Gabapentin Versus Horizant for Restless Legs Syndrome: What's the Difference?

[@VogMasu]

You are the most knowledgeable person for RLS I have seen so far. Would you consider doing a more comprehensive lecture type video? I think many people would be extremely grateful. 🙏

[@andyberkowskimd]

Thank you! Yes, I will eventually add longer, more detailed videos as time goes on. Right now the majority of people watch KZbin videos for 2-3 minutes at the most. Even some of these 7-minute videos are stretching attention spans. I have some longer webinars available through the RLS Foundation (www.rls.org/member-portal/webinars), though it requires RLS Foundation membership to view previous recordings if you don't see them live. There is also a great virtual summit coming up and I have a 20 minute lecture on myths and misconceptions of RLS: www.rls.org/events/2023-summit-home

[@Stogdad1]

You're videos are very informative. Thanks.

[@andyberkowskimd]

Appreciate it

[@danielwren-ud1hl]

Thank you for your informative videos. Unfortunately for me the first drugs prescribed for me were dopamine agonists. The first four months were great! Then the augmentation started. Each time I had augmentation, I was prescribed higher doses of the dopamine agonist until the augmentation and side effects of the dopamine agonist (insomnia and irritability) became unbearable. I was then placed on Horizant. Unfortunately, the Horizant effected me for a full 24 hours. I am now on regular gabapentin with a small dose of a dopamine agonist. Daytime drowsiness and sleepiness have been greatly reduced. Sadly, I have not been able to completely discontinue the dopamine agonist. I have terrible RLS each time I try to completely discontinue the dopamine agonist. If you suffer from RLS don’t give up. Everyone’s journey is different!

[@andyberkowskimd]

Thanks for sharing your story. Dopamine agonists can be fool's gold as they may work extremely well for the first few months or years before things sour. Unfortunately, RLS is often a condition that needs lifelong treatment, not just for a few months or years so one must have a long-term perspective on treatment.

[@liamporter1137]

Thank you for sharing this 👏👏👏👍. Can tell you're a specialist in RLS. Not many people know about RLS, not even doctors. Have been suffering from RLS for decades but the last ten years, symptom has gotten worst. Started with small dose of Sifrol medicine. It worked well. Then started iron supplement and seemed to worked for a while then it stopped working. Now taking Gabapentin. It works well as well but not a cure to root problem. Also worry that one day it'll stop to be effective, needs to increase dosage or long term damage to health 🙏🙏🙏. RLS is a serious and torturing illness and not simply solve by exercise etc. Tried so so so many things to avoid taking medicine but failed. Feel for everyone who are suffering from it.

[@andyberkowskimd]

Unfortunately, in the U.S., RLS affects 5% of the population but almost no medical centers prioritize it due to lack of procedures to diagnose or treat the condition. This is how they make their money and RLS is not a money-maker in the U.S. This blog explains this phenomenon in the U.S. in more detail: www.relacshealth.com/blog/a-relacsing-blog-10-why-is-rls-the-red-headed-stepchild-of-medicine

[@bballer191]

Been using Gabapentin for 4 years as I suffer from severe peripheral neuropathy stemming from a spinal cord injury, and it has really saved my life. However, my body has recently built up a tolerance to the medication and it is no longer working for me. My pain doctor just recommended Lyrica to me, but I'm hesitant and nervous to start it because of all the negative reviews I've read, many of which sound like horror stories.

[@andyberkowskimd]

Gabapentin and pregabalin (Lyrica®) are like cousin drugs in the same class. One may work better than the other. One may cause side effects that the other does not. It depends on the individual with a wide variety of responses to treatment.

[@golden-63]

Gabapentin restored my sleep and my sanity.

[@andyberkowskimd]

It works for many. That is why this class of drugs are a first-line medication group for this condition.

[@colinfidgeon242]

Another excellent video. Thank you so much for putting this information online. Is Gabapentin effective for secondary restless legs? I have restless legs from use of Effexor.

[@andyberkowskimd]

Good question, it is not clear whether there is a distinction between primary and secondary RLS. It is likely there are dozens of genetic variants of RLS, many of which are affected by other substances including antidepressants. Gabapentin works by decreasing the RLS/urge to move signals in the brain, and as far as we know, it is agnostic to the cause or triggers of the symptoms.

[@colinfidgeon242]

@@andyberkowskimd Thank you. I'm going to ask my Psychiatrist if I can try Gabapentin. I will let you know if it works!😁

[@liamporter1137]

I'm taking Gabapentin now and it works well for me. But worry it can affect my health in the long run. Are there patients who are on Gabapentin for 20, 30 years without causing other damages to the health? Thanks.

[@andyberkowskimd]

Gabapentin was originally a seizure medication and has been used for decades. With every treatment, there is a side effect, particularly for drugs that affect the brain. However, gabapentin does not seem to cause long-term side effects and is generally limited to things like drowsiness or dizziness right after taking it. With many years of real-world use, long-term consequences should have shown up by now if there were major concerns.

[@airworksgreat]

Taking pregabalin 50 Mg 3 month now. On and off. Working 70%of the time. I tried be off 1month but come back now drug doesnt seem to work.like 50%. I used to take wellbutrin 1year before RLS started then i quit wellbutrin. Any connections?, can i take wellbutrin again?i am feeling depressed.

[@andyberkowskimd]

The biggest clinical trial of pregabalin used 300 mg: www.nejm.org/doi/10.1056/NEJMoa1303646 Bupropion may be the only "RLS-neutral" antidepressant and was even studied to see if it would help: www.jabfm.org/content/24/4/422.long

[@bobboscarato1313]

Doctor Berkowski I've been using Methyl B Complex or Super Vitamin B-Complex both of which contain other mineral and nutrients and it helps a great deal with RLS. without them I couldn't get any sleep. I was prescribed Gabapentin 300 mg. three times a day but it was awful and I quit taking it!

[@andyberkowskimd]

Gabapentin is not for everyone. Typically, physicians dose gabapentin once close to bedtime or once with dinner and once close to bedtime. In most without augmentation, RLS affects patients only at night so it is not needed during the day. Regular gabapentin may wear off by the morning if only taken at night, which helps to mitigate side effects compared to other conditions like nerve pain in which someone may take it several times per day.

[@bobboscarato1313]

@@andyberkowskimd Thank You Doctor!

[@CyborgMaMa]

I take Ropinrole 3x day - works better than nothing but i still have frequent break thru RLS. It has gone into my arms also. When i have s bad attack in both legs & arms it’s unbearable. Ordered Magnesium oil spray to try. Hope it helps some.

[@andyberkowskimd]

The problem with dopamine agonists like ropinirole is that they eventually cause augmentation, or a worsening of the condition with long-term use, which was not picked up in the shorter studies that led to FDA approval two decades ago. kzbin.info/www/bejne/nYCTpoScfrF6h80

[@ujahu]

Can you please advise... My mom has severe RLS and she is currently taking 0.375mg Pramipexole. Should she switch to any form of Gabapentin? If so, what dose size do you recommend? Thanks!

[@andyberkowskimd]

Again, these videos and comments are general information only. RLS specialists are hard to find in the US but the RLS Foundation (rls.org) has a list of Quality Care Centers and clinicians expressing knowledge of RLS in various states/countries: www.rls.org/treatment/find-a-healthcare-provider

[@eleanoraquitaine2966]

I'm on 1800 mg per night of gabapentin and it works but not completely. I don't want to increase my dose. Now I'm looking at natural remedies like magnesium spray and chamomile oil instead of taking more gabapentin. Any suggestions?

[@andyberkowskimd]

In general, gabapentin may be poorly absorbed above 600 mg so many doctors prescribe 600 mg to be taken separated by 3-4 hours, including a dose with dinner to get more out of the same amount. Studies have not shown benefits to taking magnesium for RLS and I'm not aware if anyone has studied chamomile oil.

[@eleanoraquitaine2966]

@@andyberkowskimd Thanks so much. I've been taking magnesium for years and still do and maybe it's helped a bit but the gabapentin has helped the most for me.

[@Pine_bluffs]

Please be aware of serious side effects sometimes appearing a couple of years into using this. Very hard to come off due to withdrawal effects, requires yearlong tapers in many cases. There is a FB support group for this drug w 23.000 members. I regret going on it. The high was a buzz though.

[@andyberkowskimd]

Not every drug works for everyone or is well-tolerated. Gabapentin and similar drugs have not been shown to cause dependence or need for prolonged taper.

[@Pine_bluffs]

@@andyberkowskimd With all due respect Dr, misuse of Gabapentin is well documented and on the rise. With euphoria like that seen in opioids, and severe anxiety, tachycardia and seziures in withdrawal, I’m pretty sure it will make it onto the controlled substances list eventually. www.ncbi.nlm.nih.gov/pmc/articles/PMC6333539/

[@wendy444]

I couldn't take Gabapintin so I was given another medication that was prescribed. They both made me dizzy, fuzzy eye site and nausea. So I wouldn't take anymore pills.

[@andyberkowskimd]

Thanks for sharing. The majority of patients who did not have their condition permanently worsened by dopamine agonists would not need medications to keep symptoms under control, particularly if iron was aggressively supplemented or iron infusions were performed. With medications, sometimes the side effects are worse than the disease. RLS is not a degenerative condition or one that has to be treated for prevention of something else (e.g. treating high blood pressure to prevent heart disease), so it is treated to the point of acceptance/tolerance by the individual. Sometimes that means one does nothing to treat it.

[@wendy444]

@@andyberkowskimd thank you!! I will look into Iron infusion. I never heard of that procedure. All I know was the cure was worse than the problem- however restless legs are very annoying.

[@safari5786]

Cheap easy fix (electrolytes potassium and magnesium). Trying to hide it from you to sell useless drugs.

[@bobbydavis2299]

​@@safari5786Unfortunately for a lot of us the natural approach did not work, I have tried it all with little success.

[@bobbydavis2299]

I was prescribed Gabapentin @ 300mg, did nothing, another Doc said the starting therapeutic dose is 900mg, works great! I tried 600mg after watching this video and it did not work. So it looks like I am absorbing more than 600mg, I take 3 x 300mg caps 2/3 hrs before bed.

[@andyberkowskimd]

Gabapentin's absorption is highly variable among individuals including the same individuals on different days. There is definitely more drug in the system from 900 mg than 600 mg but nowhere near 50% more.

[@johnwood702]

Having been on these drug with reaction I would not want to have again and some info recently come across I personally would not recommend. I have found magnesium to work well for restless legs/ body issue.

[@andyberkowskimd]

Yes, with any medication, one may experience side effects that make it difficult to use for treatment. This is one of the reasons why prevention is so important.

[@RedDieGaming1]

I used gabapentin 50mg first i did feel a slight change but then everything went back to being the same then used 150mg didn’t feel a single change except for more sleep and drowsiness and nothing else

[@andyberkowskimd]

Thanks for sharing your experience. Many patients require 300-600 mg gabapentin to have a strong effect on RLS. Some people have side effects from doses that limit the ability to get up to that amount depending on the person.

[@aethylwulfeiii6502]

Why has no one even considered suvorexant?

[@aethylwulfeiii6502]

Seems safer than opiates and dopamine agonist.

[@andyberkowskimd]

Great observation, and from what I have heard there may be some ongoing clinical research on suvorexant in RLS so perhaps we will find out soon if it may help.