Brief Answer:
Many patients get substantial relief from gabapentin

Detailed Answer:
Good afternoon. Thank you for your question.

In general, gabapentin is considered a very good first choice in patients who have "nerve pain" referred to as NEUROPATHY or DYSESTHESIAS from a neurological point of view. The trade name for gabapentin is NEURONTIN but gabapentin is universally available now in generic form and should be available everywhere.

Gabapentin is good for several reasons when treating painful NEUROPATHY. First, it does not interact with too many other medications which patients are often taking...especially patients with MS. Secondly, it is well tolerated by most people although there definitely are some side effects that are troublesome and make it impossible for some patients to manage. The most significant of those would be FATIGUE, SLEEPINESS, and CLOUDING of memory and ATTENTION problems. This can affect some people to the point of not being able to comfortably work, drive a vehicle, or use heavy or dangerous machinery. You should talk to your doctor if you are concerned for any of those types of potential problems since the doctor will need to either reconsider the medication or be very careful with the dosage.

The other thing about gabapentin is that it can be titrated from quite low dosings to quite high. Theoretically, doses above 2400-3600 mg. are considered to be equipotent and are said to cause more side effects than benefit, however, I have patients with MS who require no less than 7200mg. daily otherwise they simply cannot function due to pain from their MS. Therefore, the limits to dosing are more contingent on what the patient can handle with their kidneys, mentation/thinking, and levels of fatigue when they take those types of extraordinary doses.

But on average most patients probably do reasonably well somewhere between about 1800-2400mg. daily and usually divided into 2-3x/day. There are other formulations of gabapentin that come as EXTENDED RELEASE tablets, however, I've not found a lot of success...or I should say, AS MUCH success as when using smaller doses of the regular/standard formulations spread out over several times per day. That is what I counsel all my patients though some doctors and certainly the pharmaceutical company would love it if you or your physician would push the ONCE DAILY forms of gabapentin. Personally, for my patients I don't even recommend those medications due to cost and lack of efficacy.

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