How Does Gabapentin Enacarbil (Horizant®) Work Differently for Restless Legs Syndrome Treatment?

Gabapentin enacarbil (Horizant®) is now a consensus first-line medication in the treatment of restless legs syndrome (RLS) along with pregabalin (Lyrica®) and gabapentin, but how does it work and what are its benefits? ‪@andyberkowskimd‬ reviews Horizant and how it works for RLS including its advantages and disadvantages. For more background on gabapentin and Horizant, watch this video:
• Gabapentin Versus Hori...
In this video Andy Berkowski, MD covers the following:
- how the gabapentin drug works in the brain to relieve RLS symptoms
- barriers to obtaining Horizant including cost and lack of insurance coverage
- improved and long-lasting absorption of Horizant from the gut into the bloodstream, making it function as an extended-release medication
- absorption with food versus empty stomach
- how much time it may help with RLS symptoms
- when it is best to take Horizant based on how the drug works
Lyrica is in the same class as gabapentin but it has different features. Watch here to learn:
• Lyrica for Restless Le...
These videos are for general medical information, but those who live in or near Michigan, Ohio, or Florida can hire ‪@andyberkowskimd‬ of ReLACS Health for formal consultation regarding Horizant, treatment of RLS, and help with any other sleep symptoms that require a little more time and expertise. Go to www.relacshealth.com/ for more information.

[@danielwren-ud1hl]

I appreciate all you do for those of us who struggle with RLS. HORIZANT completely stopped any symptoms of RLS for me. Sadly the drowsiness would not go away until it was time to take it again.

[@andyberkowskimd]

Gabapentin enacarbil is absorbed over a long period of time and functions like an extended-release gabapentin. This can be beneficial to those wanting it to last through the night after one dose, but in some, the adverse effects can also last a long time as well, including into the next day. It depends on the person.

[@aahsigh8706]

It typically occurs at the nap hour, and if you are in an environment whereby the room conserves heat too well, then the best approach is to do a before nap time workout routine of your choice for an hour and also remember to keep the dry air out during the summer the best way you know how or winter time using the thermo control with the "fan" control setting on "auto" fan setting simultaneously and not "on". Dry fan air will dissipate at auto setting, and it's good for the lungs when you do your workout out in your room at night before bed. That's my conclusion and cure after 38+ years, too. It seems that at this age, it is the gold standard age experience I've noticed. Human evolution wasn't meant for energy saving high-tech rooms, which trap dry air in rather to the contrary outdoor experience. Who even gets cured off of restless leg syndrome on a couch rather than outdoors doing stuff and then napping in the forest somewhere. I am serious about this. It's a cure on my behalf in every season of the year and counting. My time for a workout is at the 12 mark to 1am. It is cold outside to open windows and dangerous too. unpredictable too if you live with your loved ones.

[@user-em8bi9ky8l]

Thank you Dr. Berkowski- I am considering switching from regular gabapentin to Horizant, so your video offered helpful information- much appreciated!

[@andyberkowskimd]

You are welcome!

[@magpiesneedle2575]

I’ve been working my way through all your clips. I really appreciate your personable manner and how clear and concise you are. I am seeing my neurologist soon and now have a lot to ask her.

[@andyberkowskimd]

I appreciate that! I will try to keep them coming...

[@AlexFromTheDistance]

Thank you Dr. Berkowski from a RLS patient. Do you happen to know when Horizant cheaper alternatives might be available?

[@andyberkowskimd]

The best cash price my patients and I have found has been Truax pharmacy, which is a mail-order pharmacy based out of Minnesota, which charged $55 + shipping for 30 tablets of 300 mg or 600 mg: www.tps-rx.com/ Some patients are charged $555 AFTER insurance approval for a month's supply, so this medication is part of the complex insurance/drug company relationship leading it to be generally out of reach for most patients, perhaps until it goes off patent?

[@kesterhoward5942]

Hello from Australia, Thank you for all work you are doing . I have been successful taking 2 mg buprenorphine for 4 years now . I know some people who have been taking buprenorphine for 10 years still on the same dose Sadly I received another suicide video this week. We are the victims of the opioid war , I pray that you can change the mind of doctors on a global Scale with your videos. Have you thought of interviewing patients. Kester from the land down-under

[@andyberkowskimd]

In the US system the pendulum may have swung very far in the opposite direction away from opioids, such that many patients may be suffering when opioids could be used appropriately including for pain after surgery or severe RLS when it is a consensus treatment. This blog addresses this in more detail: www.relacshealth.com/blog/why-are-doctors-unwilling-to-prescribe-opioids-for-restless-legs-syndrome Buprenorphine is an opioid that should reassure clinicians against fears of abuse or breathing problems but it seems like clinicians are even more unwilling to prescribe this one compared to others, perhaps due to lack of knowledge and experience with this drug outside of certain specialties like addiction medicine. kzbin.info/www/bejne/pHTSfIB_g6mcrc0

[@airworksgreat]

Is better than lyrica?

[@andyberkowskimd]

There are no head to head trials. Think of these as cousins, they are the same class of drugs but slightly different. One may work better for one person and one for the other. Same with adverse effects.

[@valeriyb6617]

Doctors don't want to take a responsibility or something else. I suggested to prescribe me a horizon and she did. But it doesn't help me it all.

[@andyberkowskimd]

Treatment effectiveness depends on a lot of factors including the dose of the drug, the timing, previous exposure to dopamine agonists: www.sciencedirect.com/science/article/pii/S1389945718305094?via%3Dihub With all treatments, there is substantial individual variation and definitely possible this treatment may not work for many.

[@captainblando]

I was taking upwards of 2800 mg. Then its stopped working after a few years

[@andyberkowskimd]

Many medications are shown to cause "tolerance" in which a medication that was previously effective becomes less effective or requires a dosage increase. The class of drugs to which gabapentin/gabapentin enacarbil belong are not known to cause tolerance. Generally, there is another process occurring that makes the condition worse such that the previous treatment is no longer as effective. Here are a few examples: kzbin.info/www/bejne/a3uUqXhvq9uiec0