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DEAR DR. ROACH: I’m 74 years old, not overweight and in generally good health. Your recent article on spinal stenosis hit home. I’ve had six cortisone injections in the past year in my lower back and neck, which have helped tremendously.
My pain management doctor prescribed gabapentin at 300 mg every night. I could not take it — it put me in la-la land — so he reduced my dose to 100 mg nightly.
This is better. I sleep soundly, but do wake up to answer nature’s call during the night. He wants to me to do the 100 mg nightly for a month.
What is your opinion on gabapentin? My vein doctor said it was an ugly drug. My primary doctor put me on it four years ago, but when I read up on it I stopped taking it (shame on me for self-diagnosing). — S.L.R.
ANSWER: Although gabapentin is approved by the Food and Drug Administration for certain seizures and for pain after shingles, it is often used for many kinds of pain from damaged nerves (neuropathy). I have used gabapentin for many years, and my experience is that it is very effective for some, moderately effective for most, and not at all for a few.
The side effects of sedation and dizziness are almost universal, but they can be minimized by starting at a very low dose (such as your 100 mg nightly) and very slowly raising the dose as tolerated.
The target dose for pain after shingles in the study that got approval was 1,200 mg three times daily, and it can take weeks or months to be able to tolerate this dose. Three hundred milligrams, three times daily, is the minimum dose for most people to get good relief from nerve pain.
When used properly, it is not an “ugly” drug at all; however, some people just cannot take the side effects no matter how low a dose you start with or how slowly you increase. In your case, I think it may be worth sticking with it.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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