Patient reports increasing swelling, sedation, and has complaints of being dizzy. She has been having worsening urinary incontinence which has been classified as stress incontinence. She was recently discontinued off her Enablex as she felt it did not work. Gabapentin apparently has not been effective for her neuropathy per her report. Her current medications include;
- Aspirin 81 g daily
- Gabapentin 300 mg TID
- Estrogen topical
- Atorvastatin 40 mg daily
- Valproic acid 250 mg BID
- Chlorthalidone 12.5 mg daily
- Lisinopril 10 mg daily
- Ambien 10 mg hs prn
- Ben Gay prn
Given this scenario, I would be a supporter of discontinuing the gabapentin or possibly increasing it. If the patient has lost faith in gabapentin doing anything, it would be hard to convince them of increasing the dose. We also have reports of potential side effects of gabapentin (sedation, dizzy, swelling).
What to replace it with? Duloxetine makes a lot of sense in this scenario. Duloxetine is a frequent choice in aiding with neuropathy type symptoms and interestingly, duloxetine is sometimes used off label for stress incontinence. It makes sense to try to kill two birds with one stone in this scenario.
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Hmm sedation and dizzy? Check the Ambien..
This is one of the few drugs with gender based dosing, 5mg MAX for females.
I would also venture she is older and so age based guidelines would support the 5mg MAX daily.
Interesting off label stress incontinence use for duloxetine,
Obviously, not given the whole picture in this scenario..
Great ideas Grant! – thanks for sharing