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Amitriptylyne or Gabapentin?

Hi hope someone can advise me? My MS nurse has been in touch to tell me that she has written to my GP to advise that he prescribe me Amitriptyline or Gabapentin (I assume she meant one or the other?) I am on nothing except Plegridy at present which I started last week so clueless about medication.

The main reason that I had asked to be prescribed something is that currently (been happening for at least 6 months) I wake up after being in bed for a maximum of 2hrs and then continue to wake constantly throughout the night, I do have altered sensation/burning/stiffness etc in my legs(mainly) but I can cope with that it’s good sleep that I would love!

My question is if you have been on either of these drugs did either help you sleep and what are the side effects? I want to go to the GP ‘well informed’ about what I want/need.

Thank you x

Hi,

Gabapentin is for twitchy muscles, I think it retieves sporadic firing of nerves in the muscles, some people call it restless legs… Amitriptyline will help you to sleep, it is addictive as is any serious sedative and it passes the blood brain barrier, not a good idea. Check it out on the Barts MS blog. I use Clonazepam, also addictive but does not cross the blood brain barrier.

I take both drugs for same reason as you

Patrick

Hi Belle It’s a strange situation, they are two drugs which do slightly different things, but both associated with neuropathic pain. I take Amitriptyline for burning type sensations, but I also take Cloneazepam. I should think that probably the Amitriptyline would work best for your burning legs, but you should make sure you take it early in the evening, ie by about 8pm. This way you avoid any kind of ‘hangover’ type experience the next morning. Gabapentin is something that is less sedating, so you can take it through the day. It does seem that you are having more night time trouble than daytime though, so if it is an either/or scenario (and I would expect that, otherwise you wouldn’t know what effect each drug is having) you would be better off with something that is more sedating. But actually Patrick is quite right, Cloneazepam would be (in my opinion) an excellent drug for burning/stiffness and also to help you sleep. Why don’t you go and see your GP, talk about the different drugs and see what s/he has to say. Have a look at https://www.mstrust.org.uk/a-z/pain The sensations you describe are all classed as types of neuropathic pain. It’s different to the other kinds of pain you experience, which is why we often have trouble describing exactly what the feelings are like. This page from the MS Trust explains all the different types of pain you can get and also lists drugs for pain. Basically they are recommending Amitriptyline and / or Gabapentin or Pregabalin. These drugs are most typical for MS pain. Best of luck, I hope you get a good nights sleep soon. Sue

Hi thanks Patrick. I have had a look at Barts Blog as you suggested. It seems like you say that they are both for different things so maybe she is suggesting I be prescribed both after all? It does seem however that Bart is not anti Amitriptyline. This is what he says-

"Amitriptyline is a tricyclic antidepressant (TCA) that used to be used to treat depression. It is not used for that purpose anymore as it is too sedating at doses that work for depression. Neurologists use it to manage pain. An advantage of amitriptyline is that is a sedative and helps you sleep; this is useful if you have pain. Amitriptyline is not addictive and your body does not get used to it; i.e. you don’t have to increase the dose to maintain the desired effect once you get to the correct dose. I am a big fan of amitriptyline and use a lot of it."

Where did you find the info about it being addictive Patrick? I don’t want to start taking something that will cause more problems than it solves! Thank you for your help.

Yes Sue you are right. It is definitely a decent nights sleep that I crave! I feel that everything is more bearable after a good nights sleep but other than the odd ‘blip’ I haven’t really had one of those for years and I certainly haven’t had more than two in a row!

During the daytime symptoms are annoying more than anything.I have kind of got used to them…fizzing is my new normal ha ha.In fact if something isn’t fizzing or stiff it’s like when the aircon goes off and you ‘hear the silence’. You hit the nail right on the head when you say that we have trouble describing them…I always end up feeling stupid and tongue tied and waving my arms around when I try!

I shall wait for the GP to receive the letter and then go and discuss it with him but at least I have more of an idea what I am discussing ha ha!

I don’t think Amitriptyline is addictive. It’s probably habit forming, but that’s a different thing to addictive. And when I started taking Cloneazepam, I easily cut down on Amitriptyline.

Sue

I’m currently trialing Clonazepam and if I’m honest it doesnt seem to help me. I started off on 0.5mg at night to help with spasm/stiffness around 7pm, hoping it would also help with sleep, but unfortunately it didnt help with anything, so on the instructions of the spasticity consultant I increased to 1.0mg again at 7pm, i didnt feel that I was sleeping any better, still waking up like a board and also going into a spasm on waking, but more worrying was that the next day my legs felt weaker, so again on consultants instructions I’ve cut back to 0.5mg for a while.

Hi,

I cannot sleep unless I take clonazepam even if I accidentally forget unless I am suffering very serious sleep deprivation. Barts MS blog is definitely anti amitriptyline cos it can cross blood brain barrier, ProfG wrote a post about it.see

Sunday, 5 April 2015

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Its quite likely that a drug works in one way for one person and a different way for another or even be ineffective otherwise little point in developing multiple versions of the same drug, look at MS drugs.

Ok addictive is a very strong blunt word that is associated with nicotine and heroin but drugs that help you to sleep at night should be treated with a lot of respect.

Clonazepam and amitriptyline both have the same effect so it is quite easy to move from one to the other but giving up a sleeping pill is not easy once started. I do not find Gabapentin at all sedative.

Hello

I was started on Gabapentin 3 years ago because of a surgery I had. Then 4 months later I was diagnosed with MS.

They put me on Galenya, and Notice the gabapentin helped so much with my tingling and pain in my left arm and hand. It has a 5 hour life span. I take 3 times a day if needed. Usually just twice. I take it at 4 pm and 9 pm. It makes me drowsy and helps me sleep.

Hope that helps

Hi Belle,

Yesterday I had an appointment at the hospital, I had a chest infection in December and it has made my symptoms worse. Tremor, right numb side, exhausted, can’t think, dodgy left foot, waking up. You name it, the usual just more of it and quite intense. It has been most unpleasant. In fact, my swearing has increased to a monumental scale.

So yesterday, the M.S. nurse has upped my Gabapentin, it makes me feel fuzzy (and makes me fat) but the upped dose is till things get a bit more stable. I do small things at the moment so it won’t make much difference to my daily life. When the symptoms have gone down, I will lower the dose a bit. I also have pain killers but I am very careful about balancing out which I am taking, what I am doing (or not doing) and if I need everything, I make sure it is a day when I have complete rest and don’t drive.

I have learnt, for me, to take advantage of the unusual hours. I go in the garden, look at the moon and stars, I have even been known to be in the shed at 2 a.m. I read, watch horror, go on netflix, get out my old recipe books, do bed-stretching and relaxation breathing. Much better than wondering why I am awake. Apparently in the paper today, it says that this is the way to go! Smaller hours of sleeping, squeezing an extra day in when most people are awake. Also, I am on here a lot in the middle of the night. It helps a great deal.

Saying that, I slept all last night for the first time in a long time, I didn’t even get up for 13 wees. So perhaps the Gabapentin is working already.

I have found that the burning and weird sensations, have been helped my a bath or shower late on, massage, rubbing oil in my lower legs and feet, then wrapping a nice soft sock round them. It helps ease about 10% I would say, but it is stll 10%.

Thank you all for your advice. I think your answers illustrate that there is not a ‘one size fits all’ solution’! I think I will have to trust my doctors advice and if one drug doesn’t work for me then be prepared to try something else.

I like your attitude…turning a negative into a positive! I also find a nice warm bath gives some temporary relief but not for long unfortunately.

So glad you got a decent night’s sleep last night (although you won’t have got half as much done lol) Let’s hope it continues.

Hi Belle69. I took amyitriptyline for for 5 years on consultant’s advice, side effects horrendous, took me 7 weeks to feel normal after I stopped taking it.As I went cold turkey. If your having trouble with sleep try taking a drowsey antihistamine like Piriton 4mg, knock me out like a baby and there are no side effects. My leg spasms stopped me sleeping.

Hi Belle

Amitiptylyne has been used as a neuropathic pain reliever for decades, my father who is a retired 80 year old surgeon remembers prescribing it as a Housemen (jr Dr) back in the Stone Age. My pain dr complained it was still being used when a much newer and more effective replacement has been available for a long time. Nortriptyline has the same benefits as ami but without inducing the zombie side effects. If your GP suggests Ami ask to have the Nor instead.

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