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  • Neurontin (gabapentin) can cause weight gain


    Posted by .(JavaScript must be enabled to view this email address)
    Thursday, March 18, 2004 1:55 pm Email this article
    The anti-convulsant Neurontin (gabapentin) can cause weight gain according to a 1997 study.

    57 PERCENT GAINED 5 PERCENT OR MORE

    Changes in body weight were as follows:

    The weight gain started between the second and third month of taking Neurontin (gabapentin) in most patients, and tended to stabilize after 6 to 9 months of treatment.

    WEIGHT GAIN WITH OR WITHOUT OTHER ANTIEPILEPTIC DRUGS

    Weight gain occurred in patients taking Neurontin (gabapentin) in combination with each of the major antiepileptic drugs including Felbatol, as well as in patients taking Neurontin (gabapentin) alone.

    SUBJECTS

    The study reviewed changes in body weight in 44 patients treated with Neurontin (gabapentin) for a year or more.

    All patients had a seizure disorder and the dose of Neurontin (gabapentin) was increased aiming at complete seizure control or until side effects limited further increase.

    Twenty-eight of the 44 patients were taking more than 3,000 mg per day.

    USED FOR EPILEPSY AND PAIN

    Neurontin (gabapentin) is used to help control some types of seizures in the treatment of epilepsy.

    This medicine is also used to manage a condition called postherpetic neuralgia (pain after shingles).

    REFERENCE

    Detoledo J, Toledo C, Decerce J, Ramsay R. Changes in body weight with chronic, high-dose gabapentin therapy. Ther Drug Monit. 1997 Aug, 19(4):394-96.

    Articles on the same subject can be found here:


    COMMENTS

    On Mar 19, 2004 at 11:11 am SheriM wrote:

    . . . . .

    I have gained 40 lbs. since starting to use Seroquel (100 mg., now 200 mg.) since last year.? I also take Neurontin for pain (600 mg. at night and 400-800 mg. during the day).? I suffer Bi-Polar disease and late-stage, chronic Lyme disease.? The Lyme has caused osteo-arthritis everywhere.? I?m wondering if my using the Seroquel and the Neurontin together have contributed to such a weight gain.? I am trying to exercise for 30 min. each day, and am hoping that I will see a change within a month or so.?

    (Larry Hobbs posted this comment for SheriM under this article since it also refers to Neurontin. This comment was copied from a previous article "Seroquel associated with modest weight gain". http://fatnews.com/index.php/weblog/comments/325/)

    On Mar 19, 2004 at 11:13 am Robert Skversky, M.D. wrote:

    . . . . .

    If possible, this patient?s Primary Care Provider or Psychiatrist should replace Neurontin with Topamax in that they are both effective for adjuvant treatment for bi-polar disease and peripheral neuropathy.

    Unfortunately her exercise regime, even if tripled, will be ineffective for reasonable weight
    loss.

    The patient in my brochure lost 47 lbs after being switched from Neurontin to Topamax (topiramate).

    After 3 years she is holding steady at 121 lbs with no additional anorectic medication.

    (Larry Hobbs entered this comment from an email he received from Dr. Robert Skversky.)

    On Mar 19, 2004 at 11:15 am Marjorie Yong, M.D. wrote:

    . . . . .

    Larry,

    I have noticed patients gaining weight with Neurontin. But, it is a great medication for chronic pain. If Sheri needs the Neurontin for pain control, then, she may need to continue it. Exercise can only help so much to prevent weight gain. The most important component to prevention of weight gain and weight loss is the nutrition component.

    Marjorie Yong, M.D.

    (Larry Hobbs entered this comment from an email he received from Dr. Marjorie Yong.)

    On Jul 14, 2004 at 4:58 pm r.cooke wrote:

    . . . . .

    I take nurontin 300mg 4tid and have been for several years and 500mg ultram a day plus (3) 625mg arthritis strength Tylenol 3tid. My former Neuro put me on this med. for chronic pain in my ribs under each breast. My normal weight was 123lbs and I am 5'3". I have ballooned up to 187lbs. My frame is not designed to carry this kind of weight. If anyone knows how to lose weight while taking Neurontin please tell me. I am becoming desparate. I realized that if you take neurontin then eat, the food kills the medicine so you have to take more. I do not eat in between meals. I take my meds starting at 6 or 7am. I do not eat breakfast just coffee. I may or may not have lunch and if I do it is light or very low calorie, then I take my second round of meds which is usually about 2pm. I have dinner usually around 8pm then take my last dose of meds between 9:30 and 10:00pm. I then start the process over the next am. Please help me find a way to lose this weight. It is killing me.

    On Jul 14, 2004 at 7:24 pm Larry Hobbs wrote:

    . . . . .

    R. Cooke,

    I will ask some doctors specializing in weight loss if they have any suggestions for you.

    Note in one of the comments above that Dr. Robert Skversky states that Topamax (topiramate) is effective for peripheral neuropathy, which is nerve pain that usually involving the feet, hands and sometimes the legs, arms and face. Symptoms may include numbness, tingling or burning sensations, pain, abnormal reflexes, weakness and partial paralysis.

    Dr. Skversky notes that one of his patients lost 47 lbs after switching from Neurontin to Topamax (topiramate).

    You might want to talk to your doctor about Topamax (topiramate) and see if there is any evidence that it might help your pain, and in the process help you lose weight.

    On Jul 15, 2004 at 7:33 am Robert Skversky, M.D. wrote:

    . . . . .

    I assume the patient has been on neurontin for quite some time.

    Topamax (topiramate), in addition to being used for peripheral neuropathy, can surely be tried for chronic pain regardless of etiology (cause).

    I have found it to be effective for migraine, back pain and fibromyalgia.

    On Jul 15, 2004 at 10:30 am Jay Piatek, M.D. wrote:

    . . . . .

    I have quite a bit of experience with Topamax.

    A newer one is Zonegran (zonisamide).

    A lot of the neurologists in my area are using that for peripheral neuropathy (nerve pain).

    The key to losing weight for this patient is lower the pain level which, will lower the stress level and try to be on a weight losing drug.

    I typically start patients either on Topamax or Zonegran at low dose, while they continue taking Neurontin.

    Each month increasing the Zonegran until there is no pain.

    Then I slowly wean them from the Neurontin.

    Zonegran is outstanding for sweet cravings, pop drinking and binge eating. It seems to be a new and improved Topamax.

    The other thing that she could do to get an injection, some kind of nerve killer if you will, something to stop the pain.

    [This comment was posted by Larry Hobbs from an email received from Dr. Piatek.]

    On Jul 15, 2004 at 10:37 am Jay Piatek, M.D. wrote:

    . . . . .

    Here is what I tell my patients about Zonegran.

    -----

    There is a new medication that I also wanted to let you know about called Zonegran (zonisamide).

    Zonegran is an exciting breakthrough in medications for weight management.

    Zonegran has been used in other countries and on the market internationally for ten years and in this country for over two years.

    There are over one million patient experiences; it has also been given to children.

    It has actually been used for the same indications as Topamax. It is used to treat seizures (indication), as well as back pain, nerve pain, headaches, restless legs and bipolar disease (off label).

    It appears to have fewer side effects than Topamax and also has very few contraindications.

    It has no interactions with other medications and has a very low side-effect profile.

    It does not affect birth control pills and does not cause the glaucoma that has been associated rarely with Topamax.

    A weight loss study was published in JAMA in April 2003 with patients using Zonegran. The study found that the patients that took the Zonegran lost weight, and it was well tolerated.

    Most patients liked the medication as it tended to stop binge eating and made sweets as well as carbonated beverages undesirable.

    As the medication is void of serious side effects, only one participant dropped out of the study due its side effects.

    Approximately 33% of the study participants complained of fatigue; therefore, I do give it at night as it should help you sleep.

    It is rarely associated with kidney stones in previous stone formers. If you have a history of kidney stones, you should be cautious and drink lots of fluids with it.

    Note: You should not take it if you have a sulfa allergy.

    I have recently started giving it to quite a few patients (over 100) and have been very impressed -- especially when used in conjunction with a stimulant medication such as Adipex (phentermine).

    The capsule can actually be opened and the dose titrated [increased slowly].

    I typically do this in the rare event of a side effect.

    I have patients start off with one-100 mg pill every other night for one week and then increase to one every night.

    In many cases, the higher the dose, the more the appetite is suppressed.

    We typically increase on a monthly basis.

    It is obtained through a pharmacy, and most insurance companies do pay for Zonegran as it is used to treat those illnesses I mentioned earlier.

    [This comment was posted by Larry Hobbs from an email received from Dr. Piatek.]

    On Jul 16, 2004 at 7:08 pm r.cooke wrote:

    . . . . .

    Thank you so much, I am going to bring this to the attention of my pain physician. I have asked so many doctors this same question about the weight gain and the pain. This is the first time I have received any positive feed back and this is very exciting. I will stay in touch and keep you posted. Again, Thank You.

    Sincerely,
    R. Cooke

    PS: If this works, I will be able to have my life back! I can have the quality life I used to being active and healthy again. I can do the things a mom should be able to do with her little one. I can do more for others. I would like to know where the two aforementioned Physicians are located, Dr. Piatek and Dr. Skversky i.e.(what city, state) if at all possible. Thank you Mr. Hobbs.

    On Jul 16, 2004 at 7:50 pm Larry Hobbs wrote:

    . . . . .

    R. Cooke,

    From Dr. Piatek and Dr. Skversky -- you are welcome.

    Here are their addresses.

    Roger Andrew (Jay) Piatek, M.D.
    745 Beachway Dr.
    Indianapolis, IN 46224
    (317) 243-3000 phone

    -----

    Robert Skversky, M.D.
    Weight No More
    320 Superior Ave #210
    Newport Beach, CA 92663-2741
    (949) 645-2930 phone

    -----

    Keep us posted how you do.

    On Jul 19, 2004 at 11:46 am Larry Hobbs wrote:

    . . . . .

    CORRECTED JULY 19, 2004

    DR. PIATEK ASK ME (LARRY HOBBS) TO MAKE SEVERAL CORRECTIONS TO HIS COMMENT. THE CORRECTIONS ARE NOTED IN THE TEXT IN BOLD BELOW.

    ------

    "There is a new medication that I also wanted to let you know about called Zonegran (zonisamide). Zonegran is an exciting breakthrough in medications for weight management.

    ZONEGRAN USED IN OTHER COUNTRIES FOR 10 YEARS

    Zonegran has been used in other countries and on the market internationally for ten years and in this country for over two years.

    There are over one million patient experiences; it has also been given to children.

    ZONEGRAN HAS THE SAME INDICATIONS AS TOPAMAX

    It has actually been used for the same indications as Topamax. It is used to treat seizures (indication), as well as back pain, nerve pain, headaches, restless legs and bipolar disease (off label).

    ZONEGRAN HAS FEWER SIDE EFFECTS THAN TOPAMAX

    It appears to have fewer side effects than Topamax and also has very few contraindications.

    It has no interactions with other medications and has a very low side-effect profile.

    NO EFFECT ON BIRTH CONTROL PILLS OR GLAUCOMA

    It does not affect birth control pills and does not cause the glaucoma that has been associated rarely with Topamax.

    ZONEGRAN WEIGHT LOSS STUDY IN 2003

    A weight loss study was published in JAMA in April 2003 with patients using Zonegran.

    [Go to http://fatnews.com/index.php/weblog/C73 to read a summary of the Zonegran study.]

    The study found that the patients that took the Zonegran lost weight, and it was well tolerated.

    Most patients liked the medication as it tended to stop binge eating and made sweets as well as carbonated beverages undesirable.

    As the medication is void of serious side effects, only one participant dropped out of the study due its side effects.

    Approximately 33% of the study participants complained of fatigue; therefore, I do give it at night as it should help you sleep.

    ZONEGRAN IS RARELY ASSOCIATED WITH KIDNEY STONES

    It is rarely associated with kidney stones in previous stone formers. If you have a history of kidney stones, you should be cautious and drink lots of fluids with it.

    DO NOT TAKE ZONEGRAN IF YOU HAVE A SULFA ALLERGY

    Note: You should not take it if you have a sulfa allergy.

    DR. PIATEK GIVES ZONEGRAN WITH PHENTERMINE

    I have recently started giving it to quite a few patients (over 1,000) and have been very impressed -- especially when used in conjunction with a stimulant medication such as Adipex (phentermine).

    It seems to be additive, that is, adding Zonegran probably causes an additional 3-4 pounds per month of weight loss.

    IN THE CASE OF SIDE EFFECTS, INCREASE THE DOSE SLOWLY

    The capsule can actually be opened and the dose titrated [increased slowly].

    Zonegran comes in 25 and 50 mg capsules.

    I typically do this in the rare event of a side effect.

    DR. PIATEK STARTS WITH 25-50 MG PILL EVERY OTHER NIGHT, THEN EVERY NIGHT

    I have patients start off with one-25 to 50 mg pill, then increase the dose slowly up to 100 mg every other night for one week and then increase to one every night.

    In many cases, the higher the dose, the more the appetite is suppressed.

    We typically increase on a monthly basis until the appetite is suppressed ??? usually 100-200 mg.

    It is obtained through a pharmacy, and most insurance companies do pay for Zonegran as it is used to treat those illnesses I mentioned earlier.

    ------

    ADDITIONAL COMMENTS ABOUT ZONEGRAN FROM DR. PIATEK

    ZONEGRAN BEING USED FOR PERIPHERAL NEUROPATHY (NERVE PAIN)

    A lot of the neurologists in my area are using Zonegran for peripheral neuropathy (nerve pain).

    [For someone with pain,] the key to losing weight for this patient is lower the pain level which, will lower levels of cortisol [stress hormone]. It is also important to use any medications to control the pain that may be more associated with weight lose then weight gain. Certainly patients also sleeping better at night have a more better cortisol level which, does assist with weight lose as well.

    FOR THOSE WHO HAVE GAINED WEIGHT TAKING NEUROTIN, ADD ZONEGRAN TO CONTROL THE PAIN, THEN SLOWLY WEAN OFF NEUROTIN

    [For someone who has gained with taking Neurontin (gabapentin),] I typically start patients either on Topamax or Zonegran at low dose, while they continue taking Neurontin.

    Each month increasing the Zonegran until there is no pain.

    Then I slowly wean them from the Neurontin.

    ZONEGRAN GREAT FOR SWEET CRAVINGS; THE NEW AND IMPROVED TOPAMAX

    Zonegran is outstanding for sweet cravings, pop drinking and binge eating. It seems to be a new and improved Topamax.

    ------

    As noted above, the above information is from Jay Piatek, M.D.

    On Jul 21, 2004 at 2:25 pm Dennis Padla, M.D. wrote:

    . . . . .

    Topamax (topiramate) titrated up to 100 mg per day [starting with a lower dose and gradually increasing up to as much as 100 mg per day] seems to help with Headache.

    My headache specialist friends like it. Maybe it'll help with chronic pain.

    Gabitril (tiagabine HCl, an antiepilepsy drug) has been used with modest success in some chronic pain syndromes at around 8- 12 mg/day.

    I'm not sure about weight gain with it.

    I hope this helps.

    Dennis Padla, M.D.
    Founder,
    Center for Psychiatry and Weight Management
    http://www.ManageYourWeight.com

    ---

    [This comment was added by Larry Hobbs from an email received from Dr. Padla.]

    On Aug 04, 2004 at 9:56 am William Wilson, M.D. wrote:

    . . . . .

    In my experience, it is not unusual for certain patients to store extra fat while taking Neurontin.?

    She needs to focus not on calories but rather reducing her intake of high glycemic carbohydrates.

    [These are foods that raise blood sugar rapidly, such as potatoes, bread, rice, sugar, honey, etc.]

    And if she has symptoms of dopamine/norepinephrine deficiency (fatigue, short term memory problems, excessive hunger, carbohydrate cravings, cognitive dysfunction), consider adding a low dose enhancing medication such as Adderall or Phentermine.

    [The comment was added by Larry Hobbs from an email received from Dr. Wilson.]

    On Aug 10, 2004 at 8:53 pm Sheri Matsumoto wrote:

    . . . . .

    Thank you so much for all the info. on Topomax and Zonegran. I've been on Topomax before and had serious cognitive disfunction with it. However, I'm going to tell my psychiatrist about the Zonegran. He is usually very good about trying new meds. I began taking Neurontin again last month, because I was in terrible pain, and have gained back all the weight I was able to lose while off it. I've got tremendous sweets and carb cravings! I hope the Zonegran works for me. Thanks again. Sincerely, Sheri M.

    On Aug 10, 2004 at 9:13 pm Larry Hobbs wrote:

    . . . . .

    Sheri,

    You're welcome from all the doctors who have commented on this.

    Let us know how you do.

    On Jan 14, 2005 at 12:44 pm T. Tymchuk wrote:

    . . . . .

    I have been taking Neurontin for almost 2 years, along with several other medications. I was in a near fatal car crash that caused several nerves to avulse in my neck, rendering my left arm completely paralyzed except for the shoulder. I suffer from "phantom" nerve pain, it feels like my hand and some forearm, are being crushed and dipped into a deep fat fryer. It is a pain that cannot imagined by anyone who hasn't gone through it.

    I have gained 70 pounds, and have a sweet tooth that won't stop. I was wondering if I can lose weight by cutting down on simple carbs, or if a change of medication is in order? I have a sulfa allergy, so Zonegran would be out of the question. Would Topamax help at all, or am I basically up the proverbial creek?

    I take the following meds:
    Neurontin-5600mg/day Trazadone-50mg/day
    HydroMorphContin-54mg/day Dilaudid-as needed
    Effexor-150mg/day Lorazapam-as needed
    Amitriptyline-50mg/day

    Any help would be greatly appreciated!!

    On Jan 18, 2005 at 10:47 am Larry Hobbs wrote:

    . . . . .

    T,

    I'll ask some doctors and see if they have any suggestions.

    Amitriptyline as well as Neurontin can cause weight gain.

    On Jan 22, 2005 at 6:25 am T. Tymchuk wrote:

    . . . . .

    Thanks Larry

    On Jan 28, 2005 at 7:51 am Randy Smith, MD wrote:

    . . . . .

    The obvious medication causes of weight gain are Neurontin, Trazodone, and Elavil. I was going to suggest Topomax but see you have had trouble with it. Pamelor may provide pain relief similar to Elavil without the weight gain or the Effexor dose could be increased to improve response. The use of melatonin 6 - 9 mg at bedtime (as much as 20 mg can be used) may help with sleep to the point of being able to eliminate the Trazodone.

    I hope this helps.

    Dr. Smith

    http://www.antiagingatlanta.com

    On Jan 28, 2005 at 9:00 am Monte J. Meldman, MD wrote:

    . . . . .

    I wonder why you are taking this list of medications.

    If your neuropathic pain is as bad as it sounds, it cannot get much worse, so I deduce the medications are not helping.

    Your weight gain is possibly due to the array of medications you are taking.?

    Trazadone, Effexor, and Amitryptyline (Elavil) are very likely to cause weight gain, in the order of magnitude of 80 pounds or more.

    Are they of any benefit?? If not why are you taking them?

    There are several anticonvulsants that help with weight loss and antidepressant effects.

    They are called Lamotragine, Tiagabine, and Topamax.

    Each one has different effects and each one alleviates depression,?anxiety (Tiagabine) ?and can relieve neuropathic pain.

    They are better than neurontin in many cases.

    There is a well known progression of treatments for pain as bad as yours, but they start out with hypnosis, electrostimulation of multiple body?areas, ultrasonic vibrations with SoundSkin,?acupuncture with lights on the spots and needles in the traditional fashion, TENS units, and proceed on up to major operative procedures like rhizotomy and sectioning of the cord, and as far as several?brain operations.

    It depends on how you respond to each one going up the scale of intensity until you get relief.

    Drugs often work but when they are used as they are in your case they may cause as much?trouble as the pain they are supposed to relieve.

    On Jan 29, 2005 at 5:07 am Monte J. Meldman, MD wrote:

    . . . . .

    Installment 2 After thoughts:

    The withdrawal from the medications is difficult and needs to be managed carefully.

    I use Klonopin 2 milligrams at bed time and 0.5 mg three times a day and as necessary, along with Atenolol 25 milligrams 2-3 times a day.

    It is an art to withdraw a patient from that load of medications.

    First get off the Elavil and then the trazadone and then chip away slowly on the Neurontin.

    It is best done by an addictionologist.

    Then Topamax can be started at small doses 25 bid and then 100 milligrams a day.

    Phentermine is usd for the weight loss if the bp is stable and 37.5 milligrams twice a day with a 1500-1800 ?calorie diet--depending on the person's initial size -- ?will work to start and get him stable.

    The Phentermine is good for treating migraine headaches and many of my my migraine patients have only 1 or 2 headaches a year when on Phentermine.

    It also might help the Neuropathic pain.

    On Jan 29, 2005 at 5:14 am Michael Anchors, MD, PhD wrote:

    . . . . .

    Dear T. Tymchuk,

    Sorry to hear about your terrible accident and the chronic pain that has ensued.??There may be other causes?for your weight gain, but a very important cause?is?the?increased appetite from?taking amitriptyline (Elavil) 50 mg a day.??To avoid?weight gain you should get down to as low a dose of amitripityline as possible or get off the medicine completely.
    ?
    To lose weight you need to eat less food, by which I really mean fewer calories.? The answer is always in the size of portions.? If you will send me your address, I will send you chapters from my not-yet-published book "Life Between Meals"..? Alternatively I recommend the new book "French Women Don't Get Fat:? The Secret of Eating For Pleasure".? I wrote a book "Safer Than Phen-Fen" back in 1997.? It's out of print but can sometimes be found on E-bay or Amazon.
    ?
    Reducing?carbs allows?you to lose weight faster, but only the level??of calories determines the weight you?eventually reach.
    ?
    If you are plagued by excess hunger, you can add phentermine 30 mg a day (start with 15 mg for the first 5 days).? Together?with the Effexor you already take, the addition of phentermine constitutes the phen-pro combination (NOT the same thing as phen-fen).? Phen-pro is safe.? For 8 of the last 10 years it was the most effective, safe, available?medical treatment for obesity.? We have Topamax now,?but Topamax is expensive and 1/3 of patients can't tolerate it.? I'd try phen-pro first IF hunger gets in your way.? As you lose weight you will become less hungry.? Obesity itself increases hunger.? Dieting gets easier.? The only way to fail is not to start.

    On Jan 29, 2005 at 5:22 am Alan Terlinsky, MD wrote:

    . . . . .

    I hope I can offer this unfortunate gentleman -- T. Tymchuk -- some helpful advice.

    As several physicians have already commented, action should be taken to re-evaluate the need for all of his meds, particularly the weight promoting group which has been identified.

    This makes sense to me as his pain control seems far from optimal.

    Likewise, substitution/addition of his regimen with Lamotragine, Tiagabine,and/or Topamax is also worthy of consideration and logical in the presence of his weight gain.

    I would also consider adding/substituting Bupropion into his anti-depressant configuration.

    We are not told anything about the gentleman's present BMI or concurrent medical problems.

    I would advise this man to make sure he is not diabetic or insulin resistant, for if this were the case, he should be placed on a specific nutrition plan aimed at treating these conditions.

    I would aim for diet which provided for 30-35% of his daily calories as protein and try to restrict his total carbs to somewhere between 50 and 90 grams per day.

    I would make sure he gets a fasting insulin level or perhaps a two hour post prandial glucose and insulin level.

    If he were hyperinsulinemic, consideration for the use of metformin could be entertained. The new "sweet tooth" suggests to me the possibility of blood sugar swings which could be insulin resistance. This also could be due to low serotonin levels as a result of chronic pain (sweet craving). He could try some 5'HTP, carefully of course, if he remains on SSRI's.

    I would also recommend taking a good look at his thyroid, adrenal, gonadal and hypothalamic function. His complicated medical regimen and his chronic pain could be acting as significant endocrine disruptors.

    His Free T-4 and Free T-3 thyroid hormone levels should be kept in the upper 50th percentile of normal.

    Chronic pain could lead to hypothalamic dysfunction, so TSH should not be the test to determine normal thyroid status.

    Depending on his body fat and age, he could also have a testosterone or free testosterone problem. Many drugs will increase SHBG [sex hormone binding globulin] which will lower bio-active testosterone due to increased binding and reduced free testosterone.

    I would also like to see a reasonable AM cortisol. Excessive AM cortisol levels would confirm a probable contribution from high cortisol secretion contributing to his weight gain.

    I assume he does not sleep well and this needs to be addressed. To the extent that he can, he must also try to exercise including resistance and stretching.

    In Summary. it would be nice to think that a simple solution exists for this man's weight problem and that some "magic bullet" is out there to bring him relief. I don't think that is the case. Neither do I agree with him that he is "up the creek."

    I believe he would be helped by a comprehensive approach which includes optimization of his pain control through standard approaches and alternative approaches, improved sleep, stress management, exercise, complete evaluation of his medical condition including his overall hormonal status, a well designed nutritional plan and a shopping list which excludes sweets, and other energy dense food items.

    On Jan 30, 2005 at 3:48 pm Robert Skversky, MD wrote:

    . . . . .

    Agree with above recommendations and suggest possibly tryng Cymbalta in place of Effexor. They are both snri's but Cymbalta has significantly more norepinephrine effect and has been approved for diabetic neuropathy and wonder if it might be of benefit for your "phantom" limb pain. Topamax of course should be tried and if untoward side effects occur then Zonegran could be an alternative. I know you stated you had a "sulfa" allergy, but if diagnosed in childhood it may not be accurate. If you ever tried any of the cox-2 inhibitors (ie; celebrex/bextra) and didn't have an allergic reaction then the sulfa allergy would be unlikely.

    On Jan 31, 2005 at 8:44 am Christian L. Potter, MD wrote:

    . . . . .

    Topamx helps to reduce appetite.

    It may also be helpful for the phantom-limb pain as well.

    A trial of this medication starting with a low dose and tapering up may be beneficial.

    Christian L. Potter, MD
    Charles River Medical Group - Marlboro
    Partner's Community Heath Care
    101 Coolidge Street
    Hudson, MA
    Phone (978) 562-0564
    Fax (978) 562-5646

    On Feb 01, 2005 at 7:12 am G. Michael Steelman, MD wrote:

    . . . . .

    Here are a few thoughts re T. Tymchuk :

    First, if the treating physician thinks it would be appropriate, switching from Neurontin to Topamax certainly might be helpful.

    Likewise, if the amitriptyline could be discontinued and nortriptyline or desimprimine substituted... or increases in trazadone or effexor made... this will sometimes help.

    Amitriptyline seems to be the worst offender in the "cyclic anti-depressant" group as far as weight gain and sweet cravings.

    Finally, I would suggest Chromium (200-600 mcg) and Magnesium (500-800mg) to help with the sweet cravings.

    Also, we often use a lozenge made with stevia that temporarily (2-4 hrs.) renders the taste buds unable to detect "sweet" ( Sweetenders). This keeps people from grazing on sweets, since they no longer taste good.

    Sugar and starchy foods increase cravings for sweeets, so, avoiding these and loading up on lean proteins, fruits and veggies will help reduce the cravings as well.

    Definitely, a low refined carbohydrate diet that is also calorie reduced would be my first choice of a dietary regime.

    On Feb 01, 2005 at 7:36 am Jay Piatek, MD wrote:

    . . . . .

    Dear T. Tymchuk,

    In my experience, Topamax is better than Zonegran for neruopahty, although some neurologists disagree.

    However, Zonegran is better than Topamax for sweet cravings.

    If I had a patient like you, I would start them on a low dose of Topamax -- maybe 25 mg -- and very slowly increase the dose over a month or two while at the same time slowly weaning you off of Neurotin.

    I would also give Adipex (phentermine) along with the Topamax to help you lose the weight you have gained.

    At some point -- you can only do so many things at one time -- I would also slowly wean you off the Effexor and start you on Cymbalta (duloxetine), and slowly increase the dose to probably 60 mg.

    Cymbalta (duloxetine) is a new antidepressant from Lilly that works great for neuropathy and, in some cases, seems to be able to cure fibromyalgia (unexplained muscle pain).

    For your information, Cymbalta (duloxetine) can also cure urinary incontinence.

    By the way, Zonegran can be used in people with a sulfa allergy if the sulfa allergy is not life-threatening by starting with a small dose of Zonegran and increasing the dose slowly.

    If a person has an allergic reaction, I have them take Benadryl and if the symptoms to do abate, I would have them go to the Emergency Room, however, I have not seen this happen in any of my patients.

    If a person has an seriouis, life-threatening sulfa allergy, I would not even entertain the idea of using Zonegran.

    However, as I noted above, Topamax is better than Zonegran for neuropathy.

    On Feb 15, 2005 at 4:21 am Dennis Padla, MD wrote:

    . . . . .

    Regarding T. Tymchuk and his phantom nerve pain...

    I would try Topomax up to 200 mg instead of Elavil/neurontin and just see how he does.?

    He would probably lose weight, but I'm not sure the pain would be controlled.

    Dennis Padla, MD
    Founder,
    Center for Psychiatry and Weight Management
    http://www.ManageYourWeight.com

    On Feb 15, 2005 at 3:34 pm Charles Leroy, MD wrote:

    . . . . .

    Since he is already on Effexor, adding Phentermine would create Phen-Pro situation which we all find to be very effective.

    Topamax is an effective weight reduction drug starting at 25 mg per day and working up to around 300 mg per day - there are protocols online for same - I attended an Ortho-McNeil symposium some months ago for the very purpose of presenting Topamax as a diet pill.

    He should watch for Acomplia - it could be something special altho it should only be presented to the FDA in April and we all know how long approval takes even on the fast track.

    Some people advise drinking a carbohydrate-containing beverage prior to meals to saturate the brain receptors for sugar, thereby abating hunger when one goes to eat.

    There was a recent article referencing the difference between servings and portions, something a lot of patients don't know about - a man called Atkins recently to complain about weight gain despite his close adherence to the program, reporting that his breakfast consisted of 6 eggs and a pound of bacon each morning!

    He could use objects to reduce portions: golf ball = 1/4 cup, tennis ball = 1/2 cup, baseball full cup, check book 3 oz. or ones check register if the food is thin like veal.

    The "bite" diet suggests 70 bites (what fits intelligently on a fork!!!) a day, about 18 per meal x3 with a few left over for a snack.

    Best regards,

    Charles Leroy, MD

    On Mar 30, 2005 at 12:08 pm Becky wrote:

    . . . . .

    Becky,

    I found another article on the Neurontin. It also has some useful information in about another medication (Zonegran) which controls pain and sweet cravings.

    On Mar 30, 2005 at 1:31 pm Larry Hobbs wrote:

    . . . . .

    Becky,

    For information on Zonegran (zonisamide) for weight loss, see here:

    http://fatnews.com/index.php/weblog/C73/

    On May 28, 2011 at 4:09 pm Audrea Dyer wrote:

    . . . . .

    I have taken Topamax in the past and it worked very well for me and noticed it really did help with my weight once I got off of it. Was taken off due to having too many kidney stones withen two months. Once off of it I got pregnant had a child and was at a great weigh for my height 5'8" and 142. I was a runner and did weights three times a week. I was put on Neurontin and have gained so much weight and am now up to 190. My quetion is that I do not eat much at all. I know that is not good to restrict calories, just wanted to maked it clear it is not due to too much caloric intake. I have to force myself to eat anything before dinner. I know that has contributed as well. From everything I have read Neurontin makes you gain weight due to the carb crave, which I will not denie at times, but is not overpowering. I have just been put on Topamax and want to know if it will help these pounds come off? Will it just be due to the aspect of not wanting the carbs as much?

    Thank You.
    Any Reply would be appreciated.

    On May 28, 2011 at 4:16 pm Larry Hobbs wrote:

    . . . . .

    Audrea,

    Ask Robert Skversky, MD.

    He is the expert on this.

    He has used phentermine pus Topamax for something like 12 years.

    Here is his contact info.

    Robert Skversky, MD
    Weight No More
    320 Superior Avenue
    Suite 210
    Newport Beach, CA 92663
    Tel: 949.645.2930
    Fax: 949.645.1059

    .(JavaScript must be enabled to view this email address)
    http://www.weightnomore.com/

    Robert Skversky, MD
    Weight No More
    31537 Rancho Pueblo Road
    Suite 105
    Temecula, CA 92592
    Tel: 951.699.0848
    Fax: 951.699.0509

    ------

    You can read articles by Dr. Skversky here:

    http://fatnews.com/index.php/weblog/C493/

    Links to videos of him on the Dr. Oz TV show are posted there.

    On May 28, 2011 at 4:21 pm Larry Hobbs wrote:

    . . . . .

    Audrea,

    Taking a supplement of potassium bicarbonate, or consuming maybe 20 ounces of Low Sodium V8 Juice may reduce the risk of kidney stones associated with the use of Topamax.

    Topamax has been found to lower bicarbonate levels in the blood.

    A study found that a supplement of potassium citrate, which converts to bicarbonate in the body, reduced kidney stone formation 13-fold in people who had a history of getting kidney stones.

    Note that one of the articles by Dr. Skversky also notes that Potassium may help prevent or treat paresthesia (abnormal skin sensations such as tingling, tickling, itching or burning sensation) caused by Topamax (topiramate) according to Dr. Skversky.

    At least one paper suggested that the abnormal skin sensations had the same cause as the increased risk of kidney stones.

    On May 29, 2011 at 11:43 am Robert Skversky, MD wrote:

    . . . . .

    Audrea, Several suggestions. Make sure you maintain high fluid intake. I would keep the topamax dosing below that which precipitated your previous kidney stones. It might be prudent to have a renal ultrasound to evaluate any evidence of calculi or stag horn calculi in your kidneys. I would definitely consider the addition of an anorectic agent such as phentermine/Adipex to your regime, which would have additive effect for weight-loss even with a compromised dose of Topamax. The above suggestion of potassium citrate also makes good sense but be sure to check levels especially if you are taking potassium sparing BCP, ACE inhibitors, diuretics.

    On May 29, 2011 at 11:46 am Robert Skversky, MD wrote:

    . . . . .

    Audrea, Forgot to mention ...Zonegran although I haven't found it to be as effective for weight-loss compared to Topamax in my practice might allow for increased dosing and lower risk of stones compared to Topamax.

    On Jun 01, 2011 at 10:20 am Audrea Dyer wrote:

    . . . . .

    Thank you for the reply. I am currently taking Lasix and also Potassium Chloride. I do know there were some renal calculi in my kidney about three years ago when I had an ultrasound but have not had any more problems after stopping the Topomax 5 years ago. The types of stone formed were stag horn. Does that make a difference now that I have decided to go back on the drug? I also want to know if there is a big difference between potassium citrate and the one I am currently taking as far as it helping to avoid stone formation? The parasthesias really would not be a bother as it would be a side effect I would gladly accept to gain the medicinal values of the drug in all of it's capacities.

    On Jun 01, 2011 at 12:33 pm Larry Hobbs wrote:

    . . . . .

    Audrea,

    Dr. Skversky can answer the question about staghorn kidney stones.

    Potassium chloride will NOT reduce kidney stones the way that Potassium Citrate (or Potassium Bicarbonate) Will

    Regarding potassium chloride versus potassium citrate for kidney stones...

    No, potassium chloride will NOT reduce the risk of kidney stones the way that potassium citrate will.

    Citrate Converted Into Bicarbonate in the Body to Buffer Acid

    My guess is that potassium bicarbonate will also reduce kidney stone formation since citrate is converted into bicarbonate in the body.

    Good Article by Dr. Goldfarb About Using Potassium Citrate or Bicarbonate to Reduce Kidney Stones

    There is a good article about alkalization of the urine by using potassium citrate or potassium bicarbonate to help reduce kidney stone formation.

    The article is written by:

    David S Goldfarb, MD
    Director, Kidney Stone Prevention Program
    St. Vincents Hospital
    Professor of Medicine and Physiology
    NYU School of Medicine

    The article is posted here:

    http://www.cystinuria.com/articles/urinary-alkalization/

    'You Don't Want Potassium Chloride", Dr. Goldfarb Writes

    Dr. Goldfarb writes, "You DON'T want... potassium chloride [because it] has no alkalinizing property."

    He also notes that:

    "Base comes in the form of molecules called ?organic anions?, such as citrate and malate. They are converted to bicarbonate by the liver. Bicarbonate is the blood?s form of base. One citrate is converted to 3 bicarbonates."

    'Taking Citrate and Bicarbonate are Equivalent", Dr. Goldfarb Writes

    "So taking citrate and bicarbonate are equivalent," Dr. Goldfarb notes.

    --------

    Topamax Reduces Both Potassium and Bicarbonate

    A recent study by Gadde (Lancet, 2011) gave phentermine plus Topamax for weight loss notes that Topamax reduces both potassium and bicarbonate in the body which seems to be the cause of:
    - taste alterations
    - paraesthesia [tingling, pricking, or numbness of the skin]
    - kidney stones

    Here is a quote from the paper by Gadde (Lancet, 2011, page 1350, col. 2, 2nd paragraph)

    "Inhibition of carbonic anhydrase by topiramate [Topamax] presumably accounts for the paraesthesia [tingling sensations of the skin] and taste alteration, decreased concentrations of serum bicarbonate and potassium, and risk of nephrolithiasis [kidney stones]."

    REFERENCE

    Gadde K, Allison D, Ryan D, Peterson C, Troupin B, Schwiers M, Day W. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (conquer): A randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Apr 16, 377(9774):1341-52.

    --------

    Bottom Line: Potassium Citrate or Potassium Bicarbonate

    Potassium chloride is NOT equivalent to potassium citrate or potassium bicarbonate for reducing kidney stones.

    Potassium citrate or potassium bicarbonate are the form to use to reduce the risk of kidney stones (and paraesthesia as Dr. Skversky has previously written about), and maybe reducing taste alterations as well.

    Larry Hobbs

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