Gabapentin (Neurontin)

[Nick47]

Is Tetrandrine a common drug that a GP could prescribe?

I doubt it. I'm not hopeful as it was only a part of an undergraduate thesis using a dozen mice. I can't give direct advice, but only cite studies and research and what some seem to get benefit from. I'm in a similar boat to you using very small amounts of benzos daily to survive, and I want to look at other options.

 

[aarond23]

Like a few other responses, my tinnitus developed while I was on Gabapentin. I don't blame the Gabapentin. I think it was more the underlying condition of Trigeminal Neuralgia, the Gabapentin was used to treat that. It helped the Trigeminal Neuralgia to a certain point before I had to switch to Carbamazepine. Luckily my Trigeminal Neuralgia has been in remission for 3+ years, but tinnitus since November 2018.

But to sum it up, I don't think Gabapentin did anything good or bad for me tinnitus wise, I haven't taken Gabapentin for years and my tinnitus is pretty much unchanged, mild to moderate, good days and bad days.

 

[Nick47]

I injured my back at the gym last night. I got severe pain and I had some Gabapentin in the cupboard. I took 300 mg and it didn't help much with the back pain, but the tinnitus dropped a lot after a couple of hours. I woke up and it was still low. Could be a coincidence. Hence I took another 300 mg this morning and my tinnitus is still manageable.

 

[momus]

I think it's hard to say. Probably varies from person to person. Gabapentin is actually more for neuropathy, but works for other things. The good thing about it is that it rarely is a problem when used w/ other medications, and because it's not an opioid, it doesn't have an addiction factor, so you shouldn't have to increase dosage due to a build up of tolerance. It can work as a mild pain aid, especially if it's your back, as there are a gazillion nerves that are all scrunched up where they enter the base of the spine.

I've been taking it for around 6 years or more, generally at 400 mg at night as it acts as a sleep aid. If you take too much, you will definitely feel loopy and your balance will be affected, which is why I seldom take it during the day when I ride my eBike. There was a time when I thought it made my tinnitus worse, but I can't see the causation of when my tinnitus goes up or down. It just does, and it defies any sort of logical reason. I've read that it may not be good to be on it long term, but not all the studies agree on that, and some people have been taking it for 10-20 years w/ no issues.

 

[Nick47]

We recently made the unexpected discovery that GABA can activate voltage-gated potassium (Kv) channels composed of heteromeric assemblies of KCNQ2 (Kv7.2) and KCNQ3 (Kv7.3) pore-forming α subunits (Manville et al., 2018).

Here, we report that gabapentin is a potent activator of the heteromeric KCNQ2/3 voltage-gated potassium channel, the primary molecular correlate of the neuronal M-current.

Did anyone realise this? It was my understanding it only worked on calcium channels.

Gabapentin Is a Potent Activator of KCNQ3 and KCNQ5 Potassium Channels

Quite frankly, Gabapentin was effective for me. I did feel a bit sedated and vague at 600mg/day. I woke up with blurred vision that settled after a couple of hours.

Aren't these the channels we are creaming over on XEN1101 and BHV-7000?

 

[Roger79]

Did anyone realise this? It was my understanding it only worked on calcium channels.

Gabapentin Is a Potent Activator of KCNQ3 and KCNQ5 Potassium Channels

Quite frankly, Gabapentin was effective for me. I did feel a bit sedated and vague at 600mg/day. I woke up with blurred vision that settled after a couple of hours.

Aren't these the channels we are creaming over on XEN1101 and BHV-7000?

The UMCG in the Netherlands are busy with a study to see if GABA can help with tinnitus.

 

[Nick47]

The UMCG in the Netherlands are busy with a study to see if GABA can help with tinnitus.

GABA or Gabapentin?

 

[kingsfan]

The UMCG in the Netherlands are busy with a study to see if GABA can help with tinnitus.

There have been several clinical trials done on Gabapentin and tinnitus. Here is one:

Relief of Idiopathic Subjective Tinnitus - Is Gabapentin Effective?

I'm having trouble finding it, but I believe there was one on Gabapentin and Nortriptyline together. My doctor at University of California Irvine tried it with me. Spoiler: It made my tinnitus temporarily louder.

 

[Nick47]

There have been several clinical trials done on Gabapentin and tinnitus.

Gabapentin seems to be effective in a subgroup with acoustic trauma.

We found that gabapentin significantly decreased the VAS score in patients with tinnitus due to acoustic trauma. Moreover, gabapentin significantly increased the frequency of patients responding to treatment (≥30% decrease in VAS).

Short-Term Effect of Gabapentin on Subjective Tinnitus in Acoustic Trauma Patients

In fact, I experienced about a 30% reduction in tinnitus intensity taking Gabapentin.

 

[kingsfan]

Gabapentin seems to be effective in a subgroup with acoustic trauma.

Short-Term Effect of Gabapentin on Subjective Tinnitus in Acoustic Trauma Patients

In fact, I experienced about a 30% reduction in tinnitus intensity taking Gabapentin.

Yea I have personally had some tinnitus relief from Gabapentin. 50 mg would reduce the intensity for about 3 or 4 days and then it would come back. I'd then have to stay off of it for about a week before it would work again. If I took more than 50 mg, it would make it worse. I'm not sure what was going on. It doesn't seem to help at all now after my recent trauma.

I am a little confused at the dosage in the study. It says they were given 300 mg/day, but medication was administered twice a day. Capsules usually start at 100 mg, so how would they take 150 mg twice a day. Or did they actually take 300 mg twice a day?

I may try this out since they said they had best results on recent acoustic traumas. Just not looking forward to the side effects. Also, the Gabapentin I have is expired and I doubt I can get more.

 

[DeanD]

Gabapentin seems to be effective in a subgroup with acoustic trauma.

Short-Term Effect of Gabapentin on Subjective Tinnitus in Acoustic Trauma Patients

In fact, I experienced about a 30% reduction in tinnitus intensity taking Gabapentin.

Are there any case studies @Nick47 that show whether Gabapentin can keep having this effect, or whether the body build tolerance as it does for some benzos?

Does it continue to reduce it by around 30%?

I assume it does nothing for the reactivity?

 

[Nick47]

Or did they actually take 300 mg twice a day?

This.

Yes, I felt a bit vague. Would this settle over time? Some do well on it.

Are there any case studies @Nick47 that show whether Gabapentin can keep having this effect, or whether the body build tolerance as it does for some benzos?

Does it continue to reduce it by around 30%?

I assume it does nothing for the reactivity?

Yes, and reduced reactivity.

Zapp, 2001, is a 2-year case study.

 

[grate_biff]

Are there any case studies @Nick47 that show whether Gabapentin can keep having this effect, or whether the body build tolerance as it does for some benzos?

If you read the user reviews on drugs.com, you´ll find that many builds tolerance super fast and some will not. Kinda like with benzos. When it comes to alleviating tinnitus, I think it is safe to say you´ll need to have a START-STOP routine for it to work.

Gabapentin Is a Potent Activator of KCNQ3 and KCNQ5 Potassium Channels

Great find. It seems there are drugs out there that affects these channels that are not common knowledge.

Baclofen for instance:

Baclofen, an agonist at peripheral GABAB receptors, induces antinociception via activation of TEA-sensitive potassium channels

In summary, the data of the present study suggested that activation of peripheral GABAB receptors by baclofen induces antinociception via the opening of the voltage-dependent K+ channel or the G-protein-coupled inwardly rectifying K+ channel. Other K+ channel types such as large and small conductance Ca2+-activated and ATP-sensitive K+ channels appear not to be involved. This is the first demonstration of the peripheral antinociceptive effect of baclofen and of one of its possible mechanisms of action.

Effects of potassium channel blockers on baclofen-induced suppression of paroxysmal discharges in rat neo-cortical slices

Evidently Baclofen suppresses such discharges by opening potassium channels normally involved in limiting the burst activity.

Maybe a bit vague, but strengthens my belief in KCNQ research.

 

[Nick47]

Great find. It seems there are drugs out there that affects these channels that are not common knowledge.

Yes, it kind of makes things fall into place. I became aware of Gabapentin when a neurologist friend of mine "culled" some info from the internal ENT guidance on tinnitus. Amongst hearing aids and CBT there was "Gabapentin for tinnitus caused by acoustic trauma." He said you would be lucky to get it prescribed but they may throw you some to get you out the office.

So why acoustic trauma? Well Dr. Shore's research focuses on noise-induced hearing loss. She found that animals who developed tinnitus after noise exposure did not show recovery in potassium channel activity.

Which may explain why Gabapentin is not universally superior to placebo when you lump all tinnitus patients together. Maybe Retigabine only worked for those with noise-induced hearing loss? And maybe XEN1011 etc will also work on this subset?

As for Baclofen, it worked in animals but not in humans. You are the only positive case study I know.

In terms of start-stop routines, you may be right. But would tolerance to the effects also occur with Biohaven and Xenon Pharmaceuticals formulas?

I lean towards your method of circulating what's effective to 'keep them fresh.'

 

[grate_biff]

In terms of start-stop routines, you may be right. But would tolerance to the effects also occur with Biohaven and Xenon Pharmaceuticals formulas?

That's what I'm wondering too. But first things first. I just sent Biohaven an e-mail, asking about tinnitus and hyperacusis.

As regard to Baclofen, it would be interesting if more people were to try it. If benzos work, why not Baclofen. I'm talking about using it sparingly, just so that is clear.

 

[Nick47]

But first things first. I just sent Biohaven an e-mail, asking about tinnitus and hyperacusis.

Well done.

As regard to Baclofen, it would be interesting if more people were to try it. If benzos work, why not Baclofen. I'm talking about using it sparingly, just so that is clear.

It's one of the easier medications to obtain here as Cyclobenzaprine isn't licensed.

 

[Nick47]

I am planning to try Gabapentin as well. My tinnitus is very related to my nerves in the cochlea. What dosage would you recommend of the combination?

@David S, did you ever give Gabapentin a go?

 

[David S]

@David S, did you ever give Gabapentin a go?

No, I did not. But except for that I tried pretty much everything. For me an SSRI and benzo worked fine, but did not do too much for the tinnitus sound itself.

 

[Nick47]

No, I did not. But except for that I tried pretty much everything. For me an SSRI and benzo worked fine, but did not do too much for the tinnitus sound itself.

I tried Gabapentin for a few days with success. It took away most of the metallic screeching. Mine is noise-induced hearing loss. Is yours?

 

[ajc]

I tried Gabapentin for a few days with success. It took away most of the metallic screeching. Mine is noise-induced hearing loss. Is yours?

Why did you stop taking it?

 

[Nick47]

Why did you stop taking it?

I ran out.

 

[sakrt]

Gabapentin does not help my loud tinnitus. It temporarily relieves the nerve and achey ear-pain aspect of my hyperacusis, because it provides a bit of temporary numbing, sedative effect, to feel loopy with brain fog. In my situation, Gabapentin was not prescribed, nor discussed in the top Otolaryngology field.

Gabapentin temporarily somewhat helps my disabling ear/head pain (neuralgia), hyperacusis, dizziness, caused by cochlear implant (CI), which I continue suffering from, but it does not help my severe chronic tinnitus.

Gabapentin was originally prescribed to me following new abnormal seizure activity and pain following CI surgery, because it's an anticonvulsant drug. However, it's prescribed and being experimented as a cross-over drug for other ailments and, as stated by folks on this thread, to see if it helps in tinnitus reduction. Unfortunately, it does nothing for my tinnitus but helps the neuralgia a little (with unpleasant side effects). I believe it depends on the type of tinnitus and, like with benzos and antidepressants, it can be hell to taper off.

If Gabapentin helps your tinnitus - great! Anything to find relief, a way out from this hell.

 

[kingsfan]

Alright. So I tried Gabapentin again for about 1 week, maybe a couple days over that. I started with my usual 50 mg every night for about 4 or 5 days and saw no effects on my tinnitus like I used to prior to my latest acoustic trauma back in May. I know it's a really small dose and the half-life for this stuff is short, but it always worked for me for some reason. Maybe I am really sensitive to it. I also take it at night because it seems to increase my tinnitus while it is active and then quiet it down for about 12 hours after it has wore off.

I decided to up the dose to 100 mg every night and I actually was able to string together a couple decent days until it stopped working. At this point I was contemplating trying 150 mg at night and see if my tolerance was increasing or something. I opted to just stop taking it and see what would happen. Low and behold, the day after skipping a dose my tinnitus was much better again.

This shit is perplexing, but may also just all be coincidence.

Last night, which would be the second night skipping a dose, right around the time I would normally be taking it I began to feel under the weather and dizzy. It seems like I'm having slight withdrawal? So soon and on such a low dose? This is all very interesting.

Sorry if this is rambling and incoherent but I'm feeling very out of it right now as I type this.

 

[Nick47]

started with my usual 50 mg every night

How do you get 50 mg?

 

[kingsfan]

How do you get 50 mg?

Pop open a 100 mg capsule, dilute into water and drink half. Not an exact science, I know.

 

[Nick47]

Pop open a 100 mg capsule, dilute into water and drink half. Not an exact science, I know.

What do you do with the other half? When exposed to air, I presume it degrades.

 

[kingsfan]

What do you do with the other half? When exposed to air, I presume it degrades.

Put it in a glass bottle with a lid and put in the refrigerator.

 

[Kleiner]

You scale at microdoses guys, I find it hard to see how such a low dose can have any effect, I hope it's not a placebo.

Here the ENTs prescribe you up to 3x 100 mg. And by their own admission, at this dose it's more of a placebo than an active drug, they don't want to take the risk of prescribing standard doses of Gabapentin to a tinnitus sufferer because it's very frowned upon.

I've never tried Gabapentin alone, but it seems to be a good combo with other antiepileptics, even if the results don't seem definitive.

Some cases of tinnitus can go as far as the complete annihilation of tinnitus with antiepileptic molecules, but inducing a definitive plasticity of this new state is something else. Maybe by increasing BDNF levels? Otherwise it would be a question of taking it long enough without loss of effectiveness, which can be difficult.

 

[Nick47]

You scale at microdoses guys, I find it hard to see how such a low dose can have any effect, I hope it's not a placebo.

Here the ENTs prescribe you up to 3x 100 mg. And by their own admission, at this dose it's more of a placebo than an active drug, they don't want to take the risk of prescribing standard doses of Gabapentin to a tinnitus sufferer because it's very frowned upon.

I've never tried Gabapentin alone, but it seems to be a good combo with other antiepileptics, even if the results don't seem definitive.

Some cases of tinnitus can go as far as the complete annihilation of tinnitus with antiepileptic molecules, but inducing a definitive plasticity of this new state is something else. Maybe by increasing BDNF levels? Otherwise it would be a question of taking it long enough without loss of effectiveness, which can be difficult.

I take doses of 200-300 mg twice a day, when I take it. I agree, anything <100 mg is pointless, really.

Gabapentin seems only worth trying if you have noise-induced hearing loss/acoustic trauma, certainly based on the studies.

Given my history of loud noise exposure and hearing loss, added to the reactive nature of the tinnitus, I figured it's irritated nerves causing the issues.

I was told by a professor that medications are a type of neuromdulation/signal molecules, but I'm not sure about promoting long-term plasticity.

I'm very much of the opinion that a multifactorial approach to treatment brings the best long-term plasticity. So hearing aids, ALA, electrical stimulation, CBT and a "combination" of medicines at low doses are the way to do it. Otherwise going through each treatment on its own to see what works is tantalizing and futile.

Unfortunately, here in the UK, we are very much into unimodal outdated stuff with tinnitus. So they give hearing aids and ask if they help. Then they prescribe an SSRI and ask if it helps, and so on...

It would be like giving an HIV patient one medication and seeing if it helps, then switching to a different one. All the medications on their own only extend life by a few years, as the virus adapts to overcome the medication. Perhaps the equivalent of reaching tolerance. Some time ago they realised a "combination" of 4-5 medications works, and they live a normal life span, as the virus is not able to overcome the "combination."

What medication combination have you used and to what effect?

 

[Kleiner]

I take doses of 200-300 mg twice a day, when I take it. I agree, anything <100 mg is pointless, really.

Gabapentin seems only worth trying if you have noise-induced hearing loss/acoustic trauma, certainly based on the studies.

Given my history of loud noise exposure and hearing loss, added to the reactive nature of the tinnitus, I figured it's irritated nerves causing the issues.

I was told by a professor that medications are a type of neuromdulation/signal molecules, but I'm not sure about promoting long-term plasticity.

I'm very much of the opinion that a multifactorial approach to treatment brings the best long-term plasticity. So hearing aids, ALA, electrical stimulation, CBT and a "combination" of medicines at low doses are the way to do it. Otherwise going through each treatment on its own to see what works is tantalizing and futile.

Unfortunately, here in the UK, we are very much into unimodal outdated stuff with tinnitus. So they give hearing aids and ask if they help. Then they prescribe an SSRI and ask if it helps, and so on...

It would be like giving an HIV patient one medication and seeing if it helps, then switching to a different one. All the medications on their own only extend life by a few years, as the virus adapts to overcome the medication. Perhaps the equivalent of reaching tolerance. Some time ago they realised a "combination" of 4-5 medications works, and they live a normal life span, as the virus is not able to overcome the "combination."

What medication combination have you used and to what effect?

I used Gabapentin with a Kv7 opener. From what I understand in my case (related to hearing loss), tinnitus is largely a central problem, maybe even totally.

My opinion is that whatever you try, the main problem is to obtain definitive results. That's why, in addition to drugs/technologies that objectively bring tinnitus to a lower level, I now have to find a method to reinforce plasticity during this window. There are drugs that increase BDNF for example, but perhaps auditory stimulation also makes sense, or even physical stimulation, and all in the meantime.

And I agree, defeating tinnitus without going through hair cell regeneration assumes, in my opinion, a combo of different techniques to increase action range.

What conclusion do you draw from Gabapentin in your case so far?