An anticonvulsant/anticonvulsant approved to treat seizure disorders in 1993 Neurontin, is used, off-label, to treat chronic fatigue syndrome (ME/CFS), fibromyalgia, irritable bowel syndrome (IBS), neuropathic (nerve) pain, hot flashes, migraines, PTSD and bi-polar disorders.
Neurontin decreases the release of pain enhancing and excitatory neurotransmitters such as glutamate, norepinephrine and substance P by altering the activity of calcium channels in the brain. It appears to increase the levels of the feel good neurotransmitters GABA and serotonin. Neurontin and it s close cousin, Lyrica, may regulate the inflammation produced through pathways governed by the NF-kB transcription factor some researchers believe plays a key role in ME/CFS.
Lyrica (pregabalin), a close relative of Neurontin, was developed as an upgrade to Neurontin by Parker Davis (Pfizer). Lyrica is reportedly more potent and absorbs better (thus requiring lower dosages) but may not have fewer side effects. Neurontin may be as effective in some patients and is much cheaper.
Neurontin May Be Effective in Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Because…
It may reduce the levels of neurotransmitters that contribute to pain and ‘central sensitization’ in these disorders and can be helpful with sleep. It is one of the few drugs used successfully at times to treat multiple chemical sensitivity. Neurontin was featured as a sleep drug in the IACFS/ME Treatment Primer.
Chronic Fatigue Syndrome (ME/CFS) Patients Report
Thirty four of 119 ME/CFS patients reported Neurontin produced moderate or major (n=3) improvement, 44 patients experienced no effect, and 39 patients experienced moderate to severe side effects on Curetogether as of March, 2013.
Chronic Fatigue Syndrome (ME/CFS) Doctors Report
Dr. Paul Cheney puts Neurontin in his list of ‘neuro-protective’ drugs that helps reduce over sensitivity to stimuli. In ‘Betrayal of the Brain’ Dr Goldstein reported that many patients reported increased energy with low dose Neurontin. Dr. Vinod Patel reported Neurontin was useful for neuropathic pain and to control myoclonic jerks in his patients. Dr. DeMeirleir finds anticonvulsants enhance deep sleep and are more effective sleep remedies than typical sleep drugs in ME/CFS.
Neurontin ME/CFS and FM Studies
A 2011 Cochrane report of Neurontin’s effectiveness in chronic pain conditions including fibromyalgia stated Neurontin would provide high levels of pain relief in about a third of patients who took it. Neurontin significantly improved the BPI average pain interference score, the Fibromyalgia Impact Questionnaire total score, the Clinical Global Impression of Severity, the Patient Global Impression of Improvement, the Medical Outcomes Study (MOS) Sleep Problems Index, and the MOS Short Form 36 vitality score compared to placebo in a 2007 fibromyalgia study.
Neurontin and Lyrica were associated with significantly reduced pain, increased sleep and quality of life but not mood or fatigue in a 2009 Fibromyalgia meta-analysis. Neurontin use was associated, however, with increased use of opioids, SNRI’s, anticonvulsants, benzodiazepines, topical agents and ‘combination therapies’ in fibromyalgia in a 2009 study. (Lyrica was associated with reduced use of some of these drugs.) Reduced brain blood flows were associated with a poor response to Neurontin in a 2010 fibromyalgia study.
The IACFS/ME Treatment Primer recommends 100-1500 mgs for sleep. Erica Verillo reports that Dr Cheney recommends starting at 300 mgs 3/x’s a day and that Dr. Teitelbaum starts out with 1-300 mgs/night, slowing increasing to 3-900 mgs three times a day.
A 2011 Cochrane report stated that adverse events (dizziness (21%), somnolence (16%), peripheral oedema (8%), and gait disturbance (9%)) were ‘frequent but mostly tolerable’ and that few serious side effects were seen. Neurontin should not be discontinued abruptly as it can trigger withdrawal symptoms similar to those found in benzodiazepine or alcohol withdrawal. It has been associated with increased risk of suicide.