Neurontin decreases the effectiveness of PO pain meds?

merlee · Sep 19, 2011

I love my neurontin, I think it helps with my overall pain relief.

roma4204, BSN, RN · Sep 19, 2011

It makes sense if it's working on the same receptors.

Flo., BSN, RN · Sep 19, 2011

Never heard of that. In fact we add it in if someones pain is out of control.

leslie :-D · Sep 19, 2011

lortab et al, are usually not very helpful with neural pain.

we usually prescribe neurontin or depakote for that particular type of pain, and it helps tremendously.

methadone is the only opiate drug that works on neuro.

they definitely should not have dc'd the neurontin, but add to it.

hope he is on the road to recovery.

and talk to that doc about restarting the neurontin.

leslie

CoffeeRTC, BSN, RN · Sep 19, 2011

300 tid isn't that big of a dose.

nurseprnRN, BSN, RN · Sep 19, 2011

gabapentin (neurontin, trade name) 300mg tid is not a maximal dose for neuropathic pain

postop pain is not (generally) neuropathic, and gabapentin won't touch it. if they were holding his gabapentin for some reason, his neuropathic pain could be acting up on him.

opioids are usually used for post surgical pain; not everyone responds to every opioid the same way. if lortab (hydrocodone and acetaminophen) wasn't working for him, they should have tried him on another.

i have never heard of neurontin decreasing the function of other kinds of pain receptors. sounds like the md was giving you a wag (wild-assed guess). he ought to have called his colleagues in pain management for a consult. i hope your dad is better, but if he isn't, i hope his pain mgmt docs have chimed in by now.

vanburbian · Sep 19, 2011

12 hours post CABG to start Vicodin seems a tad early to me.

I think IV pain relief for that caliber of surgery is warranted for ~24-maybe in some cases, even up to 36 hours, depending on previous history, home meds, etc.

chevyv, BSN, RN · Sep 19, 2011

lortab et al, are usually not very helpful with neural pain.
we usually prescribe neurontin or depakote for that particular type of pain, and it helps tremendously.
methadone is the only opiate drug that works on neuro.
they definitely should not have dc'd the neurontin, but add to it.
leslie

I had no idea depakote is used for pain. I love allnurses! I'm a psych nurse and we give out a lot of depakote. I'm remembering this tidbit :nurse:

xtxrn, ASN, RN · Sep 19, 2011

Ok my dad takes a pretty large dose of neurontin. I think like 300mg tid. He had a wreck about 10 years ago and broke his back and the neurontin helps the tingling in his legs. Well two weeks ago he had a CABG. He was on IV morphine for about 12 hours but he was still sound asleep from the anesthesia. Once he woke up he wad changed to lortab for pain. He was in excruciating pain. The lortab didn't touch it. They tried PO dilaudid and it didn't stop the pain. Now I know that lortab nor dilaudid would not have completely taken away all of his pain. But they should have given him some relief so he could rest. It didn't touch it. Finally a doctor suggested the neurontin was decreasing the effects of the pain medicine. Has anyone ever heard this? I tried researching it but found nothing.

Minimal dose of Neurontin.

3600mg/day is the suggested max/24 hours. Some docs go higher. In my own experience, I did not get greater benefits from a larger dose (I took 1800mg BID for a few months, and it was pointless to go above 300mg in the am & 600mg at hs- for me).

http://www.mywhatever.com/cifwriter/library/eperc/fastfact/ff49.html

Neurontin is used as a pain med, either adjunct or primary. It depends on the source/type of pain.

That doc sounds uninformed????

cherrybreeze, ADN, RN · Sep 19, 2011

gabapentin (neurontin, trade name) 300mg tid is not a maximal dose for neuropathic pain
postop pain is not (generally) neuropathic, and gabapentin won't touch it. if they were holding his gabapentin for some reason, his neuropathic pain could be acting up on him.
opioids are usually used for post surgical pain; not everyone responds to every opioid the same way. if lortab (hydrocodone and acetaminophen) wasn't working for him, they should have tried him on another.
i have never heard of neurontin decreasing the function of other kinds of pain receptors. sounds like the md was giving you a wag (wild-assed guess). he ought to have called his colleagues in pain management for a consult. i hope your dad is better, but if he isn't, i hope his pain mgmt docs have chimed in by now.

they did: according to the op, they also tried po dilaudid without success.

ErinS, BSN, RN · Sep 20, 2011

Now I am a hospice nurse, and so we do things a little different. But how much dilaudid did they try? 1mg? 2mg? I find that often in hospitals they are unwilling to increase narcotic dosages past some arbitrary starting dose. There is no narcotic ceiling, and there are other oral pain meds. Oxycodone, morphine, even fentanyl. Perhaps your dad just has a high tolerance to pain meds.