Is 800 Mg Neurontin Twice Daily Too Much?

[Guest GreyDogsRule]

I recently posted about our 10.5 year old fellow named George. He had a limp and severe leg pain which led me to think he had osteo. Luckily, X-Rays proved negative.

 

George still has severe leg pain. Our vet now thinks he has a damaged disc or possibly a tumor pushing on a nerve. George was started on prednisone and Tylenol 3 which managed his pain well. He has a chronic pancreatic condition and takes Pancrezyme with his meals.

 

Shortly after starting prednisone, George began loosing weight and drinking water incessantly. Apparently, the prednisone stopped his pancreas from producing insulin and he is now effectively diabetic either short term or forever. He lost nearly ten pounds in five days and became profoundly lethargic. We started him on insulin 36 hours ago. The prednisone is being reduced slowly.

 

I had expected to see a big improvement in George in about 24 hours, but he seems to be about the same. I carry him everywhere as he is very wobbly. He does manage to eat and do business on his own. His appetite is good. If not eating or doing business, he is sleeping.

 

I am beginning to wonder if we have him on too much neurontin. The original prescription was three times daily. I told our vet I thought it was too much and she cut it back to twice daily. I still think it might be too much for a Greyhound.

 

[duncan41]

How is his sugar/insulin being monitored? How much neurotonin is he being given per day? Just random questions - I have no experience, just a healthy dose of curiosity. You may want to consider having his x-rays sent to OSU for evaluation by Dr. Couto. Hugs to you and George. Will keep you both in our prayers - sounds like there's a lot going on. Please let us know how he's doing.

[Guest TheUnrulyHound]

Oh gosh.... He sounds just like Outlaw Please give him a hug and kiss for me. Outlaw was on 300mg of nuerontin three times daily but I know nothing about the maximum that you can give. Outlaw took a few days for the neurontin to work in his system though so if he has only been on it for 24 hours you may see more improvement tomorrow. I feel for you... this sounds so similar it is bringing tears to my eyes

[kudzu]

Gabapentin per Merck Vet Manual:

Dosing for Dogs: 25-60 mg/kg, PO, divided tid -qid; 100-300 mg/dog, tid

Half Life: 3-4 hr

Time to steady state: <24 hr

Possible side effects: Sedation, dizziness, ataxia, fatigue, diarrhea; reduce dose with renal dysfunction.

Above is the dosing I found in the anticonvulsant drugs section so presumably it is gauged to seizures. It is also used for chronic pain but I did not find a seperate dosing for that purpose. Going by the above that 800mg bid (2x/day) is not too much gabapentin per day. However, I am wondering about the way it is being split up.

 

Now dosing in dogs is different than humans so keep that in mind when I tell you this. I am a 130 lb female taking 600 mg tid (3x/day). That's as much as I can take & still function though I could take more at night if I needed. It takes a while for your system to get used to it. For a while I took 300mg bid. It would wear off before the next dose. Then it took an hour or so for the next dose to kick in. In addition, the side effects were more pronounced then when I switched to 300mg tid. (Perhaps that is because it kept a steadier amount in my system.) That worked well for a while but still wasn't enough. Then, on my own, I increased to 300 qid (4x/day). That was awful. Would feel normal for a while then get major brain fuzzies. (Presumably same problem with not having constant dose.) At my current dose, 600mg tid it is high enough to control the nerve pain & keeps the side effects at a minimum. Notice that the side effects were actually less obvious at tid even though each time it was a dose increase. Seems strange until you think about it. Twice a day let the drug wear off. Then the next dose started over so my body just couldn't adjust. Ditto with four doses daily. For a while each day I had a lot more in my system than at other times. For me tid is just right & keeps me on an even keel. I can vary by an hour, sometimes 2 hours, without dramatic problems but it works much better when kept on schedule.

 

With a half life of 3-4 hours, I have to wonder if you dog is maybe getting a dose that gives him more dramatic highs & lows of the drug in his system than if it was split up into three doses per day instead of just two. (I am in accounting so don't take this as vet advice. Am just musing.) For me, it took a few days after starting for my system to adjust & each time I increased the dose my system needed to adjust again. Gabapentin can really mess with your equalibrium so for a little while after starting it you can feel really wobbling & the sedating effects are much more. I would think that general thing could apply to dogs also. I know the one time I lost a capsule on the floor & my senior Grey chewed it up, he acted very sedated all afternoon & woozy.

 

If he is hurting then gabapentin may really help him. I take it for leg pain related to my back. Perhaps you can ask the vet the reasoning for the current dosing of just two large doses instead of 3 smaller ones.

 

Hope you baby feels better soon. My prayers for both of you.

Edited September 16, 2009 by kudzu