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Gabapentin & Neuropathy
Mar 11, 2003

Hello Dr. Boyle:

In June 2002, I was diagnosed with AIDS. I have been through five hospitalizations/hospice stays since that time. I am considered to be healthy, despite a near-death scare in July, at which time I lost almost 70 pounds. I now weigh 192 pounds (at 6' 1") and I think that that speaks for itself. As well, my white cell counts are around 350, and my viral load is down to about 150. My HIV specialist expects that the next tests will hopefully show that the load is undetectable. I have been suffering from neuropathy since August, as I was on Zerit. About a month ago, I asked to be switched, because the pains were quite severe. My doctor prescribed Combivir.

Last week, I noted that my neuropathy has not lessened since Zerit was removed from my regime, and my doctor put me on Gabapentin. The nightly throbs are not as severe, but, believe me, the neuropathy is still quite bothersome. How long do you think it should be before I will find total relief? A couple of my friends, who know me very well, wondered how I got AIDS. I have not had intercourse in almost 20 years (I've had oral sex but no intercourse), and I have never taken a needle that was not administered by a health-care professional. I do not remember ever having a blood transfusion other than that which was given to me this past summer.

I have determined, since I take my oral hygiene very seriously, that the likely cause comes from my flossing my teeth, during which time I probably struck a gum, causing a bit of bleeding, and then later had sex. At no time did I know that a person should not have oral sex within a 24-hour period of flossing.

Do you have any thoughts about this? If this is an issue, I hope that we can somehow put a bit more emphasis on this. I have discussed this with others, and some of them did not know about the flossing problems, either.

Thank you for your time. I appreciate it.

Brian

Response from Dr. Boyle

Brian It can take a few weeks for gabapentin to start to work. Also, some patients require higher doses than others, so if the initial dose you received doesn't work, talk to your doctor to see if a hgiher dose might be appropriate. If its needed, up to 800-1200mg of gabapentin three times a day can be used. If that doesn't work, which is uncommmon in my experience, then there are some other alternatives, such as lamotrigine. Also, a pain medication, such as ibuprofen (or even something stronger if it is needed), can be given with the gabapentin and may help while you are waiting for it to kick in. I have not had much success with topical pain medications, although some reports have indicated that these may be beneficial as well in some patients. As far as your risk factor for HIV, that is tough to say. Several studies have indicated that while the risk of oral sex is very small, it probably does exist.



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