Wow, there’s alot of talk about these two, gabapentin and lyrica. They are a couple of great options to treat pain, painful problems, and other stuff…. Fibromyalgia, neuropathy, sciatica, sleep, and the list goes on. Take a look. I’ve got some road miles on this one
I’m going to talk today about gabapentin brand name naronton which is the precursor to another gabapentinoid that’s the class gabapentinoid lyrica brand name or pregabalin and i go back with this drug i was an early adopter the early pain docs i was one of them had didn’t have a lot of choices for neuropathic pain nerve type pain certain types of pain that were
Very resistant to traditional analgesics like opioids we just didn’t have anything so we used carbamazepine which is tegritol the lant and we used these other drugs that had baggage and you had to get blood work he had to monitor it side effects i can’t tell you how many people had gingival hyperplasia or that’s where the gums get really big on the lantern
Sometimes it has to kind of be cut away i mean who wants that kind of drug but yeah if you’re hurting like some of these people did yeah you wanted those drugs so out came a letter to the editor right out of the middle of nowhere in 1994 and this low-level anti-epileptic drug or anti-seizure drug was found to be really pretty good and you didn’t have to get a lot
Of blood work didn’t seem to have a lot of side effects it was clean it was a clean drug and talk about embracing a drug it was a good adjunct an adjunct is something we use so you get the one plus one equal three effect in other words you get an effect that tends to amplify another drug’s desired effect in this case it was an opioid and gabapentin does that
It does help diminish the opioid load it’s opioid sparing it guess what we do that with oxycodone hydrocodone we had acetaminophen opioid spearing theoretically so there we were using this drug off to the races like here we are writing that drug how do you write the drug well it’s an anti-epileptic drug for certain seizures and it’s its label so it’s off label
We’re writing it off label fine half of the drugs we write as healthcare providers especially in the pain world off-label it might surprise you what is an off-label drug we use for pain such as amitriptyline it’s an antidepressant right well we use it for myofascial pain there are some indications for it so example so park davis developed that drug and park davis
Was a drug company i don’t think it exists anymore but they went into naughty land they uh did a few promotional things that really really took a good drug and put it in peril in other words uh his trip this drug was turned into be a blockbuster and to give you some idea even today it’s blockbuster in 2017 i think it was the 10th most common written drug that’s
A big drug it’s generic back then it wasn’t generic and so it was promoted off label well the federal government had a field day with that and they got into all sorts of litigation with the company it was picked up by another drug company that’s still around it’s a good drug really a good drug but they paid out a lot of money for using it off label okay so here
I am and i am a believer in fibromyalgia and i believe we need to look neurologically at fibromyalgia it’s neuroinflammation most likely glial cell level it’s in the weeds isn’t it but wouldn’t gabapentin work there might so i was using that drug and i approached the company they approached me it was kind of a simultaneously hey can we look at fibromyalgia with
This drug and this is on the heels of understanding that pre-gabilan was coming out pretty soon that’s the next generation gabapentanoid and that would be labeled lyrica um so i did a study and you know i had a thousand pages of data and everything and this thing came along with park davis and that study i never i never published it i published parts of it a
Different way but and i had written some work on it but it was obscure however my data on fibromyalgia looked pretty good and in fact pregabalin was labeled for fibromyalgia i thought it was because of me but in fact let me tell you it wasn’t because of me but it was recognized that gabapentinoids are really a good drug so why are we here today it’s because i
Have been on youtube learning how to do youtube and i check out related stories then i go to facebook group check out related stories they are murdering they struck on youtube and they are presenting it in all sorts of unsophisticated irrational ways that i just want to clarify okay you want to talk everything over with the health care provider that’s standard
Disclaimer and a qualified health care provider but i’ve given well over a million doses of this drug i get this drug so side effects yeah makes you a little sleepy but that’s good too because if you have trouble sleeping vis-a-vis fibromyalgia failed back syndrome interstitial cystitis a number of problems gabapentin enhances stage four stage four sleep is
Important because in pain if you look at sleep studies uh sleep is interfered at alpha 2 intrusion what that means is you don’t get to that deep sleep stage 4. that helps with memory it helps with refreshed thought the next day and you’ve heard it i just can’t think i i can’t remember anything the fibro crew they know that well that’s the point you can take a
Side effect to your benefit if you do it right another side effect is not necessarily a side effect per se but it is an important consideration with the pharmacokinetics and pharmacodynamics what the drug does to you and what you do to the drug you throw it off when you saturate these little amino acid transport systems in the early part of your gut that’s the
Problem with gabapentin a lot of it gets just thrown off in the uh 90s 2000s we were given huge doses of this drug 3 200 milligrams geez that’s over three grams of drug and a lot of that was just getting thrown off a little is good lots better no not with this drug so well what do you do with that you develop a drug that helps that transport system work better
They have that now brand name gray lease it has a gastro retentive technology in other words you gotta eat a little fatty meal and you take it at the time of the fatty meal and it keeps the drug and the part of the gut it needs to be at to be absorbed better so you don’t saturate those transport mechanisms that get the drug in you okay another side effect well
Yeah if it makes you drowsy and you take it during the day it’s going to make it drowsy during the day right i mean there’s a number of side effects people can get into here um that will limit its use sometimes but the most uh important thing to know about this drug is it is um unlikely to be a habit-forming drug i’m not saying it’s not you just can’t say it
Anymore starbucks coffee is it’s unlikely to cause significant withdrawal if you stop it abruptly it can i i’ve read stories stories stories stories about withdrawal um and it’s um sometimes causes the typical complaints people say and you read it in the pdr headache nausea vomiting that sort of thing diarrhea well somebody’s going to have a problem and it
Has to be reported the fda reports it to the community but the point is that’s pretty rare the withdrawal i can’t say i’ve ever seen it i know it’s probably happened and if so it was mild okay application of this drug well to understand all the withdrawal and all the other potential side effects you have to understand the risk-aware benefit of using this drug
Well it is a good drug the risk i think exceeds um acceptability on many levels in other words the risk reward benefits in your favor pretty much weigh your food so we get relief from so many things and so if it’s good for something what sticks on the wall well it was try we tried ptsd we tried a number of psychiatric problems psychosis um crps we tried uh uh
Bipolar a number of them and you can read about them it didn’t really work very well it didn’t particularly work with addiction and it was associated with potential suicidality so there’s this box you go to the pdr and now it’s potentially associated with suicide i’ve never seen it i’m not saying it doesn’t happen i’ve just never seen it okay but what it helps
Is neuropathic pain restless like yeah really helps with restless leg hot flashes go figure that and i noticed this pretty early on if somebody’s itching a lot from stuff it helps with that uh it actually has been known to help with renal induced paritis or itching with uh renal failure so if somebody has significant renal failure and they’re on dialysis or
Whatever they tend to itch it’s a great drug for that so you can use the side effects and you can balance them against the benefits and i think you’re gonna win on the benefits okay so we threw it at a bunch of stuff didn’t stick but we still use it for a lot of that stuff i think it has enough a calming effect on folks that they use it as an anti-anxiolytic
Drug so it might help with a little ptsd it might help with situational depression anxiety you just have to be cautious when you use it in people that have a little bit of troubled struggle with depression okay how does it work well it’s all over the internet we don’t know how it works yeah we do know it works alpha 2 sigma subunit it works there and it works on
This calcium gated channel has to do with how cellular activity works in the central nervous system and it’s this voltage-dependent calcium channel really has a lot to do with cellular activity again think glial cell think central nervous system it’s not perfect in its explanation but it looks pretty good it’s not necessary to go in exactly how it works but to
Say we don’t know how it works it’s not correct it’s okay it’s excreted uh renally uh sometimes in the poopies um uh really doesn’t go through a lot of hepatic metabolism to to really make that an emphasis and it it’s a good drug to um utilize in the drugs you worry about renal competition methadones hydrocodone and oxycodones and all okay so the bioavailability
Starts going down depending on that means how it’s available depending on where it’s going it’s only about seven percent across the blood bring back it’s not very high across the blood brain barrier but other parts of the uh homeosapian it’s uh homo sapiens it works pretty well um and it tends to then benefit you with less worries about sedation if you can keep
The dose low because it won’t have much going on in the central nervous system okay so there’s not a lot of metabolism in this drug not a lot of to worry about metabolites and it comes down to this why do they call it gabapentin well it’s structurally similar to gaba gamma aminobutyric acid but it’s not it doesn’t have gaba effect that’s the that’s the hiccup on
This drug people think it’s a gaba like drug there’s gaba a and gaba b so gaba b is like baclofen a muscle relaxer it does enhance stage four sleep it’s a good drug for spasticity and as gaba a gaba a is benzos and gaba a has uh uh as you can imagine a lot of a lot of baggage so there was a lot of concerns for a number of years because of that that poorly chosen
Name there’s the gaba drug it’s not so okay to summarize okay we have technology now to use this drug with gastro-retentive technology and other technologies out there too that make it very acceptable to use uh in a number of age groups when you use it correctly and you ease into it okay there’s um another brand horizon this is a very good drug it tends to be
Twice a day and it has a good release characteristic great lease you can use the side effects to your benefit because you take the whole dose with your evening meal therefore it’s peaking when you’re asleep that’s enhancing stage four sleep right so you’re waking up better slept and you might be a little perkier you don’t take anything in the morning patient
Dependent we do know it probably enhances uh opioid activity at the dorsal horn of the spinal cord are part of the spinal cord and the central nervous system so it’s probably opioid sparing we do know uh this drug is readily available it’s generic and cheap it’s uh really uh a fine choice when used go low go slow so in that long up that little low lighting pain
Start with 100 milligram go into it slow uh older folks they get the neuropathies is a great drug for that older folks get the restless drug leg that great drug for it so i hope that clarified a little on gabapentin and pregabalin um i will say this that the most common complaint i get with that drug is a little bit of weight gain gabapentin less than pregabalin
Pregabalin has more weight gain but it’s not much it’s average i think a study came out two kilogram you know maybe four or five pounds with gabapentin and it’s usually reversible it seems to be fluid in my my estimation uh pre-gabilan may be a little bit more a little bit different mechanism but that’s that’s really the most i hear and folks that start these
Want these and are enthusiastic about continuing them for prolonged periods of time it’s okay to be on this drug it’s it’s not a uh internally destructive drug it’s a pretty safe drug and in the right diagnosis right remember rule two gotta have a diagnosis it’s a a fantastic choice so um if you could leave a review it’d be great if you have questions let me
Know and i’ll answer and it’s pain information i uh have a podcast too i’ll probably be talking about the stuff on the podcast this is a rule four no dive mats right so i’m going to be looking for other meds to help out here help out in the understanding and know this in most cases the world according to me want me but i think this is pretty good stuff and this
Is pretty good experience use any drug with caution but this is a good one
Transcribed from video
The Gab About Gabapentin- And Lyrica… I get this one. By Pain Information
