Slow acclimation can help manage side effects

Dear Dr. Roach: I’m 74 years old, not overweight and in good health. Your article on spinal stenosis hit home. I’ve had six cortisone injections in the past year in my back and neck, which have helped. My pain management doctor prescribed gabapentin at 300 mg every night. I could not take it so he reduced my dose to 100 mg nightly. This is better. I sleep soundly, but do wake up to answer nature’s call. He wants to me to do the 100 mg for a month. What is your opinion on gabapentin? My vein doctor said it was an ugly drug. My primary doctor put me on it four years ago, but when I read up on it I stopped taking it.— S.L.R.

Dear S.L.R.: Although gabapentin is approved by the Food and Drug Administration for certain seizures and for pain after shingles, it is often used for many kinds of pain from damaged nerves. I have used gabapentin for many years, and my experience is that it is very effective for some, moderately effective for most, and not at all for a few.

The side effects of sedation and dizziness are almost universal, but they can be minimized by starting at a very low dose and slowly raising the dose. The target dose for pain after shingles in the study that got approval was 1,200 mg three times daily, and it can take weeks or months to be able to tolerate this dose. Three hundred milligrams, three times daily, is the minimum dose for most people to get relief from nerve pain.

When used properly, it is not an “ugly” drug at all; however, some people cannot take the side effects no matter how low a dose you start with or how slowly you increase. In your case, I think it may be worth sticking with it.