprenorphine and gabapentin =/. Just thought it was cute since on these forums we talk about addiction risk so much. He looks happy right now though, lol. I won't bore people with the details of his medical history.

 

[erg923]

I agree there is a body of evidence supporting the use of lyrica and gabapentin for anxiety and for gabapentin in the role of treating alcohol use disorder. I'm not strongly advocating for gabapentin but just sharing some of the data I am aware of.

Mason, B. J., Quello, S., Goodell, V., Shadan, F., Kyle, M., & Begovic, A. (2014). Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA internal medicine, 174(1), 70-77.

Pande, A. C., Pollack, M. H., Crockatt, J., Greiner, M., Chouinard, G., Lydiard, R. B., ... & Shiovitz, T. (2000). Placebo-controlled study of gabapentin treatment of panic disorder. Journal of clinical psychopharmacology, 20(4), 467-471.

Pande, A. C., Davidson, J. R., Jefferson, J. W., Janney, C. A., Katzelnick, D. J., Weisler, R. H., ... & Sutherland, S. M. (1999). Treatment of social phobia with gabapentin: a placebo-controlled study. Journal of clinical psychopharmacology, 19(4), 341-348.

Lavigne, J. E., Heckler, C., Mathews, J. L., Palesh, O., Kirshner, J. J., Lord, R., ... & Mustian, K. (2012). A randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors. Breast cancer research and treatment, 136(2), 479-486.

Pande, A. C., Crockatt, J. G., Feltner, D. E., Janney, C. A., Smith, W. T., Weisler, R., ... & Liu-Dumaw, M. (2003). Pregabalin in generalized anxiety disorder: a placebo-controlled trial. American Journal of Psychiatry, 160(3), 533-540.

Feltner, D. E., Crockatt, J. G., Dubovsky, S. J., Cohn, C. K., Shrivastava, R. K., Targum, S. D., ... & Pande, A. C. (2003). A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. Journal of clinical psychopharmacology, 23(3), 240-249.

Rickels, K., Pollack, M. H., Feltner, D. E., Lydiard, R. B., Zimbroff, D. L., Bielski, R. J., ... & Pande, A. C. (2005). Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Archives of General Psychiatry, 62(9), 1022-1030.

But just like in the case of benzos which have evidence for anxiety, all medications have their place. Like any aspect in medicine, it boils down to risks versus benefits. These medications are helpful when utilized properly in the right cases. After speaking with some addictionologists, as I said earlier, it still beats Xanax or worse yet, things like THC and etoh. Likewise, in my high functioning patients with minimal addiction risk, I do prescribe some prn benzodiazepines. I don't prescribe benzos a ton, just like how I don't prescribe gabapentin a ton, but they can have their utility in the right circumstances. Of course, I always recommend therapy and exposure where warranted as well.

By the way, my cat's vet prescribed him buprenorphine and gabapentin =/. Just thought it was cute since on these forums we talk about addiction risk so much. He looks happy right now though, lol. I won't bore people with the details of his medical history.

I would push all of yous guys into oncoming traffic to save my cat (Mr. Sammy)!

 

[clausewitz2]

There is a body of evidence supporting the use of lyrica and gabapentin for anxiety and for gabapentin in the role of treating alcohol use disorder. I'm not strongly advocating for gabapentin but just sharing some of the data I am aware of.

Mason, B. J., Quello, S., Goodell, V., Shadan, F., Kyle, M., & Begovic, A. (2014). Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA internal medicine, 174(1), 70-77.

Pande, A. C., Pollack, M. H., Crockatt, J., Greiner, M., Chouinard, G., Lydiard, R. B., ... & Shiovitz, T. (2000). Placebo-controlled study of gabapentin treatment of panic disorder. Journal of clinical psychopharmacology, 20(4), 467-471.

Pande, A. C., Davidson, J. R., Jefferson, J. W., Janney, C. A., Katzelnick, D. J., Weisler, R. H., ... & Sutherland, S. M. (1999). Treatment of social phobia with gabapentin: a placebo-controlled study. Journal of clinical psychopharmacology, 19(4), 341-348.

Lavigne, J. E., Heckler, C., Mathews, J. L., Palesh, O., Kirshner, J. J., Lord, R., ... & Mustian, K. (2012). A randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors. Breast cancer research and treatment, 136(2), 479-486.

Pande, A. C., Crockatt, J. G., Feltner, D. E., Janney, C. A., Smith, W. T., Weisler, R., ... & Liu-Dumaw, M. (2003). Pregabalin in generalized anxiety disorder: a placebo-controlled trial. American Journal of Psychiatry, 160(3), 533-540.

Feltner, D. E., Crockatt, J. G., Dubovsky, S. J., Cohn, C. K., Shrivastava, R. K., Targum, S. D., ... & Pande, A. C. (2003). A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. Journal of clinical psychopharmacology, 23(3), 240-249.

Rickels, K., Pollack, M. H., Feltner, D. E., Lydiard, R. B., Zimbroff, D. L., Bielski, R. J., ... & Pande, A. C. (2005). Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Archives of General Psychiatry, 62(9), 1022-1030.

But just like in the case of benzos which have evidence for anxiety, all medications have their place. Like any aspect in medicine, it boils down to risks versus benefits. These medications are helpful when utilized properly in the right cases. After speaking with some addictionologists, as I said earlier, it still beats Xanax or worse yet, things like THC and etoh. Likewise, in my high functioning patients with minimal addiction risk, I do prescribe some prn benzodiazepines. I don't prescribe benzos a ton, just like how I don't prescribe gabapentin a ton, but they can have their utility in the right circumstances. Of course, I always recommend therapy and exposure where warranted as well.

By the way, my cat's vet prescribed him buprenorphine and gabapentin =/. Just thought it was cute since on these forums we talk about addiction risk so much. He looks happy right now though, lol. I won't bore people with the details of his medical history.

I recently encountered a nursing home transfer who had been receiving a veterinary topical gel for agitation consisting of Ativan, Benadryl, Haldol and Reglan. This facility apparently used it regularly. I had no words.

 

[randomdoc1]

I recently encountered a nursing home transfer who had been receiving a veterinary topical gel for agitation consisting of Ativan, Benadryl, Haldol and Reglan. This facility apparently used it regularly. I had no words.

w...t..whaa....

 

[SourceOfDenial]

Well did it work??

 

[MrWonderful]

We've used Gabapentin quite a bit in the Addiction setting on an inpatient unit. It helps significantly with w/d sxs from OUD and AUD and we use it as an adjunct comfort med along with the standard bentyl, etc.. Seems to help with anxiety and depression. A fair number of these patients are chronic pain patients who progressed from PO opioids to heroin, so it helps with their neuropathic pain and w/d sxs together. We tried not to go over 1200mg/day and saw in one patient on a dose of 1800 a dose-dependent lower extremity edema, which was described in the literature as well. Otherwise, anecdotally speaking it seems fairly benign, well-tolerated, and important in our patients' regimen.

 

[ahmedqman]

Put me on the gabapentin train. I've had some success using it for insomnia related to post acute alcohol withdrawal. For some reason, in my experience, gabapentin and anxiety in substance users is magic.

Sure, it's abusable, but I'd rather use it compared to benzodiazepines or neuroleptics like seroquel. I hate neuroleptics for sleep (way too dirty).

What's the risk of rebound seizure in someone with no seizure history who abruptly discontinues gabapentin 1200 mg po tid? I'm going to assume it's low.

 

[DisorderedDoc417]

Put me on the gabapentin train. I've had some success using it for insomnia related to post acute alcohol withdrawal. For some reason, in my experience, gabapentin and anxiety in substance users is magic.

Sure, it's abusable, but I'd rather use it compared to benzodiazepines or neuroleptics like seroquel. I hate neuroleptics for sleep (way too dirty).

What's the risk of rebound seizure in someone with no seizure history who abruptly discontinues gabapentin 1200 mg po tid? I'm going to assume it's low.

Not sure. But I’ve had patients present having taken a 30 days supply as attempted overdose without a single symptom aside from some somnolence.

 

[clausewitz2]

Well did it work??

Not as well as the lithium she had been taking for twenty years that they decided to stop for no reason.

 

[SourceOfDenial]

Not as well as the lithium she had been taking for twenty years that they decided to stop for no reason.

Well they didn't stop it for no reason, they stopped it to put her on the agitation topical. Makes sense to me.

I wonder what the name is. And can you put it anywhere?

Edit--Actually the vet medicine part threw me--it's just ABHR that's used in hospice for intractable nausea. So that's why the nursing home has it...they are just using it for the wrong reason. Lucky they didn't use the suppository version.

 

[clausewitz2]

Well they didn't stop it for no reason, they stopped it to put her on the agitation topical. Makes sense to me.

I wonder what the name is. And can you put it anywhere?

Edit--Actually the vet medicine part threw me--it's just ABHR that's used in hospice for intractable nausea. So that's why the nursing home has it...they are just using it for the wrong reason. Lucky they didn't use the suppository version.

Huh. Maybe it is a variation in local practice thing. When I called up our pharmacy to ask what the hell this was, they told me it was coming from the vet world, but I can believe it would be useful in hospice practice. I don't think I've seen our hospice/palliative service use it but maybe they do.

 

[SourceOfDenial]

Huh. Maybe it is a variation in local practice thing. When I called up our pharmacy to ask what the hell this was, they told me it was coming from the vet world, but I can believe it would be useful in hospice practice. I don't think I've seen our hospice/palliative service use it but maybe they do.

I've never seen it used inpatient. Typically comes from a compounding pharmacy, and those often cover hospice and vet meds. The same place I order super concentrated methadone liquid is the same place I get fish flavored gabapentin chewables for my cat, ha.