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Monday, October 15, 2012

Gabapentin (Neurontin) Breakin Dose Regimen for Nerve Pain

Even though Neurontin (gabapentin the generic name) is commonly used for nerve pain in the foot or ankle, there are some problems with patients getting used to it. These problems can sometimes be avoided if the following gradual increase dosing regimen is utilized. You need to take the evening dose as soon as you finish all tasks requiring manual dexterity (making dinner, driving to the store, etc), preferably by 7 pm. This dosing requires multiple prescriptions of initially 100mg, and then 300mg also. It is preferred to build up the evening dose the fastest. The goal in most patients initially is pain relief down to levels 2 or 1800 mg/day. If you have attained pain levels of 2 consistently before 1800 mg, then you level the patient off at that level for 3 to 4 months, before beginning a slow weaning off (another post). Side-effects occur normally at the start, and taper off as you get acclimated to the drug. The regimen below is listed by week increments, but you can attempt making the changes every 4 or 5 days to speed up the course. There are many variations from here that can be considered based on individual responses to the drug and the response as more drug is added. 

Week Prescribed        AM Dose                   Afternoon Dose        Evening Dose

1                                                                                                              100 mg
2                                                                                                              200 mg
3                                                                                                              300 mg
4                                                                                                              400 mg
5                                  100 mg                                                                200 mg
6                                  100 mg                                                                300 mg
7                                  100 mg                           100 mg                         300 mg
8                                  100 mg                           100 mg                         400 mg
9                                  200 mg                           100 mg                         400 mg
10                                200 mg                           100 mg                         500 mg
11                                300 mg                           100 mg                         500 mg
12                                300 mg                           200 mg                         500 mg
13                                400 mg                           200 mg                         500 mg
14                                400 mg                           200 mg                         600 mg
15                                500 mg                           200 mg                         600 mg
16                                500 mg                           300 mg                         600 mg
17                                600 mg                           300 mg                         600 mg
18                                600 mg                           400 mg                         600 mg
19                                600 mg                           500 mg                         600 mg
20                                600 mg                           600 mg                         600 mg

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.