Re: Fatigue help

[Guest guest]

Yes, I nap. I tell myself that I don't need to, and that it's unusual for me

to nap. However, that just isn't true. Now (as opposed to in years right after

diagnosis) I can go without a nap if I need to. However, I feel far better

and actually get more done, long-term, if I nap. If I don't nap, I may be

exhausted the next day. Not just draggy, but exhausted.

You ask about sleep medications. I don't take anything intended to help me o

sleep. However, about three years ago I began taking Neurontin/gabapentin to

ease post-herpetic neuralgia (the nerve-damage pain that often follows

shingles). As a side effect, it almost always gives me deep, deep sleep without

a

" drugged " , dopey feeling. I wake up most mornings alert, rested, happy. A few

people react very badly to Neurontin; it may even be associated with suicidal

urges for some. I take the maximum dose, but I'm not aware of any

negative effect. Occasionally I have a sleepless night, but not often. I

don't know what causes them, but some of these nights have come before shingles

recurrences. Some mornings I wake up feeling like crap, and I don't know what

causes that, either. I'm very lucky in that my living situation lets me

(usually) sleep until I feel ready to wake fully. But I don't want to miss

anything

by sleeping the morning away!

Harper

Harper

In a message dated 8/11/08 5:55:49 PM, JJCATHCART@... writes:

> I wish those of you that take naps would post so the others would realize

> thay aren't alone. And, those of you who do not would start to if you are able

> to take the time........ I wish those of you that take naps would post so

> the others would realize thay aren't alone. And, those of you who do not would

> start to if

>

**************

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[Guest guest]

Hi,

Just a heads up about Gabapentin. There is a " possibility " that it can cause

liver toxicity. The following is from Medscape:

" " Gabapentin, a water-soluble amino acid, is eliminated unchanged by the

kidneys and there is no appreciable metabolism by the liver. However, there are

a few descriptions of gabapentin-related liver toxicity in the medical

literature. They include:

a.. Lasso-de-la-Vega and colleagues[1] described a case of probable

hepatotoxicity in a 60-year-old man with a piriformis sinus carcinoma who was on

several concomitant medications, including metamizole, ciprofloxacin and

clonazepam. The patient also developed dermatitis consistent with toxicoderma,

as well as eosinophilia in parallel with the liver injury, which improved with

administration of steroids. Because of these concurrent diagnoses, the authors

postulated an immunologic mechanism for the hepatotoxic reaction. It was

subsequently suggested in a letter to the editor that a hypersensitivity

reaction to ciprofloxacin was likely to have been responsible.[2]

b.. A report by and others[3] described a 50-year-old man with

diabetic peripheral neuropathy who developed clinical characteristics of

cholestasis after being treated with gabapentin (titrated up to 300 mg 3 times

daily) for 2 weeks. After the drug was discontinued, clinical symptoms and liver

function tests gradually improved. A liver biopsy revealed normal liver

architecture with evidence of portal tract expansion by a chronic inflammatory

cell infiltrate including eosinophils and neutrophils and patchy steatosis,

cholestasis, and foci of chronic inflammation within the lobules. The authors

believed that these features were consistent with a drug-induced etiology.

c.. Hsu and associates[4] described a case of hepatotoxicity in an epilepsy

patient who had been maintained on phenytoin 125 mg twice daily and

carbamazepine 300 mg 3 times daily, 1 week after gabapentin 600 mg 3 times daily

was added.Liver enzymes returned to normal after gabapentin was discontinued.

Pfizer, the manufacturer of gabapentin, reports a < 1% (0%-.9%) incidence of

abnormal liver function in clinical trials of patients with epilepsy or

postherpetic neuralgia; however, it has also collected an undisclosed number of

spontaneous reports of hepatic events in its postmarketing safety surveillance

database. " "

http://www.medscape.com/viewarticle/489977

I had also taken it but when I found numerous articles saying it could cause

liver toxicity, I stopped. I just didn't want to take any chances with an

already damaged liver.

Respectfully submitted,

Deb

PBC stage 3

[Guest guest]

Thank you so much for this message. I'll follow up, of course. I appreciate

all the work that went into your gathering this information and summarizing it.

Harper

In a message dated 8/12/08 7:33:15 AM, dmconley@... writes:

> Hi,

>

> Just a heads up about Gabapentin. There is a " possibility " that it can cause

> liver toxicity. The following is from Medscape:

>

> " " Gabapentin, a water-soluble amino acid, is eliminated unchanged by the

> kidneys and there is no appreciable metabolism by the liver. However, there

are

> a few descriptions of gabapentin-related liver toxicity in the medical

> literature. They include:

>

> a.. Lasso-de-la- a.. Lasso-de-la-<wbr>Vega and colleagues[1] described a

> case of probable hepatotoxicity in a 60-year-old man with a piriformis sinus

> carcinoma who was on several concomitant medications, including metamizole,

> ciprofloxacin and clonazepam. The patient also developed dermatitis consistent

> with toxicoderma, as well as eosinophilia in parallel with the liver injury,

> which improved with administration of steroids. Because of these concurrent

> diagnoses, the authors postulated an immunologic mechanism for the hepatotoxic

> reaction. It was subsequently suggested in a letter to the editor that a

> hypersensitivity reaction to ciprofloxacin was likely to a.

>

> b.. A report by and others[3] described a 50-year-old man with

> diabetic peripheral neuropathy who developed clinical characteristics of

> cholestasis after being treated with gabapentin (titrated up to 300 mg 3 times

> daily) for 2 weeks. After the drug was discontinued, clinical symptoms and

liver

> function tests gradually improved. A liver biopsy revealed normal liver

> architecture with evidence of portal tract expansion by a chronic inflammatory

> cell infiltrate including eosinophils and neutrophils and patchy steatosis,

> cholestasis, and foci of chronic inflammation within the lobules. The authors

> believed that these features were consistent with a drug-induced etiology.

>

> c.. Hsu and associates[4] described a case of hepatotoxicity in an epilepsy

> patient who had been maintained on phenytoin 125 mg twice daily and

> carbamazepine 300 mg 3 times daily, 1 week after gabapentin 600 mg 3 times

daily was

> added.Liver enzymes returned to normal after gabapentin was discontinued.

> Pfizer, the manufacturer of gabapentin, reports a < 1% (0%-.9%) incidence of

> abnormal liver function in clinical trials of patients with epilepsy or

> postherpetic neuralgia; however, it has also collected an undisclosed number

of

> spontaneous reports of hepatic events in its postmarketing safety surveillance

> database. " "

>

> http://www.medscapehttp://www.medschttp://

>

> I had also taken it but when I found numerous articles saying it could cause

> liver toxicity, I stopped. I just didn't want to take any chances with an

> already damaged liver.

>

> Respectfully submitted,

> Deb

>

**************

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