Lyrica Experience

[Colin83]

Welcome to the site, Tess ! :-)

[elarson]

My husband will be starting Lyrica this week. Our reasons for trying Lyrica is to manage partial seizures *along* with post-stroke neuropathic pain and possibly spasticity if we are lucky.

I would be really interested in hearing if others are taking either Neurontin or Lyrica for both of these conditions (seizures and neuropathic pain), because there are not many studies out there for both co-existing conditions. There have also been some studies that show both Neurontin and Lyrica can be effective to treat spasticity, although not primarily indicated for it, and would like to hear if either has helped anyone for spasticity.

My husband currently takes 1500 mg/day of Levetiracetam (Keppra), which is overall working well, but he still has 1-2 break through partial seizures per month. The Lyrica will be an adjunct (add-on) for Keppra for seizure control.

We are starting at 75 mg/day and ramping up by another 75 mg/day weekly over 4 weeks. We hope to have benefit, without too many side affects, at a maximum of 300 mg/day, which is half of the maximum dosage of 600 mg/day for seizure control.

I keep a daily chart whenever we start new meds, and will try to give an occasional update of how it goes ramping up. If any one has questions, please feel free to PM me.

BTW, below is a bit of what I have learned about the Lyrica vs. Neurontin debate, and overall, I think the differences are minimal, except for seizure control and cost.

For seizures, we are comfortable right now in choosing Lyrica as opposed to Neurontin. As Wise said in this article Pharmacokinetics of gabapentin (Neurontin) and Pregabalin (Lyrica):

Originally Posted by Wise Young

In the dose range of 50-600 mg/day pregabalin and 600-1800 mg/day gabapentin, pregabalin reduced seizures by 100% whereas gabapentin reduced seizures by a maximum of 24.5%. Thus pregabalin is 4 times more effective and 2.5 times more potent than gabapentin in seizure prevention.

As far as side effects, I am reading that overall, Lyrica has fewer side effects at comparable higher dosages of Neurontin. Of course, side affects vary widely, also depending on use and other medications. Overall they seem less so for Lyrica than many other add-on AED's for seizure prevention, i.e, it's picking the lesser of evils for seizure control.

Lyrica is chemically related in structure to Neurontin, and works by the same mechanism, but is more potent, absorbs faster and has greater bioavailability (not so much is lost) and is suppose to have a improved side effect profile (I am doubtful of that after reading many message boards about both).

Both have side effects, especially while ramping up and withdrawal. So if you are at high dosages of Neurontin a comparable lower dosage of Lyrica may not cause more side effects. I've read that Lyrica 600mg/day is comparable to Neurontin 2400mg/day. Also that pain relief can be ramped up to more quickly with less side effects (most side effects occur while ramping up).

I am seeing that there can be benefits to Neurontin when used only for
neuropathic pain, but that these benefits decrease with higher dosages, where Lyrica at lower dosages may be better. I found this to be a good practicle article about the lyrica vs. neurontin debate in relation to neuropathic pain http://drpullen.com/lyrica

One of the big difference is that Neurontin is much cheaper, because it's patent has run out, and there are generics available. Especially with co-pays, this can be a big difference. Because Lyrica is more effective than Neurontin for seizures, for us, our insurance will cover it 100%, so cost is not the issue.

What I really don't like about both Neurontin and Lyrica, aside from the side effects, is that some studies have shown that they block the formation of new brain synapses, reducing the potential for neuroplasticity -- definitely not a good thing for a stroke or brain injured person.

[elarson]

oops, made a mistake because of formatting problems. see below.

[elarson]

I said I would keep you all up-to-date on starting with Lyrica and am surprised to be giving you an update so soon.

We were very happily surprised by Rob’s first day on Lyrica. We had expected some possibly negative side effects, in the hope that in a week or more he maybe would have some benefit. Instead, what he/we experienced was an overall very good situation. We don’t know what tomorrow will bring, but here is our report so far. This was starting at a minimum dosage of 1 x 75 mg in the morning.

11:00 He had some tingling in his left foot (affected side).
13:15 He thought he was having a seizure, but it was more of a feeling of being outside of his body. He felt a little euphoric (stoned). He had no dilation of his pupils, and his skin was normal. After 2 minutes it was over and he felt good.
19:00 He had a short nap at his normal time and woke up feeling well.
21:00 He felt good, moved his left leg more and was able to raise it to a short table.
22:00-24:00 We stayed awake 2 more hours and talked about how he felt. This is much later than he can normally be awake. I could understand everything he said, when normally I can only understand 1 word in 5-10 so late in the night. He put some cold ice water on his hand he he did not jump in pain. I was able to touch his left side without it hurting him. He was much more able to handle his transfers to bed. He was also more empathetic and caring about me, because he said he had more energy.

Here is a list of what he said about how he felt:
It’s a weird drug
I feel more happy
I’m processing the effects in my brain
My energy is much better
I’m not exhausted by the pain
It’s night and day / day and night (while humming Sinatra)
I can feel my left side (affected side)
My brain makes stress from the pain less
I feel good
My muscles are more relaxed
I feel like a normal guy
I feel strong
My spine is not sending alert messages to my spine all the time

[elarson]

My husband is now at 1 x 75 mg in the morning and 1 x 75 mg in the night (150 mg total). He is doing very well on it, and his pain has gone from 4-6 on the pain scale down to 1-2. He is able to do much more physically, because he is not using all of his energy to deal with the pain. He is also able to stay awake later in the evenings and is in general much happier. He had some mild side effects the first 2 weeks (headaches, dizziness, feeling of being stoned) which occurred about 2 hours after taking. The side effects have mostly gone away now that he is at 2 equal doses, rather than just once per day. He is also seeing a reduction in his spasticity. We think it is also helping on seizures, as he is about 1 month without having any, which was previously at 1-2 per month.