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Doctors' Answers to "Frequently Asked Questions" - Neurontin

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 10/12/1999]
Question: Would neurontin being a non narcotic drug, have any effects
in the treatment of chronic pancreatitus? I have been taking darvocet hydrocodone oxycodone duragesic system and roxanol liquid.

Answer: Certainly useful in chronic pain. If you are referring to the pain aspect of chronic pancreatitis, worth a try. Can be helpful, and much less toxic than many.

[posted 08/13/1999]
Question: I suffer from reoccuring flare-ups resulting from a pinched nerve in my neck. Symtoms include numbness in the right hand index and middle fingers, pain(ache)in my right arn and pain (ache) behing my right shoulder blade. Seem to go in a cycle where minor pain felt first behind my shoulder blade, followed by pain in my arm and shoulder and numbness in my fingers (hard to sleep at this stage), followed by less and less pain, followed by long period of just numbness in my two fingers. I have been treating it with anti-inflamatories with little succes. Ice on the neck seemed to speed recovery last time and will start it again for this most recet episode. My father (a doctor) heard about a woman with similar problems being treated successfully with Neurontin. When I asked my HMO about it I was told it is for seizures only. What can you tell me about the use of this drug for my condition.

Answer: This drug is commonly used in both peripheral neuropathy as well as chronic pain. Some patients do get some relief. You would start at 300 mg a day and increase it to 1200 mg unless you experienced side effects. Most patients would have trouble getting above 900 mg.

[posted 09/28/1999]
Question: I have been treated for anxiety and panic disorder since 1995. I have been taking Paxil(20mg/day), Klonopin(.25mg/day), and Neurontin (900mg/day) to keep the panic under control. I just found out that I am pregnant and have stopped taking the Klonopin. My doctor has also decreased my Neurontin dosage from 900 mg/day to 600 mg/day until she can find out more about it's safety during pregnancy. I'm looking for any information concerning the use of Neurontin during pregnancy.

Answer: Little available in humans and won't be due to ethical issues. The only data available is in animals. Currently a Class C drug in pregnancy. Most of the studies are done in mice, but a fairly high number of deformations and fetotoxicity compared to others. Nothing serious published in humans, but early in the life of the drug.

Neurontin for Essential Tremor [posted 1/13/99]
Question: My wife has been taking neurontin for control of RSD pain which was the result of ulnar nerve surgery. It seems to help and she has no side effects that she is unable to live with except fatigue. We are concerned about the long term effects. She is taking 10, 400 mg doses spread out over the day to keep the RSD effects under control. She has been at this 4000 mg/day for a year now. Her current doctor, who did not originate the neurontin treatment, knows little about the drug and we can not find any reference on using it at this dosage. Can you provide any information or guidance ?

Answer: Well, you are using it for a non-FDA approved indication, but it is used like this a lot, since it seems effective in some syndromes that we don't have good treatments for. 4000 is certainly a high dosage, and I have no specific experience with this dosage. You might check with the company Parke Davis: 800-223-0432.

Neurontin for Essential Tremor [posted 1/13/99]
Question: I'm looking for information concerning the effects of Neurontin on Essential Tremor. Has it been effective in reducing the tremor in any tests or with patients?

Answer: No information that I'm aware of, but check with the scientific department of the company that makes it, Parke-Davis: 800-223-0432.

Neurontin Risks [posted 1/12/99]
Question: I am on 1200 mg of Neurontin a day, used as a mood stabilizer to control bipolar disorder. I find it has less side effects than lithium, depakote, tegretol, and clozapine, and other drugs I have used. It seems to be keeping me stable. However, I heard a rumor from a bipolar friend that a neurontin study of 2400 patients was recently done and 10 of the participants died inexplicably. What is that all about? Also, are there any known long term side effects or dangers, i.e. liver or kidney damage or increased cancer risk?

Answer: I'd check with the company, there is no obvious risk, but the drug hasn't been around all that long. Try Parke Davis: 800-223-0432.

Neurontin [posted 1/4/99]
Question: I was hunting for information about neurontin, which I just began taking this week. I found your FAQ page, but my I didn't see what I really wanted, which was a PDR link. I was especially looking for all the information I could get, including the sort of information that usually the doctor sees. If you could tell me where I could get such information, I would be really grateful.

Answer: The PDR has all the data we do, if not on the net can be found at any library and most book stores. Also, your pharmacist could provide you with the package insert, which is essentially the same as the PDR.

Neurontin Levels [posted 12/01/98]
Question: What are the uppermost levels of Neuronton being used to control seizures? I was started on it in March of 1998 in addition to Tegretol which I have been taking since 1970. It is not working at 2400 mg daily so my doctor is doubling that amount over the next three weeks and talks of another increase in two months. Thanks for your information.

Answer: Depends on serum levels, but, we're pushing this drug a lot due to low toxicity.

Concerns About  Neurontin [posted 11/17/98]
Question: I am 65 years of age and am taking 2400 mg of Neurontin a day for peripheral neuropathy in my feet. I take the drug three times a day 2 - 3 - 3. If I have unusual discomfort before my next dose I take Ultran. What is the maximum amount of Neurontin that I can take? (of course I would consult my physician) I have no side effects that I notice or anyone else notices. I work full time and other than medication for high blood pressure and estrogen, I do not take any other medications.  I do of course take calcium, vitamin E and a multi vitamin. Your comments would be appreciated.

Well, hard to say. Some physicians have increased it to very large doses for peripheral neuropathy without problems, but most would keep it under 5-600 mg a day.

General Information on Neurontin [posted 10/15/98]
Question: Information about neurontin, please, thank you.

Answer: Neurontin is a relatively new antiseizure medication. Its mode of action is not known. It is generally well tolerated and has begun to be used in chronic pain syndromes, peripheral neuropathy and a host of other syndromes to see its effect. Long term side effects are currently not known since it has only been available a couple of years in the U.S. Some patients develop nausea and GI problems. There can be interactions with other seizure medications.

Neurontin for Pain [posted 10/8/98]
Question:I have had five serious shoulder and elbow injuries, ending a long career in law enforcement. I have been under treatment for the past eleven years. It's been fourteen surgeries, but after each one, I was told that I would have to retire. The pain has been intense and covering it up this long has resulted in extreme stress for I have worked to progress in my career. My doctor just changed medications to arthrotec and neurontin; and for the first time, I am not reminded of the intense pain daily. I have begun to lose feeling in my right arm approx. 2 years ago and am continuously dropping things. That has not been relieved but at least my family can tolerate me in a less painful state. I am still uncertain how these two combined drugs works to resolve pain when all the literature I read is dealing with mood disorders. can you explain? Thank you for your time.

Answer: Neutontin is a relatively new drug. Initially used for seizures;but, found to be effective in many other syndromes including chronic pain. I suspect that is why you are on it-to relieve the chronic pain.

Neurontin [posted 10/8/98]
Question: I have been taking neurontin for rsd. I have only taken it for a week. I have multiple bruising of the extremities. also I had blood work done for this and it showed a bun of 67 and a creatine of 5 and platelets of 125,000 thank you for letting me know anything you may know about this drug.

Answer: Very unusual reaction, but, I wouldn't take it any further.

Neurontin[posted 10/2/98]
Question:I have been on neurontin for two months so far it has help my Headaches. My new neuro. Said to get off, he is putting me on pamelore, I Talked to other doctor, and he said, that it was okay to take both of the meds together.

Answer: Why both if neurontin was working? However, no obvious interaction problem.

Neurontin [posted 10/1/98]
Question: I have been on neurotonin for months, and it has worked well for the bad headaches I was getting. Now I another doctor wants to take me off it. Putting me on pamelore, claiming that neurotonin doesn't do anything for you. My primary doctor says No, citing too many side effects with pamelore, and wants to put me on prozec instead. Why can't I just stay on neurotonin? It was working, I was up to 600 mg/day getting ready to up to 900 mg/day. I can't help but wonder if these doctor's know what they are doing.

Answer: Well, the first rule I generally teach medical students is "If it works keep doing it". We often get too carried away with theory without watching for what really works. I agree with the side effect problem with Pamelor. Why won't your primary care prescribe the neurontin? Especially if it is working?

Neurontin and Sciatica [posted 8/7/98]
Question: Eight months after a dissectomy, I still suffer from sciatica and back pain. My physician has prescribed neurontin. Does anyone know or postulate how neurontin works? What are the mechanisms that make it effective? Has neurontin been proven effective in treatment of sciatica? If it does help me, will I take it for a long period? Does it work like dilantin and have the same sort of effects on the body? What makes nerve pain from disc herniation or scar tissue treatable with the same drug as epilepsy?

Answer: Neurontin is one of those drugs which have been observed to help in patients with chronic pain. It seems to work at the neuro synapse (actual site not known currently) and does have some effect in chronic pain. However, then so do Elavil, Dilantin, etc. Neurontin seems to have less side effects and is becoming the initial drug of choice due to this fact. As to whether it will help with you, only a good trial will tell - there is no predicting the improvement with this drug. It is done in a case by case manner.

Neurontin for Nerve Pain [posted 8/7/98]
Question: 2 years ago I had a partial dissectomy for a herniated disc at C-7/T-1. Then 1 year ago I had dissectomy and fusion at C5-6 and C6-7, which still hasn't solved the original problem of pain, numbness, and some weakness in my left arm and hand. The neurologist says there is scar tissue at C-8 and has prescribed Neurontin as a pain reliever. I can't seem to find information on this medication for this purpose. Truthfully I haven't noticed a whole lot of difference. Do you have any information on neurontin as a pain reliever? Do you know of any solution to this problem? It's become quite a problem and I don't know where to turn. I'm a seamstress and use both my hands to work.

Answer: Neurontin has been used for many purposes, pain relief, migraine prevention, etc., in addition to its seizure uses. However, so have other anti-seizure drugs. Like many other drugs that we use as an adjunct in pain relief it was found by chance. It helps some patients and does not help others. If it works with you, I'd use it. If it doesn't work, stop it.

Neurontin Side Effect [posted 7/23/98]
Question: Is Neurontin associated with lack of libido? I was just wondering if that is a possible side effect of the drug.

Answer: In some patients, yes.

Neurontin [posted 7/22/98]
Question: I have had no benefits from any anti-depressives or combinations there of for treatment of depression and anxiety. I began neurontin and had positive results immediately. Can you help me understand why this is working when I don't fit into the seizure category in any way?

Answer: No, but this is a drug we are using in a number of unusual syndromes with occasional dramatic results. The list of things that neurontin has been tried for is extraordinary. However, if it works keep doing it.

Question: I would like to know the side effects of Neurontin. I am suffering from hair loss and mood swings. I am also having trouble with vision and speech. Is this normal?

Answer: Neurontin is a relatively new anti-seizure medication. The mode of action is unclear and still being researched. Common side effects include drowsiness, vertigo, fatigue, nausea, and vomiting. Alopecia (hair loss) is listed as a possible side effect, but is uncommon.

Question: Please send information on neurontin as a treatment for epileptic seizures and possible side effects.

Answer: Neurontin is a new medication approved by the FDA for 'add on' therapy for the treatment of seizures. What this means is that Neurontin can be helpful if a patient is already on an anti-seizure medication but needs better control. Neurontin may be added to the first medication. Neurontin generally is very well tolerated and one of it's nice features is that it has a very low incidence of interacting with other medications including the other routinely employed anti-seizure medications. As with all medications there is no way to predict if it will help you. Common side effects tend to be: fatigue, somnolence, dizziness and balance difficulties. The appropriateness of using this medication can be discussed with your neurologist.

General Information
Question: I need information on neurontin and its side effects.

Answer: Neurontin is an anticonvulsant whose mode of action is not known. Side effects include vertigo, somnolence & depression, ataxia , fatigue, and nausea and vomiting. Like most drugs, there is a long list of potential problems(see the PDR) but, these are the usual ones. There are also potential drug interactions between dilantin, cimetidine, valproic acid, Phenobarbital and probenecid. If the patient is taking any of these drugs, the physician should be contacted. Also, do not take this drug with antacids. There is a potential long term risk of different cancers in initial studies, particularly pancreatic cancer. This is currently being studied.

Slurred Speech
Question: I am taking Neurontin for neuropathy. It slurs my speech and I can't drive. How long will this last?

Answer: This drug is used to treat seizures. Due to the fact that there is little effective treatment for peripheral neuropathy, we tend to try different drugs. This is one of the newer drugs used to treat neuropathy and has modest success in some patients. However, the slurred speech will probably last as long as you take the drug.

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