Gabapentin: Neurontin

[Music] hello I'm dr. ken Landau thanks for watching let's talk about neurontin or gabapentin very widely used medicine consistently among the top 10 prescribed drugs in the United States it first became available in 1993 as neurontin and then it became generic in 2004 as gabapentin it was originally prescribed as an add-on medicine for adults who had partial seizures and in 2000 it was used for children with partial seizures and then in 2004 it was used for post herpetic neuralgia originally it was manufactured by the warner-lambert division of parke-davis pharmaceuticals later Pfizer bought them it had a rapid increase in the use during the latter part of the 1990s but without any supporting medical documentation that the pill worked so the FDA has certain approved indications but I just mentioned but the drug was being used misused and abused more frequently than it was used correctly and it was being used for recreational purposes for treatment of hot flashes for anxiety or bipolar disorder or mania or depression that was used for migraine prevention and obsessive-compulsive disorder multiple sclerosis and alcoholism that was used to assist in getting off of cigarettes or people who had itchy skin with kidney disease or people with essential tremor or low back pain or sciatica people who had insomnia it was also used for children with attention deficit hyperactivity disorder for the irritable bowel syndrome for overactive bladder and then it was used appropriately so to speak for post herpetic neuralgia but the studies that showed it was effective in post herpetic neuralgia were only of moderate quality they weren't top-notch and they might not even be accurate so when studies were done the studies pretty consistently showed about a 50% reduction in pain that's the minimum that you notice so 50% reduction in pain but only in 15% of the people who took the drug and to get that benefit people were often taking excessive quantities of the drug so that basically means that 15% of the people got 50% improvement that means 85% of the people didn't even have noticeable improvement of their pain in studies that lasted anywhere from four to 12 weeks but the pain can last for months or years if you have post-traumatic neuralgia well if you're going to take the drug you start off that one pill once a day then after a period of time you go to two pills like one every 12 hours then after that you take three pills a day then you go up to a total dose of 600 milligrams every eight hours that would be the max you're supposed to take and they have now an extended release form called release that you only have to take one pill a day but you start off with a low dosage and then you increase it up to 1,800 milligrams a day now it's not known to help any other pain condition so if you have surgery of knee surgery and you have pain abdominal surgery and you have pain this is not the pill that you're going to take if you happen to have sensory neuropathy from HIV infection or maybe you have the regional pain syndrome that we call reflex sympathetic dystrophy it's not gonna work doesn't work in even the neuropathic conditions that aren't either diabetic neuropathy or post herpetic neuralgia doesn't seem to work in any of the relatives and interestingly all doses seem to give you pretty much about the same amount of relief and it's just as effective but much less expensive than lyrica so some people have an impression it's a pain pill as I said it's not some people think it's just a general neuropathic pill it is not there's no reliable evidence for that and even for epilepsy that it was approved for it seems to work only in about 20% of the people so in other words 80% of the people who take it for epilepsy the partial epilepsy it doesn't even work ten percent of the people who take placebo get as much benefit well there's no appreciable metabolism inside the body of the medicine it's excreted unchanged in the urine and it's not bound to any protein circulating in your bloodstream the half-life is about five to seven hours that's why you have to take so many in the course of the day unless you're going to take the very expensive slow release form and the good news if there's any good news about the drug this doesn't change any other drugs metabolism so you can take it with or without food you can actually even break the pill in half but if you break the pill in half you better use it relatively quickly because it's shortly going to become ineffective and interestingly with this drug the more you take the less is bioavailable inside your system so if you take a dose of 900 milligrams 60% is going to be bioactive in your body but if you take those 2,400 milligrams or 3,600 milligrams or 4,800 milligrams only a third of it is going to be effective inside your body pregnancy not a good idea preclinical studies show that it can cause skeletal and visceral abnormalities increased fetal death it's passed in the Mother's Milk so we don't think it's so safe for use by women who were breastfeeding used war and women than it is in men it seems that it's used as frequently in people over age 60 as it is under age 60 there's some drug interactions that you have to be aware of the drug interacts with other central nervous system depressants so interestingly if you take it it is going to decrease the concentration of hydrocodone in your system that's interesting but it means that if you stop taking the gabapentin then you're going to have an increase in the amount of hydrocodone in your system and that might be sufficient to knock you off that's very dangerous situation if you take it with morphine morphine is going to increase the concentration of gabapentin in your system and as you'll see gabapentin has a significant number of side effects so how does it work it's the central nervous system to present work similar to a chemical that you might have heard of gaba GA ba and it works on a variety of areas of the brain it also probably interacts with a group of other receptors it probably works on the NMDA receptor and maybe some of the inflammatory cytokines and protein kinase C the side effects that's what you have to worry about a lot of side effects in taking gabapentin or neurontin side effect of dizziness probably up to 30% of the people who take the drug at least initially gonna feel very dizzy and remember I said it's a central nervous system depressant so one in five people going to suffer from fatigue or sleepiness or drowsiness or gait abnormalities some of the people are going to retain water so they're going to have swelling of hopefully just the feet sometimes even the face some people develop tremor from taking the drug or their eyes dart back and forth like that sometimes it can cause in men's sexual dysfunction erectile dysfunction loss of libido that causes the usual side effects headache nausea vomiting constipation indigestion diarrhea dry mouth it can actually cause some teeth problem because it interferes with saliva it can cause some lured vision and slurred speech if you take it with the benzodiazepines or the opioids or you drink too much it can really suppress your central nervous system and then you could die that's the problem side effects especially in relatively young people include hostility and agitation it can increase the size of the male breasts not the female breasts it can cause liver abnormalities jaundice elevated liver function tests that can cause high blood pressure and palpitations and in older individuals their kidney doesn't work as well so more of that builds up inside the system and is more of it builds up then you become sleepy so sleepiness is a significant problem in senior citizens especially it can cause a variety of problems because it can cause you to be sleepy you got to be careful driving the car operating heavy equipment that can cause hypersensitivity reaction causes your tongue as well causes your blood pressure to fall breathing abnormalities and there's an interesting syndrome called dress and dress stands for drug reaction with eosinophils and systemic symptoms and what that can do is cause inflammation all over it can cause a fever it can cause nausea it can cause lymph nodes to be swollen and it can cause inflammation in your heart your liver your kidneys your muscles your lungs that's a major issue and if you stop taking it suddenly and you have a history of seizures well it can cause you to have epileptic seizures and it can cause increased incidence of suicide and suicidal behavior and especially in children between the ages of 3 and 12 it can cause significant emotional lability and hostility and thought disorder and movement disorders pendant animals it can cause a pancreatic acid or cell carcinoma and in preclinical studies it was shown to increase the risk of adenocarcinoma it's one of the most widely prescribed substances why did he abuse substances the Centers for Disease Control says it's not addictive drug but because it's low-cost and it's widely available and it's not a controlled substance people are abusing this one like you can't believe in 2012 there were 39 million prescriptions written for the drug in 2016 that number had increased to over 64 million and continues to go up between 2011 and 2016 there was a 300 fold increase in the number of prescriptions written drug abuse in Appalachia has increased about 3,000 percent over the period of the past ten years it can potentiate the action of other central nervous system acting drugs so it increases the high supposedly although and people who take methamphetamine it sort of makes the mellow it's also used to cut heroin well in abuse it's known as Johnny's or Gabby's and as matter of fact probably fifty percent of the people who abuse just opioids also abuse gabapentin and if you abuse opioids and either muscle relaxants or benzodiazepines 25 percent of people abused this one too in Ohio there were 9 million more prescriptions for gabapentin than there were for oxycodone and it's the most widely abused and diverted illicit drug in the US prison system so there's a lot of abuse going on in this if you look at the general population somewhere one two percent of the people abused the drug if you look at the opioid users well probably more than 60% abused the drug well it's very frequently used in combination with cannabis and with alcohol and with the SSRIs and with gaba are the GHB first reported case in the medical literature came out in 2007 in a woman who was 67 years old she was taking far in excess of the recommended dose she was taking 7200 milligrams a day she suddenly stopped the drug she had withdrawal symptoms she had trembling and she had sweating and she had excitation and she turned ashen question is why do people abused the drug people abused the drug because it increases their sociability it increases their euphoria they get a marijuana like high it causes relaxation a sense of calm and mellow but in some people it causes what's known as a zombie-like effect now if you stop taking the drug you got to stop taking the drug slowly if you suddenly discontinue it you will have withdrawal symptoms they can range from anxiety and insomnia and nausea and vomiting and headache you can be sensitive to the light you can be confused and disoriented you can have seizures and chest pain you can have sweating and flu-like symptoms now starting in the mid late 1990s the drug was marketed by the drug company for in excess of 12 non approved conditions so that the FDA hadn't approved their studies hadn't shown that it was effective and the studies that were done were small studies that were funded by the company and they selected the ones that they wanted to publish and the ones that showed it wasn't any good they didn't publish well as a result of this kind of nonsense and the shenanigans going on the company paid more than 400 million dollars in fines and then they were also sued by the Kaiser Foundation had paid them about 150 million dollars because they were being promoted they promoted the drug the company for bipolar disorder migraine headache prevention without any kind of indications and actually a lot of the internal documents regarding the drug came out because of lawsuits and what's called the discovery and it was called in internal emails actually by the executive medical director I'm not making this up executive medical director said it's a snake-oil of the 20th century and the former vice president of neuroscience said it had negligible effect on treating depression so actually there was a study that was published in 2009 in the New England Journal of Medicine highly respected and what they did was because of all of the lawsuits they had some internal documents of the company and they looked at some studies they looked at the studies that were done they looked at the protocol that was used and then they looked at the protocols that were published and they found a lot of differences what that means is you change the result to show whatever you want and that's not the way science is performed that causes significant problems well there's some extended release forms of gabapentin there's release and there's horizon now both of them are phenomenally expensive and as a matter of fact the insurance companies tend not to want to cover these things they both came out in 2011 that release was for post-traumatic neuralgia The Horizon is a prodrug and it's used for people who have restless leg syndrome that's moderate to severe in nature or for post-traumatic neuralgia well how much is all this gonna cost is the question if you go to Costco and you get a month's supply of generic gabapentin it's gonna cost you 15 bucks cash if you go to Walgreens it's gonna cost you 70 bucks and if you go to CVS they'll charge you $80 cash on the other hand if you go to good rx and you get a coupon it's gonna cost you less than $20 cash with or without insurance now if you're silly enough to want to take the brand name of the drug if you want to take the neurontin you can go and buy it but it's gonna cost you $600 cash and it's not any different than the generic drug at least as far as effect is concerned and as I said the horizon and the other drug that release horribly expensive so you see all these ads for lyric and remember lyrica and gabapentin neurontin basically are the same family they do the same thing they work the same way basically and they have the same effects and unfortunately neither of them work very well if you want to know more about lyrica what's my discussion on the web about that one but as far as gabapentin is concerned it's prescribed too often it's prescribed for indications that are inappropriate it doesn't seem to work very well has a lot of side effects so you got to be careful with this one unfortunately it seems like we have another drug that's abused more than used appropriately it's ition I'm dr. Ken Landau and thank you for watching [Music] you

Channel: wellnowdoctor

Views: 134,894

Keywords: Gabapentin, Neurontin, Pain, Post-Herpetic Neuralgia, Low back pain, Fibromyalgia, Neuropathy, GABA, Glutamate, Diabetic neuropathy, Painful feet, Snake oil, Neuralgia, Neuropathic pain, Bipolar disorder, Drug abuse, Depression, Gralise, Horizant, Epilepsy, Partial epilepsy, Johnnies, Gabbies, Addiction, Withdrawal

Id: Ht7Kk82gFcc

Length: 18min 57sec (1137 seconds)

Published: Thu Jan 11 2018