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

Nerve Pain: Email Followup as Patient Attempts Increasing Neurontin

Good morning, Rich/Dr. Blake,

I hope all is well with you since our last appt.

Here's an update of this past week of being on 500mg of neurontin, which

started Fri, Dec. 2nd, at 8PM.

Dr Blake's comment: Christine had been on 100mg Neurontin three times per day and it was helping some of the tarsal tunnel (nerve) symptoms in her ankle/foot. I am having her initially add 100 mg more just to the evening dose. So for one week she went to 100mg am, 100mg afternoon, and 200mg as soon as she would get home. Then the week in question is 100mg am, 100mg afternoon, and 300mg evening, with the total at 500mg. 

Good news: Overall, my pain has been reduced in my foot to about a 2-3 on

the scale. There have been a couple of times that the pain has been at a

4-5.5, based on standing, but the pain doesn't linger. Aside from the pain

while standing, I'm working ever so slowly (only did it 1x thus far) towards

wearing sneakers and sketcher winter boots; I know that the discomfort in

this case is simply a result of using different muscles.

Here are a few notes for your review:

Friday 11PM - As I was falling asleep, and a couple of times throughout the

night, I felt sensations deep in my Achilles area in my left calf. The

sensations were in the meaty part of my calf muscles, about 2 inches above

the ankle. I felt a constant discomfort for a few minutes, then the

sensations would abate, and then they'd return. The pain was only about a

3-4 on the scale, but noteworthy since I've never felt anything before in

this area. Did I mention that overall this stuff knocks me out and I sleep

for up to 5 hours without waking? WOW... it's quite difficult to shake the

exhaustion during the day, but I love the deep sleep at night!

Dr Blake's comment: This is why we try to get the patient to take Neurontin or Lyrica as soon as they are going to be home for good. By the next morning, I want as much of the drug out of their system. The nerve symptoms with Neurontin/Lyrica take affects their day to day functioning normally is going seen as they try to get use to the drug so most docs push them through these small doses quicker than I. 

Sat. day - Went to view art with a friend in an old school building. Was so

uncomfortable - couldn't stand for more than a couple of minutes, leaning

into things didn't do the trick, couldn't sit for too long.... my friend was

aghast at my level of pain. Ended up lying on a sidewalk to stretch... what

fun! This pain could have been unrelated to my foot since when I saw my

chiro on Monday she said some joint was out, causing bone to meet bone.

Symptoms have shifted since having a couple of adjustments. And, what's

noteworthy is that standing and sitting are worse than walking.

Dr Blake's comments: This patient is a real trooper, but it shows how dedicated to the process you have to be before starting, or else you would give up. 

Sun 11PM - Similar discomfort deep in my calf while falling asleep and on

and off while sleeping. Again, the pain wasn't too bad. I've framed the pain

to signify that the effects of the neurontin are finally moving to that area

due to the additional dose. ??

Dr Blake's comments: I believe that is correct, but unsure.

Mon night while sleeping - Woke a few times with sensations at my ankle

bone. They were a combination of compression right at the most sensitive

spot (like someone pressing his thumb on the tissue right at the curve of

the joint, where there's consistent tenderness) with a slight

fingernail-like discomfort. I tried to weave this sensation into my dreams,

but finally woke up because the dreams couldn't quite do the trick.

Tues - Good news! Went to a xmas party/benefit gathering and wore my squishy

sketcher winter boots. Stood for a few minutes at a time, leaned into things

on and off for 20 minutes at a time, and sat for about an hour and did

pretty well! No lingering discomfort as a result.

Tues night while sleeping - First time ever that I've woken as a result of a

massive twitch happening in both legs at the same time. Who knows if it's

important info for you, but here it is!

Wed, Thurs, Fri - nothing to note that was new or unusual. Acclimating to

the meds. Still have prolonged exhaustion.... Not sure what comes out of my

mouth during business meetings that have a lot to do with my future

livelihood and can only hope it's intelligent or at the least entertaining!

Good news! I do notice that, with the increased dose, I'm putting more

weight on the left foot which is helping my sacrum stay in place and thus

reducing my back pain. I clearly see the link between habitually placing

most of my weight on my right leg and my lower back instability. My chiro

says my discs (L4/L5, L5/S1) have been in place (no bulge) for the past 7

days - which is fantastic news, and which feels great because I'm in way

less back pain. Still tough to sit for long periods.

Good news! Have gone on two 15 minute walks - on grass or earth... can't

help myself. I have to move and it's been such sublime weather!

Also, walked 4 city blocks - on pavement - once when I dropped my car off

and once when I picked it up. Doesn't sound that thrilling, yet for me it

is!!

FYI, forgot to increase my dose last night to 400 before sleep. Will do so

tonight.

Dr Blake's comments: So, here we go. This week the increase is to 100mg am, 100mg afternoon, and 400mg evening (for 600 mg total). Want to get her to a pain free dosage, level that out for 3-4 months, then gradually wean off (carefully watching for return of symptoms). 

Please let me know if this is adequate info, too much info, or if you want

different feedback. My scientific mind will adjust!

I hope you take a chunk of time to enjoy yourself this weekend.

Thanks so much for your time and support, Rich.

Best,

Christine