Gabapentin is opioid sparing; addicts like it...

[drusso]

Drug May Help Surgical Patients Stop Opioids Sooner

Gabapentin, a drug for nerve pain, becomes a new target of abuse

---

Members don't see this ad.

 

[olayak]

People are abusing neurontin? One the one hand it's much harder to overdose on neurontin. So that's good. But I am really surprised. I've taken it before, for medical reasons, and I didn't get a "high". Interesting.

 

[kstarm]

I have had one patient out of many that has had issues abusing gabapentin. I also had a patient crush and snort hydroxyzine. In both cases the patients were very impulsive and it really didn't matter what medication was around, they were going to abuse it.

 

[lobelsteve]

Robitussin DM. 8oz.
Lomotil 20 pills.

Shake, pour over ice.

 

[Aether2000]

Prescribing 900mg a day or more of gabapentin with prescription opioids doubles the death rate compared to prescribed opioids alone. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. - PubMed - NCBI

 

[lobelsteve]

Prescribing 900mg a day or more of gabapentin with prescription opioids doubles the death rate compared to prescribed opioids alone. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. - PubMed - NCBI

Person, not the drug.

 

[emd123]

Prescribing 900mg a day or more of gabapentin with prescription opioids doubles the death rate compared to prescribed opioids alone. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. - PubMed - NCBI

Interesting. Would many have expected that, but good to know. Not that I have many on >900 mg gaba per day, but worth keeping in mind.

 

[Blitz2006]

Interesting. Would many have expected that, but good to know. Not that I have many on >900 mg gaba per day, but worth keeping in mind.

Somewhat related, I came across this great review on gabapentin dosing for neuropathic pain:

Ask the Expert: Gabapentin Dosing for Neuropathic Pain

With regards to the abuse, it seems lyrica is even worse:

" In addition, a greater number of pregabalin cases were designated as abuse cases than gabapentin cases (48.1% vs 18.6%, respectively)."

Some follow-up questions:

1) According to the literature, not much evidence for efficacy for neuropathic pain above >1800 mg/day. Would you guys agree?

2) Horizont, Gralise.....I hardly see this prescribed (compared to Neurontin). Any instance when I should consider long acting, and if so, any head to head trials (horizont vs. gralise) ?

 

[oreosandsake]

Somewhat related, I came across this great review on gabapentin dosing for neuropathic pain:

Ask the Expert: Gabapentin Dosing for Neuropathic Pain

With regards to the abuse, it seems lyrica is even worse:

" In addition, a greater number of pregabalin cases were designated as abuse cases than gabapentin cases (48.1% vs 18.6%, respectively)."

Some follow-up questions:

1) According to the literature, not much evidence for efficacy for neuropathic pain above >1800 mg/day. Would you guys agree?

2) Horizont, Gralise.....I hardly see this prescribed (compared to Neurontin). Any instance when I should consider long acting, and if so, any head to head trials (horizont vs. gralise) ?

If it didn’t work at 300 tid, and then 600 tid, I’ve never seen that person cry Hallelujah even if I tried 1200 tid. GI absorption maxes out as well.
I rarely go past 600 tid before trying a different agent or the patient shows their true colors

The gralise starter pack is intimidating. Can’t imagine Rx something so expensive when the generic is pennies

 

[lobelsteve]

1800 to 2700 is effective dose range

 

[PapaDosh]

Somewhat related, I came across this great review on gabapentin dosing for neuropathic pain:

2) Horizont, Gralise.....I hardly see this prescribed (compared to Neurontin). Any instance when I should consider long acting, and if so, any head to head trials (horizont vs. gralise) ?

If you look at their data, their big claim for better efficacy is more sustained levels of gabapentin in serum w/o peaks and valley and less side effects, and more convenient dosing schedule for patients. I've had some patients who claim that horizant or gralise has worked for them when gabapentin has not, and then had some people say that horizant/gralise gave them tons of side effects when regular gbp never did. That being said, samples of horizant are useful for a quick titration up to 600 mg q8 as patients who can't afford horizant can then be transitioned to generic gbp.

 

[drusso]

Person, not the drug.

B*llsh*t. Heresy. That's feral practitioner talk. Show me in the CDC guidelines or quote one PROP apostle who asserts that truth.

 

[lobelsteve]

B*llsh*t. Heresy. That's feral practitioner talk. Show me in the CDC guidelines or quote one PROP apostle who asserts that truth.

Why are we sitting here on the sidelines and not developing genetic testing to determine who has the appropriate risk factors so that opiates and other Controlled Substances should not be prescribed.

 

[drusso]

Why are we sitting here on the sidelines and not developing genetic testing to determine who has the appropriate risk factors so that opiates and other Controlled Substances should not be prescribed.

https://www.unthsc.edu/texas-colleg...-osteopathic-research-center/precision-texas/

 

[Ducttape]

problem with genetic testing is that it could has been used as justification for increasingly higher and out of realm of ordinary regimens.

"so you don't metabolize opioids. that means you need more."


see Forrest Tennant for further information.

 

[lobelsteve]

problem with genetic testing is that it could has been used as justification for increasingly higher and out of realm of ordinary regimens.

"so you don't metabolize opioids. that means you need more."


see Forrest Tennant for further information.

I am developing special testing to show that you will respond to a mix of the potent analgesic acetominophen (street term is APAP or PAPPY) and Dolobid (pronounced dil aw bid).