Recently I saw a patient for a complaint of insomnia. The patient described excessive daytime sleepiness and inability to sleep at night. He would fall asleep at 9:00 a.m and sleep until noon. He woke for lunch then fell asleep in the afternoon. His afternoon naps lasted for 5 hours or longer. The patient was taking 400mg of gabapentin twice a day: 6:00 a.m. and 8: p.m . His total daily dose of gabapentin was 800 mg. After his 8:00 p.m. dose of gabapentin, he fell asleep but woke shortly afterwards and could not return to sleep. Soon he was sleeping during the day and unable to sleep at night.
Gabapentin is approved by the FDA for treatment of seizures and neuropathic pain. Physicians used gabapentin to help control leg discomfort caused by diabetic neuropathy.
Gabapentin is commonly prescribed by doctors of conditions not approved by the FDA. When a medication is used for a condition that is not authorized by the FDA, this is called “off-label” use. Gabapentin is used off label for a number of conditions. Some off-label uses of gabapentin are treatment for headaches, multiple sclerosis, fibromyalgia and insomnia.
This patient had daytime sleepiness due to gabapentin.. Because the medication was taken during the day and early evenings, the patient’s night time sleep pattern was affected. In addition, upon a review of medications, the patient was taking twice the dose prescribed dose by his doctor.
From this patient we learn the importance of reading the instructions on how much medication to take and during a doctor’s visit asking the patient how he takes the medication. It’s a good idea to review the dose of your medications with a someone. Reviewing helps catch errors hopefully before serious problems arise.
Another thing we can learn is that some side effects are useful. For example, medications that cause sleepiness can be used in place of sleeping pills. If you have medications that cause sleepiness, talk withyour doctor and ask if the medication can be taken at bedtime.
After this patient’s medication was adjusted to the correct dose, he was able to sleep at night and daytime sleepiness resolved.