I can’t think of a good reason to use gabapentin and pregabalin together, but I have seen it a few times. Here’s the med list and what I would look at.
- Dulaglutide 0.5 mls once weekly
- Gabapentin 100 mg TID
- Omeprazole 20 mg BID
- Trazodone 100 mg HS
- Ibuprofen 800 mg TID
- Aspirin 81 mg once daily
- Plavix 75 mg daily
- Pregabalin 75 mg TID
- Metformin 850 mg BID
- Asking more questions about the gabapentin and pregabalin together would be my first step in this scenario. I certainly have seen cases where we are tapering off of one and onto the other due to ineffectiveness. I try to give the provider the benefit of the doubt in situations like this when I don’t know for sure, but definitely have to ask the patient and/or provider if there is a gameplan to transition to one or the other.
- The next item that would raise some concern would be to investigate the ibuprofen use as well as aspirin and Plavix. There is certainly an increased risk in GI bleeding when a patient is on more medications that can inhibit platelet effects. That’s a pretty substantial dose of ibuprofen as well. CBC monitoring would be very important as well as patient symptoms (bruising/bleeding).
- This patient is on a few meds that can cause GI side effects. Dulaglutide, metformin, as well as the above mentioned ibuprofen could all certainly impact GI status and may be contributing to the need for BID PPI. Further questioning on this would be very important to me.
What else would you look at with this medication list?
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Definite case of poly-pharmacy. Both are gabapenoids or GABA agonists and although they have a slightly different chemical shape I believe they principally act on the same receptor types. Possible case of multiple prescribers? Dropped ball on a cross taper? If anything, pick one and increase the dose to response. Gabapentin is nice in that it’s not a controlled substance (I think Kentucky and a few others are making it a V) unlike pregabalin (federal schedule V)
also there is ddi Plavix and omeprazole
I would question the low dose of Gabapentin. This very low dosing would lead me to believe the drug was just added to med list or patient is tapering off due to added Pregabalin. I would question how long they have been taking Gabapentin first, if recently added then a phone call to MD would be necessary. If not recently added, then I would be looking for tapering schedule. Eric, is there any cause for both meds to be on board at the same time? Thanks.
I have been taking gabapentin for several years my Rheumatologist suggested adding pregabalin as my neuropathy is not easing up. .I take it in the morning and gabapentin at night.
However now he wants me to taper of gabapentin and take pregabalin 3 times/day. For the last several weeks my neuropathy has gotten worse and keeping me up at night. I’m averaging 3to4 hours of restless sleep.
My PM prescribed Trazodone but it hasn’t kicked in yet.
My question is am I taking the correct medication and the correct dosage.
Gabapentin 300/ 3 for a total 900,mg
Pregabalin 75 mg 1/day
Trazodone 50 mg/ nightly
Omeprazole 25 mg 2/ day