Gabapentin is usually absorbed into your body within 20-30 minutes, and it has a half-life of eight hours. Ideally, you’d end up taking it three times a day.
Gabapentin has a huge dose range, from 100 to 4200 mg per day. If people are sensitized, often they are very sensitive to medications as well.
Therefore, it’s recommended to start off with a very low dose, like 100 mg at night only. Then, every 3-4 days, you would increase, following the pattern of starting at night, then taking one in the morning, then taking one in the middle of the day.
Following this pattern, you reach a dose where you notice your pain is improved, and you don’t have significant side effects. You’re searching for the ‘goldilocks zone’ where you have a reduction of pain, with minimum side effects.
For the majority of people, the dose range is between 1800mg to 2400mg per day. However, the dose can go all the way up to 4200 mg.
The effectiveness of Gabapentin is around 6-7. This means you need to treat 6-7 people to get a 50% pain reduction. This isn’t great, but it’s par for the course with nerve pain medications.
Nerve pain is unfortunately difficult to treat. For Gabapentin, about 20% will get excellent pain relief, 40% will get around 30% pain relief, and about 40% will get minimal pain relief and a lot of side effects. This is true of all nerve pain medications.
The maximum dose of Lyrica (or pregabalin is the generic name) is 600. Again, it’s best to start at the minimum – 25mg and slowly increase. Most people take 75mg as an optimum dose. It has a 12-hour half-life and works within around 30 minutes.
The major side effect of Lyrica is that it makes you sleepy, so it’s best to start with one tablet at night. Because of this, you only take it twice a day.
It’s important after an increase in dose to wait several days to one week to monitor how effective it is vs. the side effects which may come. There is a long list of side effects, but because this is a medication that quietens nerves, it primarily effects cognitive ability. This is because your brain is where most of your nerves live.
Side effects include low energy, poor memory, decreased thinking ability, and your balance can be affected.
The other big group of side effects that applies to all these medications is in your digestive system. For some people, taking nerve pain medications can cause nausea, upset stomach and loss of appetite.
The anti-depressant nerve pain medications (nortriptyline and amitryptiline) have a slow onset of effectiveness.
You use them once a day, only at night. It’s a good idea to take a dose 2-3 hours before you go to bed. These are very low dose medications: 10-30mg at night.
The major side effects are sedation, which is a help at night, but as they have a long half-life, you may wake up still feeling doped up. Amitryptiline is more sedating than Nortriptyline.
These medications also work on your autonomic system. They tend to slow things down in your autonomic system. This can sometimes cause: a dry mouth, constipation, low blood pressure and a slow pulse.
At very low doses, these side effects aren’t that common, but they may occur.
These medications’ main effect is on noradrenaline. These are similar to amitryptiline and nortriptyline. However, they work even better on pain combined with depression and anxiety.
Their side effects are similar to the other anti-depressant medication. These are newer drugs, and are thus usually more expensive. In some countries they’re funded, in other countries they’re not.
In summary, everyone is different when it comes to nerve pain medications. The important thing is to start small, and increase very slowly, looking for the optimal balance between pain relief, and side effects.
Unfortunately, when people have a sensitized pain system, they are more likely to react and have side effects when taking medications.
That’s why things you can do yourself (like NeuroMind techniques, exercise, breathing, diet) become a very important part of managing and then recovering from chronic pain.