The Role of Gabapentin in Pain Management

Opioids, non‐steroidal anti‐inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants are used as pharmacological agents to treat pain. However, no single class of drugs has been found to be effective in all types of pain, presumably because pain syndromes involve different mechanisms.

In addition, each of the currently available drugs is associated with adverse effects, some of which are potentially serious or life‐threatening such as idiosyncratic or toxic reactions.

Traditionally, the treatment of neuropathic pain has involved anticonvulsants, such as carbemazepine, valproic acid and phenytoin, and tricyclic antidepressants, such as amitriptyline and nortriptyline and doxepin. The main disadvantages of the anticonvulsants are their potential for drug interactions via the induction of hepatic enzymes, or resulting from inhibition of hepatic enzymes by other drugs. Minor side‐effects such as sedation, ataxia, vertigo and diplopia are associated with carbemazepine and phenytoin, whereas, anorexia, nausea, vomiting and tremor are associated with valproic acid. Chronic phenytoin use may cause peripheral neuropathy (30%) and gingival hyperplasia (20%), and fetal hydantoin syndrome if administered during pregnancy. Carbemazepine can cause chronic diarrhoea or the syndrome of inappropriate ADH secretion, and rarely aplastic anaemia, thrombocytopaenia, hepatocellular jaundice and cardiac arrhythmias.

Tricyclic antidepressants also cause side‐effects that can be troublesome or potentially dangerous, such as anticholinergic effects (dry mouth, blurred vision, urinary retention, ileus), sedation, orthostatic hypotension, tachycardia and atrio‐ventricular conduction disturbances. Such adverse effects are likely to reduce the tolerance of this group of drugs in elderly or unwell patients. Some subgroups of patients with painful neuropathy such as diabetes may also have autonomic neuropathy and may not tolerate the orthostatic hypotension associated with tricyclic antidepressants.

With increasing evidence of the efficacy of gabapentin in a wide variety of pain syndromes, especially neuropathic pain, gabapentin may be potentially useful because of its relative freedom from serious adverse effects, its lack of interactions with other drugs and its lack of potential for causing drug dependence.

A comparison of the evidence available of efficacy and toxicity for anticonvulsants (gabapentin, phenytoin and carbemazepine) and antidepressants (tricyclic antidepressants and SSRIs) in patients with diabetic neuropathy and postherpetic neuralgia has recently been made by Collins et al. [129] These two neuropathic pain conditions were chosen according to strict diagnostic criteria. Although two previous systematic reviews of anticonvulsants and antidepressants in diabetic neuropathy showed no significant difference in efficacy or adverse effects between the two drug classes [130, 131], Collins et al. found that when data from randomised controlled trials for both diabetic neuropathy and postherpetic neuralgia were pooled, the NNT for at least 50% pain relief was identical for both classes of drugs. When gabapentin was compared with other anticonvulsants, there was no significant difference in efficacy.

The NNT for gabapentin was 3.4 compared with 2.2 for phenytoin/carbemazepine. The number needed to harm (NNH, defined as the number needed to harm one patient from the therapy) for minor adverse effects was 2.7 for both antidepressants and anticonvulsants. Collins et al. used two trials to provide data on minor adverse effects for gabapentin and two trials for phenytoin. The NNH (minor adverse effects) was 2.6 similar to that of gabapentin and 3.2 for phenytoin. The NNH (major adverse effects) for the tricyclic antidepressants was 17, and no significant difference in the incidence of major adverse effects was found between anticonvulsants and placebo.

Collins et al. suggested that the difference in the incidence of major adverse effects can be compared by using the ratio between treatment specific benefit and treatment specific harm (defined as the number of patients needed to experience at least 50% benefit for one to experience a major adverse effect that warranted discontinuation of treatment). The ratio for gabapentin was 6 compared with an average of 8 for all anticonvulsants, and 6 for all antidepressants. As adverse data were pooled from both diabetic and postherpetic neuralgia studies, methodological factors and heterogenicity in these data may limit the validity and robustness of these ratios. The spectrum of the pain and short study duration tend to underestimate the treatment effect, whereas the small sample size of the studies overestimate the treatment effect.

The above evidence suggests that gabapentin is as efficacious at treating neuropathic pain with no significant difference in minor adverse effects and a low propensity for serious adverse effects compared with other anticonvulsants and antidepressants. Therefore, gabapentin is a useful agent in the multimodal approach in the management of neuropathic pain.

Adverse Reactions in Pooled Placebo-Controlled Trials in Postherpetic Neuralgia

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Postherpetic Neuralgia

The most common adverse reactions associated with the use of NEURONTIN in adults, not seen at an equivalent frequency among placebo-treated patients, were dizziness, somnolence, and peripheral edema.

In the 2 controlled trials in postherpetic neuralgia, 16% of the 336 patients who received NEURONTIN and 9% of the 227 patients who received placebo discontinued treatment because of an adverse reaction. The adverse reactions that most frequently led to withdrawal in NEURONTIN-treated patients were dizziness, somnolence, and nausea.

Following table lists adverse reactions that occurred in at least 1% of NEURONTIN-treated patients with postherpetic neuralgia participating in placebo-controlled trials and that were numerically more frequent in the NEURONTIN group than in the placebo group.

TABLE 3. Adverse Reactions in Pooled Placebo-Controlled Trials in Postherpetic Neuralgia
NEURONTIN
N=336
%
Placebo
N=227
%
Reported as blurred vision
Body as a Whole
  Asthenia 6 5
  Infection 5 4
  Accidental injury 3 1
Digestive System
  Diarrhea 6 3
  Dry mouth 5 1
  Constipation 4 2
  Nausea 4 3
  Vomiting 3 2
Metabolic and Nutritional Disorders
  Peripheral edema 8 2
  Weight gain 2 0
  Hyperglycemia 1 0
Nervous System
  Dizziness 28 8
  Somnolence 21 5
  Ataxia 3 0
  Abnormal thinking 3 0
  Abnormal gait 2 0
  Incoordination 2 0
Respiratory System
  Pharyngitis 1 0
Special Senses
  Amblyopia 3 1
  Conjunctivitis 1 0
  Diplopia 1 0
  Otitis media 1 0

Other reactions in more than 1% of patients but equally or more frequent in the placebo group included pain, tremor, neuralgia, back pain, dyspepsia, dyspnea, and flu syndrome.

There were no clinically important differences between men and women in the types and incidence of adverse reactions. Because there were few patients whose race was reported as other than white, there are insufficient data to support a statement regarding the distribution of adverse reactions by race.

 

What you should know before you buy Gabapentin online

Keep these considerations in mind if your doctor prescribes gabapentin oral capsule for you.

Before taking gabapentin,

  • tell your doctor and pharmacist if you are allergic to gabapentin, any other medications, or any of the inactive ingredients in the type of gabapentin you plan to take. Ask your pharmacist for a list of the inactive ingredients.
  • you should know that gabapentin is available in different forms that may be prescribed for different uses. Ask your doctor to be sure that you are not taking more than one product that contains gabapentin.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; antihistamines; medications for anxiety; medications that make you feel dizzy or drowsy; medications for mental illness; naproxen (Aleve, Anaprox, Naprosyn, others); opioid (narcotic) medications for pain such as hydrocodone (in Hydrocet, in Vicodin, others), morphine (Avinza, Kadian, MSIR, others), or oxycodone OxyContin, in Percocet, in Roxicet, others); sedatives; medications for seizures; sleeping pills, and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • if you are taking antacids such as Maalox or Mylanta, take them at least 2 hours before you take gabapentin tablets, capsules, or solution.
  • tell your doctor if you have or have ever had lung or kidney disease. If you will be taking the extended-release tablets, also tell your doctor if you need to sleep during the day and stay awake at night.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking gabapentin, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking gabapentin.
  • you should know that this medication may make you drowsy or dizzy, may slow your thinking, and may cause loss of coordination. Do not drive a car or operate machinery until you know how this medication affects you, and your doctor agrees that it is safe for you to begin these activities.
  • if you are giving gabapentin to your child, you should know that your child’s behavior and mental abilities may change while he or she is taking gabapentin. Your child may have sudden changes in mood, become hostile or hyperactive, have difficulty concentrating or paying attention, or be drowsy or clumsy. Have your child avoid activities that could be dangerous, such as riding a bicycle, until you know how gabapentin affects him or her.
  • remember that alcohol can add to the drowsiness caused by this medication.
  • you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking gabapentin for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as gabapentin to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as gabapentin, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Refill

You are only allowed to buy gabapentin online when you refill and you have taken gabapentin before. It means your local doctors have already prescribed you Gabapentin in the past.

Complete the health questionnaires very carefully

your online doctors only know you by your questionnaires. please complete the form very carefully.

General

Gabapentin oral capsules can be taken with or without food. Taking them with food can help to reduce upset stomach.

Storage

  • Store gabapentin at room temperature between 68°F and 77°F (20°C and 25°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you, such as in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Be sure to carry with you the prescription-labeled box that your medication came in.
  • Do not put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your local doctor will monitor your kidney function.

Gabapentin is Used to Treat Seizures and Postherpetic neuralgia ?

What is gabapentin?

Gabapentin is a prescription drug. It comes as an oral capsule, an immediate-release oral tablet, an extended-release oral tablet, and an oral solution.

Gabapentin oral capsule is available as the brand-name drug Neurontin. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, the brand-name drug and the generic version may be available in different forms and strengths.

Why it’s used

Gabapentin oral capsule is used to treat the following conditions:

  • Seizures: Gabapentin is used to treat partial (focal) seizures. It’s taken together with other seizure medications in adults and in children 3 years of age and older who have epilepsy.
  • Postherpetic neuralgia: This is pain from nerve damage caused by shingles, a painful rash that affects adults. Shingles appears after infection with the varicella zoster virus. This virus occurs in people who have had chicken pox.

Nerve pain can be a symptom of many different conditions, including cancer, HIV, diabetes, and shingles. For some, nerve pain is frustrating; for others, nerve pain is devastating and life-changing.

Whether it feels like burning, pinpricks, or sudden shocks of electricity, nerve pain can disrupt your life at home and at work. It can limit your ability to get around. Over time, it can grind you down. Studies show that people with nerve pain have higher rates of sleep problems,anxiety, and depression.Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.

There are three types of nerves in the body:

  1. Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.
  2. Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.
  3. Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Because nerves are essential to all you do, nerve pain and damage can seriously affect your quality of life.

When you have a serious medical condition such as cancer or HIV, dealing with the additional misery of nerve pain can be especially hard. But there is good news. While nerve pain can’t always be cured, it can be treated — and there are a lot of good options available.

Experts believe that 40 million Americans are living with nerve pain. The impact of nerve pain is tremendous. Both the costs to the healthcare system as well as loss of wages and productivity are staggering.

How Are Nerve Pain and Nerve Damage Treated?

In many instances, nerve damage cannot be cured entirely. But there are various treatments that can reduce your symptoms. Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. That way you can reduce the likelihood of permanent damage.

Often, the first goal of treatment is to address the underlying condition that’s causing your nerve pain or nerve damage. This may mean:

  • Regulating blood sugar levels for people with diabetes
  • Correcting nutritional deficiencies
  • Changing medications when drugs are causing nerve damage
  • Physical therapy or surgery to address compression or trauma to nerves
  • Medications to treat autoimmune conditions

Additionally, your doctor may prescribe medications aimed at minimizing the nerve pain you are feeling. These may include:

  • Pain relievers
  • Tricyclic antidepressants
  • Certain anti-seizure drugs – Gabapentin

Complementary and alternative approaches may also help alleviate your nerve pain and discomfort. These include:

  • Acupuncture
  • Biofeedback
  • Hypnosis
  • Meditation

Dosage for postherpetic neuralgia

Adult dosage (ages 18–64 years)

  • Typical starting dosage: Day 1, 300 mg; day 2, 600 mg (300 mg two times per day, spaced evenly throughout the day); day 3, 900 mg (300 mg, three times per day, spaced evenly throughout the day). Your doctor may further increase your dosage after day 3.
  • Maximum dosage: 1,800 mg per day (600 mg, three times per day, spaced evenly throughout the day)

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

Prescription may be reason for Migraine Headache and Tension Headache and Heartburn Symptoms

In our over-medicated society, people are now suffering from All kinds of Headache caused by too much arthritis pain relief and heartburn caused by too much heartburn relief!

Anti-inflammatory drugs used to relieve arthritis pain are, quite understandably, being over used, since arthritis pain is more than a once-in-a-while thing. This is not just prescription drugs, but over the counter drugs such as Advil, Aleve, and Motrin IB.

The result, for many people, is All kinds of Headache that occur just as soon as the medicine wears off. According to a report by Joe Saper,M.D., director of the Michigan Migraine Headache and Tension Headache and Neurological Institute, this is the result of brain receptors becoming overly sensitized.

Another recent report gives a second reason to cut back on these drugs. New studies are showing that continual use can lead to liver failure.

Those who find themselves with worsening All kinds of Headache may want to consider a topical medicine for arthritis pain, or non-drug approaches such as fish oil, boswellia, ginger, or turmeric.

Meanwhile, Danish researchers have released the results of a test showing that extended use of heartburn medication can cause heartburn – and thus create a dependency upon them. Is it any wonder that over 80 million prescriptions for these drugs are dispensed each year?

The Danish researachers did a split test on 120 healthy subjects, with half receiving prescription heartburn medication and half receiving a look-alike placebo. After 8 weeks they replaced the prescription drug with the placebo and those previously healthy subjects began suffering from heartburn. (Gastroenterology, July 2009)

Other researchers warn that prolonged use of these powerful acid-suppressing drugs can also lead to vitamin B-12 deficiency, weakened bones, and an increased risk of pneumonia. (American Journal of Gastroenterology supplement, March 2009.)

Today’s hectic pace and dependence upon fast foods may be the cause of increased incidence of heart burn. even though that’s the cause, then sufferers might want to consider a change in diet rather than a dangerous prescription drug.

They might also consider trying some non-pharmaceutical cures. Cinnamon and honey are said to dispel gas, while a small bowl of sauerkraut will chase away a heartburn attack for many people. Others choose a pinch of common baking soda in a glass of water.

What can I do to prevent another migraine/tension headache?

What can I do to prevent an additional migraine/tension headache?


I got a migraine/tension headache the other day and I rarely ever get them but it was really bad. I was at school and I held seeing this blurry blob that really bothered me and I couldn’t focus. Also 1 side of my vision was really sore and I had to lay down the whole day. What can I do to prevent another one? Thanks!: )

There are lots of answers, the best answer is:

Answer by Polkadot
I had comparable symptoms, went to the optometrist and found my remaining eye had astigmatism. further lenses solved my head ache issue! I mostly wear them when on the computer or reading through. You could give that an attempt! =)

include your own answer in the feedback!

What pain relief medicine should i order for extracting my wisdom teeth?

What pain relief medicine should i order for extracting my wisdom teeth?
I just extracted two of my bottom wisdom teeth and i the doctor didn’t give me a prescription for pain relief medicine. Can you guys recommend what i should get?

Best answer:

Answer by coco pops
codis,or cocodamol or iburofen….works a treat

What do you think? Answer below!

Are pain relief pills safe to eat when taken out of their bottles?

Are pain relief pills safe to eat when taken out of their bottles?
I’m planning to take a few pain relief pills (Tylenol, Motrin) out of their bottles and putting them in a sealed Ziploc bag for convenience. Does taking them out of their bottles reduce the effectiveness of the pills? Are they still safe to eat?
I figure it will be okay because they will still be put into a sealed bag, but any information would be much appreciated. Thanks in advance!

Best answer:

Answer by the_only_solorose
as long as you keep the bag in a dark place it should be fine, light causes breakdown of the active ingredients in those two nostrums. Don’t expect them to last more than a week tho.

What do you think? Answer below!

Fioricet Warnings and The Fioricet ‘High’ and Abuse

Fioricet is a prescription medication used to relieve tension headaches. It works by relaxing muscle contractions that can result in mild to moderate head pain.

Fioricet is a combination of three ingredients: the pain reliever acetaminophen; butalbital, a barbiturate; and caffeine, a stimulant.

The Food and Drug Administration (FDA) approved Fioricet in 1984. Novartis Pharmaceuticals was the original manufacturer. In 2003, Watson Pharmaceuticals bought the rights to Fioricet (Watson is now known as Actavis).

Fioricet is currently available from many manufacturers as a generic.

The original formulation of Fioricet included 50 milligrams (mg) of butalbital, 40 mg of caffeine, and 325 mg of acetaminophen.

However, in 2011 the FDA asked makers of prescription combination drugs with acetaminophen to limit the amount of that drug to no more than 325 mg in each tablet by 2014. This action was taken to protect consumers from severe liver damage, a risk linked with taking too much acetaminophen.

Today Fioricet includes 320 mg of acetaminophen, though some versions of the product sold online still have 325 mg.

The Fioricet ‘High’ and Abuse

The butalbital in Fioricet belongs to a class of drugs called barbiturates, a central nervous system depressant. Like other barbiturates, it has the potential to cause physical and psychological dependence, which can lead to abuse.

Those who use too much Fioricet may report feeling so relaxed and stress-free that they seek out the drug as a way to get high. Some describe it as feeling intoxicated. However, users can feel depressed and “crash” once the effects wear off.

Fioricet with Codeine

Another formula, Fioricet with codeine, is also made by Actavis to treat tension headaches. It contains 30 mg of codeine in addition to the other three drugs, and has an increased acetaminophen dose of 325 mg.

Fioricet with codeine carries a black-box warning about liver toxicity, and about the risk of respiratory problems and death in children caused by codeine.

Fioricet Warnings

Fioricet carries a black-box warning cautioning users about the link of acetaminophen to acute liver failure. In some cases, users of Fioricet have needed a liver transplant; in other cases, use of Fioricet has proven fatal.

Most problems have occurred with an acetaminophen dose of more than 4,000 mg a day. Those affected are often taking more than one product containing acetaminophen at the same time or have underlying liver disease.

Another caution concerns butalbital, which may be habit-forming and therefore has the potential to be abused.

Those with a condition known as porphyria, a rare hereditary blood disorder, should not use Fioricet.