Switching from Gabapentin to Pregabalin, a Question

In My Humble Opinion
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I am under a doctor’s care, but my next appointment isn’t until sometime in March. I am especially interested in personal anecdotes of dealing with switching these meds.

I have been taking ever-increasing doses of gabapentin since I finally confessed to my doc that it feels as though I was being randomly stung by bees in my feet, sometime around 1998.

Last month, I told the doc that the gabapentin really isn’t working any longer. He asked if I had heard of pregabalin, and I said of course. He asked me if I wanted to try it. “Sure do”, I told him, and so he wrote me a script for 150 mgs to take twice a day. I asked him if I needed to be titred off the gabapentin, (3,200 mgs) and he told me no, to just stop taking it.

The pregabalin works well so far, for the most part. I am pleased. I have been feeling breakthrough withdrawal symptoms, such as hot flashes/chills, some vomiting, and other symptoms. The worst is that, while the pregabalin at first slapped the restless leg syndrome* down, but now it is back, worse than before.

Any thoughts? I know that taking gabapentin and pregabalin at the same time may be a pain, and would probably make my brain fog worse. I just want to have some thoughts when I see my doc again, although I may need to have a teleconference with him over this.

*I know that most people who are not either afflicted with restless leg syndrome or have a close family member often don’t believe it’s a thing. It’s a thing.

Also, while I do have Diabetes, in Alaska I was also diagnosed with both spinal stenosis and degenerative disc disease, and have been told by the Neurologist at Providence Hospital in Anchorage that my neuropathy stems from my spinal issues, not the Diabetes.

Thanks in advance, I appreciate your input.

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I don’t have experience directly with this particular medicine change. I have dealt with gabapentin before, however, and that definitely seems like a huge jump, from a rather high dose of gabapentin to the initial dosage of pregabalin. I did that with some other medications that usually have a withdrawal period if you go off them, and it really did not go well. If you’re having what feel like withdrawal effects, I would definitely try to talk to your doctor about some sort of taper.

Looking it up, there are three protocols for going from one to the other. One is the abrupt stop as you used. Another is a cross taper of taking half and half for 4 days. And then there’s tapering across two weeks, tapering off of gabapentin over those two weeks and then on to pregabalin.

I also found info that suggested that the recommended taper for Gabapentin is to decrease by 300 mg every four days. But that’s when going off of the drug, not when switching to a different drug. So I don’t know how applicable it is.

There’s also a rough equivalence of 1/6 with the two medicines, though this is disputed. Hence why going from 3200mg gabapentin to 300mg pregabalin seems a bit steep.

But mostly my advice is just to talk to your doctor about the withdrawal effects and mentioning alternative crossover strategies.

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Thank you for responding BigT. I did just get off the phone with the nurse, and she wanted me to go to the ER since the clinic is closed, (I was on the phone on ignore with the clinic for the best part of the day). I will go to the walk-in clinic tomorrow.

Thank you again for your response.