Horizant: The Second Coming of Gabapentin

Like the religious notion of reincarnation, apparently some drugs are destined to be reborn as newly designed and re-packaged drugs for brand new indications.  I’ve written about Contrave and Silenor, for instance—two drugs with generic equivalents that have been re-tweaked, re-packaged, and renamed, for newer (and larger) markets.

This week, the FDA granted its approval to yet another “new” agent (that’s “new” with an asterisk, mind you), Horizant, developed by GlaxoSmithKline (GSK) and Xenoport.  Horizant is a name-brand version of gabapentin, which is also known as Neurontin.  While on the surface this appears to be an attempt to re-brand an existing drug, it may actually provide some advantages over the already-available alternative.  But the question is, at what cost?  And for what exactly?

Gabapentin was approved in 1994 and is marketed as Neurontin.  It’s approved for the treatment of partial seizures and post-herpetic neuralgia (although its manufacturer, Pfizer, got into some serious trouble for extensive off-label marketing of this compound—so what else is new?).  These days, it’s actually quite widely used by neurologists and psychiatrists, not just for seizures, but also for  chronic pain syndromes, anxiety, mood stabilization (where it’s not particularly effective), and even for alcohol dependence.

Gabapentin’s bioavailability—the ability of the drug to enter the bloodstream when taken as an oral dose—is rather low (and, paradoxically, decreases as the dose is increased) and the duration of its action is quite short, which means that users need to take this drug three or four times daily.  The key advantage of Horizant is that it is a “pro-drug.”  Technically it’s gabapentin enacarbil, and the “enacarbil” refers to a molecule added to the drug which allows it to be absorbed along the entire GI tract, resulting in greater blood levels.

(Interestingly, in early 2010 the FDA rejected Horizant’s first request for approval, citing a small but significant risk of cancer.  They relented, however, and approved it this year after “reconsidering the risks and benefits.”  Sound fishy?  No, I’m sure it’s all good.)

So who might use Horizant?  Well, you can bet that GSK and Xenoport hope that anyone who currently uses Neurontin (and there are a lot of them) is a potential customer patient.  Officially, though, it was approved for the treatment of restless legs syndrome (RLS).

Now, RLS is one of those “diseases that may not be diseases”—or “diseases that you didn’t know you had.”  (See the articles here and here for accusations of “disease mongering” by GSK [hey! GSK! Coincidence? I don’t think so!] when it introduced Requip, the first “treatment” for RLS.)  Hopefully it goes without saying that when you see headlines like “Disease X may affect  7-10% of the population” when, in fact, no one had even heard of Disease X ten years ago, you have to be somewhat suspect.

Nevertheless, like much else in psychiatry, there may be some reality to RLS; it may in fact be a true pathophysiological entity that responds to medication.  (Whether this entity afflicts 10% of the population is another story.)  Current treatment strategies involve dopamine replacement, in the form of Requip (ropinirole) or Mirapex (pramipexole) so maybe dopamine insufficiency is part of the process.

The symptoms of RLS are “an urge to move the limbs, which improves with activity and worsens with rest.”  That’s about it.  Which leads to yet another problem (a problem that GSK and Xenoport don’t see as a problem, that’s for sure): with such nonspecific and common symptoms (who among us hasn’t felt somewhat restless, with interrupted sleep?), a lot of people might get diagnosed with RLS when their symptoms are actually due to something else.

I thought of this a few weeks ago, when I saw that the RLS “patient page” on the National Institutes of Health (NIH) web site referred to RLS as “akathisia” (thanks to altmentalities for the link).  Akathisia (from the Greek for “not sitting still”) has long been recognized as a side effect of some—perhaps most—psychiatric medications, from antipsychotics to antidepressants.  It is often described as an “inner restlessness,” a “need to keep moving.”  Sometimes it’s associated with extreme emotional distress.  In terms of severity, it can range from a mild nuisance to—in some cases—aggressive tendencies.  (Indeed, the psychiatrist David Healy has even linked psychotropic-induced akathisia to suicide attempts and violent behavior.)

Psychiatrists really don’t know exactly what causes akathisia, and disagree on how to treat it.  It may have something to do with dopamine blockade, or something completely independent.  Treatment might consist of benzodiazepines (like Ativan or Valium), beta blockers (like propranolol), or discontinuing the drug that caused it in the first place.

Unlike RLS, which seems to bother people most when they are lying down (hence its tendency to disrupt sleep), drug-induced akathisia is worse when people are awake and moving around.  Sounds like a simple distinction.  But nothing is quite this simple, particularly when psychiatric drugs—and real people—are involved.   In fact, many psychiatric meds can cause other motor side effects, too, involving (theoretically) yet other neural pathways, such as “parkinsonian” side effects like rigidity and tremor.  (In fact, some antipsychotic drug trials show “restlessness” and “akathisia” as entirely separate side effects, and when I’ve tried to ask experts to explain the difference, I have never received a straightforward answer.)

So what does this all mean for Horizant?  I could be cynical and simply remark that GSK/Xenoport are capitalizing on the nonspecificity of symptoms, the tremendous diagnostic overlap, and the fact that motor side effects, in general, are common side effects of antipsychotics (one of the most widely prescribed drug classes worldwide).  In other words, they know that there are a lot of people out there with “restless legs” for all kinds of reasons, and lots of psychiatrists who will misdiagnose akathisia as RLS and prescribe Horizant for this purpose.  But in reality, that remark would not be all that cynical.  Remember, there is this pesky little thing called “return on investment.”

What it means for the patient (or should I say “customer”) is more confusing.  A new agent with apparently better availability and kinetics than gabapentin is now available, but approved for the treatment of something that may or may not exist (in most patients), and may or may not be more effective than gabapentin itself.  Oh, and a hefty price tag, too.  Ah, the wheels of psychopharmacology keep turning….

(NB: altmentalities has also written her point of view on the Horizant story… I suggest you check it out, too.)

96 Responses to Horizant: The Second Coming of Gabapentin

  1. moviedoc says:

    It’s really awful, Steve:

    -We don’t know what causes akathisia.

    -Now RLS is a psychiatric disorder now? It isn’t even in DSM.

    -A lot of people might get diagnosed with RLS (or almost any other illness) when their symptoms are actually due to something else. This is news?!

    -Return on investment is bad.

    Let’s you and I donate all our money to research a drug that just might help a few more people, and IF we succeed, we’ll just give it away. No ROI. Right.

    In fact: We already agree this FDA requirement of “approved” indications and implied condemnation of “off label” use makes no sense. This new drug may help a few sick people get better. Only a fool would continue to pay for and take any drug that doesn’t help them, and as drugs go this one is pretty safe. The Pfizer lawsuit you cite, and the docs who got in trouble related to gabapentin have absolutely nothing to do with current legitimate use of the drug.

    • SleepMD says:

      RLS has been around for a while. We also know that it can be exacerbated by several psychiatric medications.

      The pharma industry however is much more powerful than any group of physicians out there and they will lie if they have to, using complicit health industry professionals (physicians, pharmacists, nurses, psychologists) to ‘persuade’ the MDs to write these scripts.

      As far as return on investment. For what, a prodrug? That probably was invented at a university using taxpayer dollars? I am against welfare for the uber wealthy.

      • moviedoc says:

        I still don’t get what you’re complaining about. “RLS can be exacerbated by psch meds.” So what?

        “Pharma will lie if they have to.” You or I would lie if we have to. You claiming you never told a like?

        Is persuasion a sin now? Are most physicians spineless? You bet. Shame on them. Don’t blame pharma for that.

        Is there something wrong with prodrugs? If it was invented with taxpayer dollars, why does it take millions of dollars of private capital to get FDA approval?

        Welfare for the uber wealthy? Who do you think owns stock in those companies? I’ll tel you: pension funds for people like us and our parents, even our patients. And they were willing to take a risk. Not like welfare where you’re entitled.

        How about reporting back to us in a year. I want to know if you refused to accept samples, if you refused to prescribe the drug.

    • Melissa says:

      A few years ago a neurologist prescribed neurontin and later lyrica for some of my most debilitating MS symptoms. On both courses of the dugs he steadily increased the dosages until I was at the top of the efficacy scale according to the drug interaction leaflet that comes with the drugs. In no time at all, I was complaining to my pharmacist regarding my burned tongue and the stevens johnson syndrome I was suffering from. ( I had earlier encountered sjs while taking penicillin). The pharmacist explained that it was allergic reaction to the gabapentin that was causing my symptoms. With neurontin, I simply passed out in a blaze of lights and odd sounds. With lyrica, my entire body was in hives and my tongue was burned. I got off these meds and later recovered. This year my sleep md prescribed 500 mg of Horizant to take along with 5 mg of Lunesta mixed with Silenor at night. Needless to say the sjs is in full swing. I did not know that Horizant was actually gabapentin and pharmacist couldn”t tell me because I was given samples at dr’s office. Now I am experiencing tremendous problems because the skin peeling and itchiness in in my eyes and crwaling up my face. Help. I hate gabapentin!

      • chelle says:

        I’m not trying to blame you for this at all, but any drug you have had a reaction to like this should be listed in your allergies for your doctors to see. Doesn’t help now, but could in the future with any “new” drugs you may be prescribed.

  2. Donna Martin says:

    I am sickened by your article. I have suffered with RLS for years and it is very real and very horrific to live with. IT IS NO JOKE. Just because a disease affects millions and is chronic rather than acute dos not take away from the fact that it causes people to suffer. I can tell you first hand that I have had stage three breast cancer and would rather die from my cancer than live a life with RLS. I am on medication that controls it and guess what-the medication mirapex causes obsessive gambling of which there is now a major lawsuit of which I am part of going on in Canada.

    Millions of people suffer from cancer, MS, MD does that make it any less real or is it just more real to you because those diseases can kill. I would get your facts straight before I go about publishing articles such as this one.

    • stevebMD says:

      Donna, with all due respect, I see nowhere in my post where I referred to RLS as a “joke.” If anything, I commented that “it may in fact be a true pathophysiological entity that responds to medication,” because, as a matter of fact, I have seen people suffer dearly from this condition and, yes, respond to Requip and Mirapex.

      I was simply drawing attention to the fact that because the diagnostic criteria for RLS are so vague and nonspecific, the drug manufacturer can be assured of people being diagnosed who don’t have the degree of incapacitation that you describe. This is good for their bottom line, but not so good if you’re taking the drug (for RLS symptoms that are less “horrific” than your own) and develop compulsive gambling or hypersexuality, which, as you point out, have been observed with dopamine agonists.

      • Chuleta says:

        Funny how you choose words like “it may in fact be a true pathophysiological entity”. Where are your facts that it may not be true? If you are going to make such a statement, please have the science behind it and perhaps the double blind studies links to prove it might be untrue.

        I get the side effects of medications. I understand that some people might be suffering from anxiety or other factors.

        But to say “ it may” be is utterly irresponsible when you know very little about the condition.
        I have suffered from Willis–Ekbom disease since I was a teenager and I was not taking any medications. I grew up thinking it was just normal. It was only diagnosed when I did a sleep study in my 30s.
        I understand people think is weird that you might feel things in your legs. But not only do I get uncomfortable legs feelings, my actual legs move by themselves. I have horrible physical unconscious jerks as I’m falling asleep. They are extremely uncomfortable and painful not only in my limbs but your brain suffers too. It is not to be confused with hypnic jerks that’s something different.
        It can also happen in a movie theater or on a long plane ride.
        So please get some education before you go calling something that “it may” be true.
        Have you ever experience a headache or is that in your mind? It may be true that your headaches are pathophysiological entity but can doctor actually point to it? Was that all made up by doctors in order to prescribe pills?
        Get educated. It will only help your image then just sound like an overnight blogger that lacks skills. Real doctors really dont have time to blog they are to busy learning and understanding new illnesses.

    • Irene says:

      I wholeheartedly agree with you about the horror of RLS and quality of life can be severely affected by this condition to the extent that life itself can seem unbearable. It’s upsetting when people who have no first hand experience of RLS make judgements on the condition, RLS does not kill but it destroys any reason for living, and no, I do not need antidepressant for thinking this way!

  3. Neuroskeptic says:

    RLS certainly exists. I have experienced it, thankfully only mildly, after use of mirtazapine 45 mg which I take every night; happens about 1 night in 10. It’s hard to describe, the leg movement is halfway between voluntary and involuntary, and accompanied by a unique sensation. It is not placebo because I didn’t know mirtazapine caused RLS until I experienced it. The published criteria look extremely vague but I think “you know it when you feel it”.

    • stevebMD says:

      Neuroskeptic, you raise a good point. It’s actually quite common in medicine to “know it when you feel/see it.” RLS is probably one of the best examples of a patient’s subjective experience that is so different from normal and yet so indescribable and obviously (as of today) non-quantifiable. By the same token, there are clinical presentations that an experienced clinician will “see” (e.g., bipolar disorder vs general irritability vs hyperactivity) that, similarly, can’t be broken down into a series of quantifiable symptoms.

      This is what makes medicine so fascinating. However, the push for shorter office visits, checklist-based medicine, and the encroachment of EMRs, all conspire to remove the “intangibles” described above. As a result, we’ll end up with more slipshod diagnoses, dumbed-down doctors, uneducated patients, and wasteful (& potentially harmful) treatment.

  4. Ciro Marchetti says:

    Dear StevebMD.
    You clarified in an early post that you do not consider RLS a joke. Thank you for that at least. Nevertheless I still perceive a certain lack of conviction by yourself and many of your colleagues who in other essays and articles have questioned wether RLS is real and worthy of treatment. God help those of us who do suffer from this syndrome, that we are dismissed by such “experts” who are clearly fortunate enough to not know for themselves first hand the distress it creates and therefore have the luxury to hypothetically question its existence. And indeed some in their arrogance and ignorance concluding its all some profit generating ploy by the evil drug industry. I wouldn’t normally wish harm or misfortune on anyone, but in this case I pray that someone of influence in the medical profession would experience what I have to experience, would have to manage like me on just a couple of hours of sleep. Because then there might be a possibility that all those white coated “experts” might address the subject from a different perspective. I am no medical expert, I did not attend medical school, I do not have a diploma on my wall, but I know what many of your colleagues do not. This syndrome is very very real. My current medication Requip makes it tolerable… just. Hypothetically were that and similar medications be withdrawn from the market by lack of credibility from the medical profession as to its need, that would be for some of us a suicidal scenario, and that is not meant to sound melodramatic. The cause may indeed be in my my head, rather than my legs but that does not make it any less real. I find it truly disturbing that that is even questioned by the medical profession.

  5. Gail Callahan says:

    I agree with respondent who has RLS and questions the medical community that is skeptical about whether it is real or not. I have had restless leg syndrome since I graduated from college and my family (father, uncles, sister and one brother) all have it and have been part of a ama study. My Neurologist did a study on my family and showed evidence that it was hereditary and it was a lack of dopamine. I have been through misery for over 30 years and just recently discovered that carbidopa-levodopa caused a rebound effect and so was getting rls worse every day and earlier. I now take mirapex at night but still have rls symptoms for about 2 hours every night. Trying to fly is a nightmare when required to sit with our seatbelts on and not move about the plane! I am looking forward to this new medication and only hope that it will alleviate my symptoms more than the mirapex does.

  6. Malcolm Field says:

    I contracted severe RLS and foot neuropathy at age 76. Not the typical symptoms which is why it took so long to diagnose. Burning legs from the knees down from about 5pm to 5am and an electric like tingle over most of my body including face. Mirapex mostly quieted down my legs and gabapentin (now Lyrica) completely quieted my body. The previous writer who mentioned suicide is not far off the mark. Gabapentin saved my life. Maybe my diagnosis of RLS is incorrect, but whatever neurological disease I have is definitely real and incapacitating. I’m looking forward to trying Horizant. Hopefully, but improbably, the side effcts will be lower than gabapenton (blurred vision, balance and weight gain).

  7. Jean says:

    I HAVE Burning FULL TORSO TO ALL EXTREMITIES and an electric like tingle beneath my skin over most of my body …Starts after being in bed for 1 to 3 hours and continues and increases in intensity til I get up and stay up…THEN I AM FINE have had this for over 3 years now. seems to gravitate from side to side. Also itching from top of head..neck…armpits …waist and breasts. problems only nighttime and am usually fine all day long. can I have seen 3 Internal med Drs. 2 dermatologists..1 psychiatric Dr. 1 psychologist… 1 Chiropractor & Went to Mayo Clinic am now seeing a Neurologist.
    have taken Gabapentin…and just now HORIZANT 10 DAYS…hate all Rx’s

  8. Diane Weissenberger says:

    As a widow living on social security, I think drug companies are leeches. But I am a sufferer of RLS for over 40 years, the last 10 being very severe. This IS NOT A PSYCHOLOGICAL PROBLEM! For too many years doctors told RLS sufferers “it was all in you head” And I agree that there are not very many caring doctors around(limiting visit time, etc.) Until the time comes when researchers can see the need for it, RLS will be on the back burner. If you had done enough research you would have found that Dr Christoper Early from John Hopkins School of Medicine and James Connor at Penn State have shown that iron levels in RLS patients were low in the area of the brain that enables the transport iron in and out of cells.Leading to believe there may be a genetic defect involved in RLS.

  9. Jean says:

    stil in need of help…..I am actually breakin out..from the nighttime body heat….itching occurs once I remain up.

  10. Jean says:

    still hoping for answers to Jean

    • Brian says:

      Jean. Have you tried an antidepressant for your burning. Cymbalta completely relieves my symptoms. I know if I miss a dose as my burning will return the next day.

      • Jean says:

        yes….I try Cymbalta and any other drug recommended by Docrors…..but for a limited time….because the side efffects…hit my daytime comfort and control….mostly….my balance….

  11. Kimberly says:

    Dear Steve MD,
    I stumbled across your article as I was curious about a new medication my Doctor prescribed for me recently,Horizant. The reason I was looking it up was that it has worked incredibly well in only three days of use. I have had moderate RLS since I was a teen and then at 35 it became severe. I suffered for two years of pacing the floors all night long. I couldn’t even sit down. I was starting to wonder if I could live anymore, it was that bad. I have it in my arms and shoulders as well. Fortunately I again stumbled across an expert in the field who started me on Requip. I have had accompanied pain that has been diagnosed as peripheral neuropathy/fibromyalgia/ who knows . So I have been taking a combination of requip and tramadol for of about 10 years now and life isn’t perfect but tolerable. I still only get about 4-5 hours of sleep per night. I have tried neurontin before and couldn’t walk a straight line. Then I was accidentally given Reglan in a hospital ER. Resulting in an extreme akathisia reaction. The nurses thought it was entertaining. Crawling out of your skin and doing laps around the hospital gurney was awful!! I have been using Lyrica with so so results. Because I am one off my doctors more challenging cases he always recommended anything that is new. I have been praying for an extended release or better yet a patch. I take meds three times a day and it’s hit or miss if I hit the right time. Anyways the reason I am writing you at 2:00am is that I wasn’t able to take the Horizant at dinner time tonight and my RLS was bad. I took the Horizant while I read your article and I am already feeling the restlessness subside. My requip never works that quickly. Could it be placebo? I don’t believe so, I thought this medication was for pain and was amazed at how well it worked on the RLS.Then reading tonight I was quite surprised and excited to learn that it was indeed for RLS! I just wanted to share with you and others how well Horizant is working on my severe RLS so far, and want to encourage you and other physicians to empathize with the torture many RLS sufferers go through on a daily and nightly basis. I truly love how my own doctor can’t feel, see or measure RLS yet is so passionate about helping us with this very real odd disorder.

  12. p. simonson says:

    took horizant. it effected me so bad i thought i would have to go to hospital.. it made my legs worse,, my blood pressure real high,, 160 over 85. i can take gabapenten but not horizant,, i am suffering form rls..just thought i would share my thoughts with everyone.

  13. Malcolm Field says:

    My RLS and foot neuropathy are completely under control.
    I take 0.5 mg of Pramipexole (Mirapex) at 8pm and 200 mg of Lyrica at 8am and 8 pm. Gabapentin worked as well as Lyrica except that I had to take 600 mg 3X/day which is very inconvenient. Lyrica is far more expensive than Gabapentin, but if you can afford it, it’s worth the 2X/day convenience. I tried the once a day Horizant, but it didn’t supply enough medication to keep the RLS at bay. Had to quit it after only 4 days and go back to the Lyrica.

  14. emmy says:

    I’ve had RLS since childhood, it seems to run in my family as 1 of my older brother’s has had it all his life. We are still being told to stop shaking the floor, table or whatever is moving while we’re moving (bouncing our legs)I am 49 years old and why I do it I don’t know but legs have always felt strange.

  15. Erika Doyle says:

    I have RLS and have used Clonazepam and Requip, which worked for a while, then stopped. I was referred to a Neurologist who prescribed 600 mg’s of Horizant, (one a day,) It worked for five days when I woke itching like crazy on my back and under my breasts. On top of that, the pharmacy can’t get Horizant so now I’m waiting for a medicine that will work and not cause the itching reaction. The first few days of using Horizant was great as I was able to sleep without the twitchy feelings, which made me feel as if I was aroused because I couldn’t stay still and had to move. When it became more extreme, I had to get up and move around, as well as, get cold (like taking a cold shower.) That would help and I could go back to sleep but this occurred so often in places such as the movies, while watching TV, any place where I had to sit still or could relax…I was miserable.

  16. Shawn says:

    Akathisia and RLS symptoms are totally different. I have RLS and it’s nothing like the symptoms noted on webmd for akathisia. Also just because we never heard of something doesn’t mean it didn’t exist. You never hear about something until it’s given a name. I can also tell you I have no problem being still and don’t take antidepressants, the problem is in the sensations in my feet and then up my legs when I go to bed. Everyone who reads this blog needs to remember this is wrote purely as this mans opinion and doesn’t make it true by any means. If something works for you then great and never ever let anyone doctor or not tell you it’s all in your head or your problem doesn’t exit.

  17. Jean says:

    what about horizontal, full body burning sensation starting about 2hours…increasing every 2 hours til one gets up and stays up …then no longer exists….til bedtime horizontal and begins again..increasing evry 2 hours til staying up…and fine again all day.

    • Malcolm Field says:

      Jean, has your neuologist prescribed Mirapex and or Gabapentin (Lyrica, etc)? Most Primary Care doctors aren’t familiar with RLS and it’s many variations. I had the full body version until I started using Mirapex and Lyrica.

      • Jean says:

        thanks and yes I did keep trying….all meds….and always had those side effects….balance etc. during the day….Just do not care to have any daytime problems….still takes about 2 hours of being upright…for the horizontal pain etc. to subside…..

  18. I have suffered with RLS for most of my adult life. Again, “you’ll know it when you’ve got it.” It feels like there are ants crawling inside of my bones, and one sleep study showed me twitching 98% of the night, and I never got beyond stages 1 and 2 sleep. No REM sleep makes one slowly go crazy and have a host of other medical ailments, am I wrong?
    I slowly experienced augmentation with Mirapex and finally got myself to a real specialist who was able to help me (Dr. Mark Buchfuhrer in Los Angeles, THE guru of RLS). There aren’t a lot of drugs out there for RLS, other than the dopamine agonists (which just caused more problems for me) and opiates. I have been feeling pretty great adding Horizant to my regimen, even though I’m embroiled in appeals with my insurance company to cover it (and at over $300/month, this is a real hardship). Horizant isn’t the same as straight-up gabapentin, as this is gabapentin enacarbil, an extended release, giving it different pharmacokinetic profiles. For RLS sufferers, this means getting relief all night.
    I find your review of this drug (and RLS in general) to be pretty damning, and if you are so concerned about the loosey-goosey diagnosis criteria, then the answer is for doctors to become better informed about RLS and acceptance as a bona fide disease, and not just “all made up in your head, like fibromyalgia is” (as one spectacularly incompetent GP once told me), and allow doctors to actually try to address patient’s RLS symptoms with a few of the different pharma “tools” available. Dr. Buchfuhrer has written a clinical text for the diagnosis and treatment of RLS (which I assume this blog author has not read), and has co-written a clinical guide for treatment criteria for the Mayo Clinic, and it is available online to both practitioners and patients, shared here for the sufferers:

    Click to access PIIS0025619611621605.pdf

    Your assumption that ‘just because we didn’t know about this disease 10 years ago makes it suspect,’ is really strange coming from a psychiatrist. Look how far pharmaceuticals have brought the treatment of psychiatric illnesses — pretty far since the days of just shootin’ em all up with Thorazine.
    A side note to RLS sufferers: rls.org has a forum that is a great resource to stay informed. I’d also highly rec’d Dr. Buchfuhrer’s and the books he has written, and him as a practitioner, too.

  19. ladyjean says:

    I understand the questioning of people about the reality of a “new” diseases when it is given a name. But for those of us who have it, it’s a relief to finally have it recognized and hopefully cured. I first complained of this creepy crawly feeling in my legs and how I had to move them to get rid of the those sensations, just to have the sensations build up again. This goes on over and over. When I was a teenager the doctor said it was growing pains, whatever the heck that was supposed to be. My sister had it too and we could only commiserate together as no-one seemed to know what was wrong. I’m fortunate, I only have it rarely now, sometimes mildly every night for a week, or I can go 6 months without it. I’ve tried to describe the feeling you get if you try to keep your legs still and it’s like when someone scrapes fingernails down a chalkboard. It will build and build and you HAVE to move your legs for it to stop. I only found this forum because I looked up Horizant which my neurologist gave me because a sleep study showed I move a lot during the night and wake up with headaches.

  20. […] called Gabapentin (G).  I had a look online to try and find the difference, and it appears as per this review that GE has a better bioavailability than G.  What that means is that the body is able to pull […]

  21. Susan J Smith says:

    I am someone with confirmed disnosed severe RLS. I started taking Horizant a couple of days ago. So far it’s the only thing thst has helped. I have had RLS since childhood and it has grown worse as I’ve gotten older. I have also been on anti psychotic medications due to being bipolar. I suffer from multiple chronic illnesses and am something of an enigma to most doctors save one. RLS is no joke and very real to thosr of us who have always had it, even before the use of the psychiatric medications.

    • Malcolm Field says:

      Did you try either Mirapex, Lyrica or Gabapentin before Horizant?
      I’m currently under control with 0.5g of Mirapex at 7pm, and 200 mg of Lyrica at 7am and 7pm. Been on that regimen for past two years with success. I had the full body RLS! Arms. legs, shoulders, etc.

      • Jean says:

        UPDATE ? ANYTHING 2016 ????

      • Malcolm Field says:

        Jean, we’re on identical time schedules schedules of 7am and 7pm, except that I only take 0.125 mg of pramipexole (same as Mirapex).
        I also take 200 mg of Lyrica. Also had the full body RLS.
        Glad that regimen is working for both of us.

  22. C Rich says:

    This medication should only be used by a Movement Disorder Specialist.

    Psychiatrists should not be administering this drug.

    This medicine works for people that need it.

    People who have suffered from Long Infections. Post herpetic neuralgia and RLS are real, but get a Movement Disorder Neurologist to diagnose you, not a psychiatrist. RLS can be horrible leg spams that don’t cause the legs to even move. Everyone is different.

    This medicine works!

    (Patient at the Parkinson’s and Movement Disorder Clinic Tx)

  23. Donna Martin says:

    Donna Martin
    I am wondering if anyone knows whether Horizant is available in Canada. I have severe RLS as I mentioned earlier in response to Steve’s article. RLS is very real and very challanging to live with. It stems from the same part of the brain as Parkinison’s and unfortunately is treated with dopamine enhancers. Mirapex, Requip etc. they now know causes in some people OCD and specifically towards gambling. We have a class action lawsuit in Canda and hopefully some of us will be able to recoup at the very least some of our financial losses. The loss of dignity, integrity and family relationships can never be compensated for. I did try taking fentanyl for 1 1/2 years. It works great for RLS but a word of caution it is 100 times stronger than morphine, comes from the opiate family and for me at least caused extremely severe hot flashes almost 24/7 and severe depression. I was so suicidal I had to come off the drug. And for those that question RLS, if they do their research it has one of the highest rates of suicide due to lack of sleep which no human being can go without and believe me without meds you DO NOT SLEEP, can’t even sit and have to walk to keep your legs from twitching just to keep sane. The depression I believe also stems from the fact that it is not taken seriously with people constantly questioning your integrity and to have no affirmation of what you are experiencing on a daily basis is terrible.

    I go through the exact same with not only RLS but also the gambling caused by Mirapex. If you think people don’t believe RLS you should see how many do not believe that a drug can cause obsessive compulsive disorder(sexual addiction, gambling, shopping and drinking). However go and sit in a casino and watch how many parkinson’s patients are sitting there pushing the buttoms of the VLT’s. For anyone out there on requip sinnimet or mirapex and want to know about the gambling aspect just google mirapex and class action lawsuit!

  24. Steve says:

    You take amvery light-hearted cynical view as to the existence of RLS..for those of is who suffer from RLS there is nothing light about it..it is horrible! I dont know how i got it, perhaps from the anti-depressants prescribed by a psychiatrist years ago for chronic mild depression..what i do know is that when i take mirapex or requip i feel much better..so please a little compassion

  25. ” “Disease X may affect 7-10% of the population” when, in fact, no one had even heard of Disease X ten years ago, you have to be somewhat suspect.”

    This is from your article. I can tell you Disease X hadn’t been heard of however many years ago because there was no name for it yet, or diagnosis. I told my doctor 35 years ago about the trouble with my legs and he called it growing pains. Other doctors over the years just shrugged. It was there, just no-one knew what it was.

    • Donna Martin says:

      My condition was also called growing pains and just because something is common that does not make it not legit. For anyone out therewho wants to read about RLS there is an RLS website and foundation.

  26. Steven Funderburg says:

    I have suffered, and suffered considerably, since the age of 6 with RLS. Twenty years or so ago, I got onto Mirapex to combat it. In one way, it was a miracle; in another way, a curse. The RLS came under complete control. However, unknown to me, but observed by my wife, I became increasingly obessed with sex, especially pornography. But I couldn’t give up the Mirapex. My obsession with sex contributed in no small part to the downfall of my 40-year marriage to this dear woman, and I can’t help but feel that Mirapex was a major complicating factor. I am now trying to wean myself from Mirapex and onto Horizant. It has been tough going, because I presume that my body is so accustomed to its daily dose of Mirapex. However, after a month or so of cutting back on the Mirapex and administration of the daily dose of 600 mg Horizant, I feel that I may be getting back to myself both in terms of reduced obsessive tendencies and RLS control. If you are trying to use Horizant to control RLS, be sure to take it no later than 5:00 p.m. for in my experience, it takes about 4 hours to kick in. An unknown benefit that I may be experiencing is lack of RLS during the day, which has kept me from taking naps for all my life. But I’ll need more time to verify that.

    • Donna Martin says:

      I too went thru the same personality change on mirapex mine however being with gambling and partying. My family were at their wits ends but by then we knew that mirapex caused such problems and I am now involved in a lawsuit thru Thomson Rogers Law Firm in Toronto. Currrently I am on 25mg of fentanyl which is a very strong drug but does work amazing for RLS. It is also wonderful for Reflex sympathic Dystropy which I have in my right arm. It is however a depressant so I am on paroxetine which is an anti-depressant. I can tell you I feel relaxed for the first time in years and my gambling addiction is disappearing and my depression due to addiction is slowly going away Fentanyl is a narcotic but monitored properly it can certainly change your life.

      Donna Martin

    • Deansomnia says:

      I was also IRATE when I was reading the blog because it does really sound like it is saying that RLS is a joke. No, it doesn’t have anything to do with my comprehension skills. I see that he didn’t mean it that way, but if I found this so easily I bet there are others reading it every day and feeling incredibly insulted and leaving it before reaching the comments.

      This is a disease that can make a person quickly defensive because a severe case truly is horrible and no one gets it. I can see it causing suicide because it just plain makes me crazy when I have occasional nights when it doesn’t work or I forget to pick up my med refill. The closest comparison I can think of is that it’s like your legs being one big itch that is an inch below your skin so you can’t scratch it.

      I have been on Mirapex for about 12 years. I took 2mg/day for about 10 years and in that time I became more on more obsessed with tinkering with thing like bikes and computers.
      These are pretty safe obsessions, but I couldn’t stop and the house was always a disaster and that is the primary reason my wife took the kids and moved out. I went through 3 weeks of hell and got down to only needing 1mg/day and the obsessing got WAY better, but it’s still around somewhat. My RLS is now horrible because Mirapex makes it worse over time, but it is the only thing that has ever worked for me. I think I will look into Horizant.

  27. Jean says:

    the extreme itching is worse also….from my head to neck…even face…small bumps..full torso,,,even hands…under arms breasts, waist line….( any place where clothing fits tightly.)
    I have absolutely no fat or fluid beneath my skin. do not take any Rx meds…..except the 1 tiny SINGULAR pill.a day.
    Is there a cure for SMALL FIBER NEUROPATHY? Any one know why my extreme burn beneath skin happens only after being horizontal for usually an hour or so…and increases the longer I remain horizontal… I cannot sleep sitting up or on my back….I must still exercise or shower for releif ,,,to be able to return to sleep. am afraid to lay down during day for fear I will start to have these burn sensations while I am up. I am so grateful that my days are good.

    • Kimberly says:

      I realize I’m no help now, but this may help future readers. I have been diagnosed with RLS, but have also had dermatitis, with very similar symptoms. Burning, whole body nerve pain, severe itching all over. It’s truly as bad as RLS, but more severe in the moment (at least for me anyway). This is what I still do to this day when my body starts to feel nervy and itches.

      The doctor said to soak for 20 minutes in a warm (little warmer than body temperature) bath, then put on Eucerin cream (the thick stuff, in the tub) on your wet skin and rub until it’s all absorbed. Do this for 3-5 days and the symptoms of dermatitis will improve.

      I usually do this at night before bed, because the Eucerin will stain darker clothes. I put on thin cotton pajamas and go to bed. You will feel better after the first bath, keep doing it for at least 3 days.

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  32. Tiffy says:

    I and 34 years old and have suffered from RLS for the past two years. I tell you it is a real disease. So many nights have I suffered just laying there, not being able to sleep because of the horrible itchy restless feeling coming from my legs. I am on 600 mg of Horizant and it is a life saver. Made the entire RLS go away. It is expensive, since not covered by insurance, generally, and there is no generic brand yet, but worth every penny. All I can say is it does give me a slight dizzy feeling sometimes but if you make sure you eat regularly and have small snacks (keep food in your stomach), the dizzyness does subside for me. I also do have myclonic jerks and am on Keppra as well, so I am used to having to deal with side effects.

    • Malcolm Field says:

      I’m glad the Horizant is working for you. Did you try gabapentin first. It’s very inexpensive. The only downside is that you have to take it 3X/day. That’s why I switched to Lyrica 200 mg 2X/day. Also expensive. I also take 0.25 mg of pramipexole 1X at night. It’s the generic for Mirapex which is also expensive.
      I tried Horizant 600 mg 1X/day but it wasn’t strong enough for me.
      Continued good luck.

  33. Annie says:

    I have suffered from RLS for many years and it is a truly debilitating disease. I understand there is a genetic component to this disease. My father, God rest his soul, also suffered from RLS. He use to joke about it to me. He called himself “half time” because only one leg was afflicted. He lost his other leg in the Battle of the Bulge after stepping on a land mine and having his foot blown off. His leg was amputated from below the knee. He said his ailment was “Restless LEG Syndrome” and he was lucky since he only suffered in one leg! My dad was quite a joker. All joking aside, there is nothing funny about this condition. RLS has ruined my life. I was prescribed Mirapex several years ago for this condition. It worked miracles for my restless legs, it reaped havoc on the rest of my life. I became a compulsive shopper and addicted to gambling (slot machines). I have lost hundreds of thousands of dollars, family members, friends … the list goes on and on. My doctor prescribed Gabapentin and Clonazepam to replace the Mirapex. I am hoping this works because my life has turned into a disaster due to the gambling addiction that the Mirapex has caused. This is no joke. Mirapex is a horrible medication. I turned into a crazy person on this medication and had no idea that was the cause. I lost interest in anything but slot machines and would play until my last penny was gone. I never gambled a day in my life until Mirapex. My life is in chaos and I’ve even contemplated suicide on more than one occasion. I wish I’d known about this side effect sooner. I should be part of a lawsuit against the pharmaceutical company. Anyone have any suggestions? Just call me Hopeless, Helpless, Worthless because that would describe how I feel about myself. Thank you Mirapex and RLS. Maybe there’s hope with Gabapentin?!?!

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  35. liss says:

    Help? Was prescribed “this?”med for severe PHN pain, help w/ RLS, sleep disturbing muscle spasms etc (may be related to a seizure disorder or narcolepsy)& chronic pain, at least some of which is clearly neuropathic. >>Lyrics( helped little w.PHN)& Savella haven’t helped w/my severe widespread chronic pain. My hope 4 this drug would be relief of PHN & some chronic pain aleast the obvious neiropathic pain[burning skin,hands&feet sensitivity to touch etc] AND if my nighttime movements & day time tremors(now controlled w/klonopin) were helped w/1 pill, great!
    >>MY ?QUESTION IS: The bottle prescribed 2/7/15 SAYS “Gabapentin” mfg AMNEAL for NEURONTIN ??
    >> BUT, all of my research including my reading here says I should be taking “Gabapentin ENCARBIL”!? IS this the same drug? Or do I need to call my doctor for a change? PLEAZ LET ME KNOW I AM ANXIOUS TO START.
    >>Also is there a way to alleviate my allergy concerns? I’m allergic to penicillin& aspirin. I have some itching &nightmares w/ synthetic codeine. Alergy to Shellfish,oranges & garlic. Milk& egg sensativity. Is there a website where i can check these allergies against people who have had allergic reactions to neurontin?thank u so much for quick answers I was about to take 1st capsule when I realized that it didn’t say “Gabapentin Enacarbil” Rev. Lisa

    • Malcolm Field says:

      My understanding is that gabapentin (generic) Lyrica and Horizant are all a variation of gabapentin. I ued to take gabapentin (600 mg) 3X/day and then switched to Lyrica (200 mg) 2X/dayfor the convenience. Didn’t see any difference in efficacy. Tried Horizant (600 mg) which was advertised as 1X/day day, but it didn’t have the potency I needed.
      Been using Lyrica and pramipexole (0.25 mg) for 4 years and 5 months and they work well suppressing my WED and foot neuropathy.
      Regarding allergies, have you been to an allergist?

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  39. georgia lee says:

    I know many “diseases” are invented by pharma – think “dry eye syndrome” which is fairly standard in older people. RLS may not be official or official disease – BUT IT IS REAL! Not pain, not itching, not burning, more like can’t lie still, needing to get up, wanting to crawl out of my skin. Sleep is impossible. i usually get on the floor to stretch, which never helps. It’s not constant, possibly hormonal, seems to happen at certain times. Neurontin eliminated oh, 85 percent of occurrences, and I was prescribed this drug for dark, hopeless thoughts. Helped that too.
    MY BIG QUESTION IS: how to get off antidepressants without crashing side effects? I’ve titrated dozens of times, super-slow, and end up in despair/depression/agitation/hate everybody.
    I’m serious, do hospitals offer detox for these things? I see no other way and believe me, I’ve tried!!!! I’d love to be drug free – now I’m on 4 anti-depressants, one bi-polar med, and Kolonopin for anxiety attacks. I hate it.

    • Bronwen says:

      Hello Georgia Lee,
      As I have pointed out in my remarks below, SSRIs are contraindicated for us. And most of us have been given them over and over again.
      So if this is what you have been given, try something else, insist upon it. It is dopamine and nor-epinephrine we lack, not serotonin.
      And if you have not yet done so, request a test for female adult ADD.
      Go well.

  40. Paul says:

    We patients get put on drugs that cause side effects then get put on drugs to treat those side effects then Pharma creates drugs to treat the side effects of the side effects.

    We patients see the commercials, download the check lists, take them to the doctor who happens to just had a visit from the Pharma Rep and has samples who didn’t even know that the side effect illness had a name let alone a treatment.

    Of course the samples work and we start the treatment for the new illness that is a side effect of the side effect of the drug from the original issue. Of course it causes side effects too but soon enough there will be a pharma solution for that.

    We feel vindicated because we knew we had a new illness or disease. “It was real. See, I told you!” Of course we feel anger when we can’t get the help we need. Sometimes we even doctor shop until we find a doctor who will listen to us.

    This cycle goes on and on until we see the trial attorney commercials suing Pharma because the new drug that treats the side effect of the side effect drug for the original health problem causes causes third nipples in the offspring, male breasts, etc. etc. and demand to get off them, sign up as a class member and sometimes scold, in our respective manor, our doctor for putting us on such a dangerous drug that we told him about or at least started the prescribing deliberation, along with the Pharma rep that brought the pamphlets, pens, notepads and samples

    Eventually the list of health issues are so long that the you, the doctor and all involved forget what the original health issue was and it gets dropped off you DX list.

    Of course it doesn’t help matters now that every patient is an amauteur Google diagnostician.

    As the old shampoo bottle says, rinse and repeat.

    In 2012 I asked my doctor for a medication holiday and titrated off most of my medications and was able to “start over” and ended up with less medication, even tolerate a side effect or two to deal with orginal health issue relief.

    This is something nobody really talks about or considers. I know this post is old but Google has kept it a life.

    Excuse the grammar, punctuation, spelling, etc. My lack of empathy to proofreading tonight is a side effect of one of my meds.

  41. Robert says:

    God, you sadly remind me of Bill Maher, who says that RLS doesn’t exist, and even if it does, all the sufferer has to do is to get his lazy ass up off the couch. My RLS began some thirty years ago, when I was a young man and still taking no prescription drugs whatsoever. Doesn’t square too well with your theory, does it? I wish we could trade places, if for only one night. That would change your outlook, I assure you. But because you’re one of the lucky people without this malady, you have the luxury of fighting the bull from the stands. A little more compassion on your part would go a long way here, but it appears that would be asking too much. Perhaps you should speak with some of the family members whose loved ones have committed suicide because of their uncontrolled RLS. To them they were victims, not customers…

  42. Bronwen says:

    To all those fellow-sufferers out there, who are not being heard, and who have tried so hard to explain a most distinctly physical agony for which our language is entirely inadequate, my deep sympathies. I am seventy-one years old, highly literate, and have suffered this crippling complaint for most of my life. And I still cannot describe it.
    I inherited it, without a doubt, from my mother, who suffered it until her death at 83. There were no medications of any sort then, so she took codeine almost hourly. (Johns Hopkins, interestingly, names methadone as a treatment of choice).
    Pramipexole works, passably well, for a while, after which the dose must be upped and upped and upped. Meanwhile, one blames oneself for the associated compulsive behaviours, which are very frightening.
    The other primary side-effect of pramipexole is (one has to laugh) insomnia. What is not noted on the package insert, but is on the website, is the terrifying attacks of irregular heart-beat.
    For those who have been treated with SSRIs for depression (and anyone who sleeps as little as an RLS sufferer is most assuredly very depressed) please be aware that SSRIs are absolutely contra-indicated for us. (As are sleep meds of the antihistamine sort).
    Also be aware that there is a very strong association between ADD and RLS, both of which are linked to a faulty Dopamine system. Particularly in women, who present with ADD somewhat differently than men, (and which probably goes undiagnosed most of the time) depression is very common. And until recently it was not accepted that females, let alone grown women, could suffer incalculably over a lifetime from the consequences of ADD. Both conditions are heritable.
    And let us start giving the ‘condition’ of ‘restless legs syndrome’ (such a wishy-washy term, so easily and often dismissed as the babble of the hypochondriac) its more respectful name – Willis-Ekbom Disease.
    Best wishes to you all, even the foolish unbelievers, who will get a lot of egg on their faces sooner rather than later. Neuroscience is here.

  43. Randy Bulloch says:

    Hi – I have been suffering with RLS for over 20 years (I am 47). It has gotten worse as I have gotten older. My dad and my sister also have it, but not as bad as me. In the past, I had tried muscle relaxers which worked in the beginning, but quickly stopped helping. I had been on Mirapex (Pramipexole), but I built up a tolerance to it and kept having to increase the dosage, so I quit taking it, I slowly weened myself off, but after I totally stopped it, I didn’t sleep AT ALL for 5 nights straight. I then started taking Gabapentin and it helped a little, but not nearly as effectively as the Mirapex had done when it was working. I now take 600mg of Gabapentin about 3 hours before I go to bed. Unfortunately, it too seems to be failing me now. I am not on any other medications, other than Flonase for sinus issues. However, I had been on Lexapro (anti-depressant) and when I decided I was feeling well enough to get off of that and weened myself off, my RLS seemed to get WAY WORSE and it seems like it stayed that way ever since. I recently had about a month-long span of nights where I was only sleeping about 1-2 hours per night and the rest of the time I was wiggling and pacing around miserably (I get the restless sensations in my entire body, not just my legs). I realized I could no longer live like this and decided I was actually going to kill myself if I couldn’t get at least SOME relief/sleep. I mean, I really started to actively investigate ways to do that. People who try to downplay RLS as being the same as regular insomnia clearly do NOT understand the difference… RLS doesn’t allow you to just lay there with your eyes open… You have to keep moving ALL NIGHT LONG – it’s TORTURE.
    I decided to try some things I had not yet tried… and I did them all at once starting a little over a week ago.
    – Started taking Vitamin D supplements (i have a diagnosed D deficiency, but had been forgetting to supplement)
    – Started taking Magnesium capsule (180mg) at lunchtime and Magnesium power dissolved in warm water at night (360 mg)
    – Stopped watching t.v. in bed
    – Abstained from alcohol (which really bums me out cause I love wine, but I am that desperate!)
    – started eating about 4mg high CBD/low THC a few hours before bedtime (have to be careful with how much of that I take because I don’t smoke marijuana and am a lightweight)
    I also am trying to get more exercise and eat healthier, but I cannot say that I have done great on those over the last week…
    I don’t know whether it’s coincidence or if these helped, but the last 4 out of 5 nights, I have slept at least 5 hours! I still woke up with restless feeling, but was able to go back to sleep, unlike the previous weeks of torment.
    I know there are other drugs out there to try, but I am VERY hesitant to try them because it seems like each time I go on/off a new medication, it permanently makes my RLS symptoms worse. I would be interested to hear if anyone else has had luck with any of the things I have tried.

  44. Randy Bulloch says:

    Bronwen – that is SO TRUE! When I try to describe it to people, it does not translate. I try to tell them that it is like an extremely unpleasant tickling that you try to fight off, but it gets more extreme the longer you resist. But that doesn’t accurately describe it either. Also, “restless legs” doesn’t cover it for me – I get it throughout my entire body and when it first starts to “come on” – it feels like it is emanating from my chest and then out to my limbs.

    • Bronwen says:

      Randy – The closest I can come to describing the feeling is this – when we were children we would sit for hours in a cross-legged position chattering to friends in the playground and our legs would ‘go to sleep; – then when we had to get up for the school-bell, we got that hellish (indescribable) agony in the legs for a minute or so before all went back to normal and our legs ‘woke up’.

      Well, that’s a bit what it feels like, except that it goes on for hours and hours.

      Here’s the thing – the truth is we cannot explain/describe ANY PAIN/DISTRESS (and be understood) unless our interlocutor has had a SIMILAR EXPERIENCE. Most people have had a headache, a kick on the shins, a belly-ache, a wrenched muscle, a stubbed toe, a cut finger etcetera etcetera etcetera – the big exception is childbirth, which men cannot understand, try as they might – but women understand women, and people with RLS understand people with RLS.

      I think we should put the miseries of RLS firmly within the PAIN spectrum, and not the ‘funny feeling’ spectrum. The latter will get us nowhere except to the gormless comments of our host and others. If you add ‘Funny Feeling’ to ‘Syndrome’ (which is medical sciences’ most wishy-washy-we-haven’t-got-a-clue-label) then you’re pretty much damned from the start.


  45. Malcolm Field says:

    It’s amazing how different is for many people. I used to have to first in the shins and then if it was especially bad it would travel up my torso to my arms. I finally got it under control with a combo of Lyrica (gabapentin) and premaipaxole (Mirapex) about 7 years ago.
    After not experiencing any symptoms for several weeks, I was at the Hollywood Bowl sitting near the stage and close to the massive speakers when the band Chicago let loose. The amplification was extreme and I actually feel my chest vibrating. The RLS returned to my legs and I was twitching for the entire performance. When the concert ended, the RLS stopped. Just thought I would introduce that for the researchers to chew on.

    • Bronwen says:

      That is very interesting Malcolm. Did you know that there is a strong link between Willis Ekbom Disease and ADD? Both are involved with the dopamine system, and one of the signs of possible ADD is hypersensitivity to noise.( I believe there is an over-40% that if you have one you have the other to some degree or other).

      Of course sitting does us no good – we are just aiding the shortening of the muscles and tendons in time for a miserable night. Stretch, stretch, stretch.

      In any event, stay away form big speakers, they are doing you great harm, including raising all your stress hormones and blood pressure and permanently destroying hearing. If your ears ring after such an assault, the harm is done!

  46. Irene says:

    Restless legs does not kill you BUT it destroys any reason to live!

    • Terry says:

      There is no vagueness about rls. If you have it, you know it. You can’t read once the symptoms start (usually in the evening). You can’t watch TV. Any one who poo poos rls is uninformed. They should get it for a day or two and then see if they poo poo it. By the way, Mr. Balt doesn’t mention the use of gabapentin and horizont for nerve pain, their most important indication. I use horizant for neuropathic pain m my legs that appears every night while I am asleep. It works great. I use to use gabapentin itself, but I would have to get up 2 or 3 times in the night to take a dose. I also have terrible rls that appears very easy evening around 7:30 p.m. The horizant and gabapentin do,nothing for my rls. Absolutely nothing. You have rls, you must take a dopamine agonist (e.g., requip or,miraplex). They work great but beware, they make you sick for a week or so until your body adjusts.

  47. gabapenten will kill you says:

    \DO NOT TAKE IT Gabapentin ran my weight up by seventy pounds, then put me into Congsetive Heart Failur/eCardiac arrest. In the hospital. I was told that the gagapenten was 100& responsibl;e. and IT TOOK THREE WEEKS TO GET IT OUT OF SYSTEM. I had to get a Pacemeker, which malfunctioned (could noit bring the GABAPENTIN undercontrol. Three weeks later all I can say it “if you like gasping for air and fading of your vision as you get closer and cl;oser to a flatline…” by all means call up and get yourself a handful of Gabapenten a pen and a death certificate. you’ll need them.

    • Malcolm Field says:

      I’ve been taking gabapentin (Lyrica) for over eight years with excellent results and without weight gain or any other side effect.
      Could that be because everyone is different?

    • Terry says:

      The most ridiculous thing I have ever, ever heard in my entire life.

  48. Jean says:

    still waiting for help…..for HORIZONTAL NIGHT TIME RELIEF that will not affect daytime abilities….I need my balance all day…
    ps How does one get just 2016 messages….?

  49. Dwana Joyce says:

    my husband has severe rls his dr gave sample horizant but prescribed Mirapex…so he did the samples while waiting for insurance to approve n the samples were GREAT almost wiped away any rls then we get pres n OMG they made him sooooo sick but horizant is not approved by insurance n are sooooo expensive any ideas people thank you in advance

  50. Malcolm Field says:

    Dwana, Horizant and Mirapex are totally different drugs..
    Horizant is basically the same as Lyrica and gabapentin.
    Mirapex is the same as pramipexole.
    Horizant is taken 1X/day, Lyrica 2X/day and gabapentin 3X/day. Both Horizant and Lyrca are very expensive.
    If Horizant worked for him, ask your doctor to prescribe the very inexpensive gabapentin.
    (I’ve been taking Lyrica and pramipexole for about 8 years without problems.)

  51. Terry says:

    Let’s be more specific here. Gabapentin and lyrica are similar but clearly not the same. Lyrica is a different molecule altogether, so Lyrica may work for some better than gabapentin (or not). And yes Lyrica is more much more expensive because it is still on patent. But if it works where gaba does not, then it’s probably worth it. Now let’s talk about Horizant. Horizant is a pro-drug of gabapentin. When ingested, Horizant converts to gabapentin.The advantage of Horizant is that it acts like a time release gabapentin, so you only have to take it one or two times a day instead of four or five times a day with gabapentin itself. But yes, Horizant is incredibly expensive because it is still on patent, so if insurance doesn’t cover it, then get gabapentin and be ready to take it several times during the day or night.

  52. Judith Hall says:

    I am a 79-year-old lady. My FIBROMYALGIA disease appeared at the age of 74, with no hope of a cure from the hospital i looked further for an alternative treatments, a friend of mine told me about Health Herbal Clinic in Johannesburg South Africa who sell herbal treatments for diseases including FIBROMYALGIA disease, I contacted the herbal clinic via their website and purchased the fibromyalgia herbal remedy. I received the herbal remedy through DHL couriers within 8 days and i immediately commenced usage as prescribed, i used the herbal remedy for about a month and 1 week, my condition has greatly improved, all my symptoms including Chronic muscle pain, Abdominal pain, nausea, I am fibromyalgia free! contact Health Herbal Clinic via their email healthherbalclinic gmail com or visit www healthherbalclinic weebly com PLS fibromyalgia is not a death sentence, there is a cure!

  53. Malcolm Field says:

    Here’s something else that may be worth trying. Both my RLS and non-diabetic foot neuropathy arrived almost the same time, about 8 years ago at age 75.I’ve been taking Lyrica and pramipexole to control them. I’ve always assumed they are somehow neurologically related. Anyway a doctor friend of mine suggested I try acupuncture to relieve my neuropathy. As a skeptic, I was amazed because it reduced the neuropathy by about 70%.. An even more amazing side effect was that my RLS completely disappeared. It’s been about three months now and I’ve titrated my Lyrica down from 200 mg/2X a day down to 100 mg/2X a day. Next, I’ll try halving the 0.25 mg of pramipaxole.
    Acupuncture is relatively reasonable, so it might be worth a try.

  54. Nancy Price says:

    five months ago I constantly had to go to the bathroom. I thought it was because I gave up soft drinks and was only drinking water. One day I had a stomachache. I was in bed for 4 days. The doctor’s appointment was for a Wednesday. I got sick and went to emergency room on a Monday. I was told my blood sugar level was 810 and I have diabetes. Since then, As the disease progressed all medication stopped working, i was introduced to Health herbal clinic in Johannesburg who have successful herbal treatment to diabetes . I spoke to few people who used the treatment here in USA and they all gave a positive response, so i immediately purchased the diabetes herbal remedy and commenced usage, i used the herbal supplement for only 7 weeks, all symptoms gradually faded away, herbs are truly gift from God. contact this herbal clinic via their email healthherbalclinic @ gmail. com or visit www. healthherbalclinic. weebly. com

  55. Robert K Graham says:

    Let me tell you, RLS is a thing and please don’t insult me by saying otherwise. Now my RLS is caused by something else called neuromyotonia, which my neurologist claims doesn’t exist. Thankfully my regular doctor is more open minded and believes me when I say this stuff helps. So it seems I’m plagued with diseases that don’t exist, but thankfully I can be treated with drugs that do exist. And let me tell you: gabapentin is fucking MAGIC! It is like a miracle drug for me. It has improved every aspect of my life, and if I can have those effects all day rather than yo-yo ing up and down, then GSK please take my money!

  56. Madlyn Boye says:

    Horizant: The Second Coming of Gabapentin | Thought Broadcast

    […]“We don’t want sugar to dwell.[…]

  57. Andrew says:

    If you had rls you’d never question it. It affects your quality of life

  58. Nona says:

    Restless leg is a terrible situation where, not only the legs, but the entire body, spasms. It’s a real
    Problem and unbearable. Please don’t make light of it

  59. Indiana CBD says:

    I specifically like CBD Isolate products because they do not contain any THC so I have peace of mind in the case that I have to take a drug test for work because I am a fire fighter.

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