Neurontin - Gabapentin?

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If either of the above are offered for pain management and NOT seizures, are both "Do Not Fly" medications? Is there an similar alternative if these are "Do Not Fly" medications?
 
You can't fly with Neurontin for any reason. It takes a 36 hour wait after last dose.

Is this for neuropathy. There's not a whole lot out there that you can fly with. Some of the topical antiinflamatory patches might give you some relief. Oddly, we found these piroxicam things in Europe (OTC) that work really well for my wife. They don't seem available in the US even with a prescription.
 
flyingron said:
You can't fly with Neurontin for any reason. It takes a 36 hour wait after last dose.

Is this for neuropathy. There's not a whole lot out there that you can fly with. Some of the topical antiinflamatory patches might give you some relief. Oddly, we found these piroxicam things in Europe (OTC) that work really well for my wife. They don't seem available in the US even with a prescription.
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Even oral piroxicam is prescription in the USA, due to a greater potential for nasty side effects than naproxen and others, thus patches are (as of now) not available. I saw a market study on them, which will determine whether a maker may push approval of patches.
 
flyingron said:
Oddly, we found these piroxicam things in Europe (OTC) that work really well for my wife. They don't seem available in the US even with a prescription.
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Be careful with that one. It is probably still available in the US, but is an old medication was under the trade name (Feldene). This like many of the older more toxic NSAIDs have mostly gone the way of the DoDo bird, due to newer NSAIDs that have similar efficacy but a safer side effect profile. These old NSAIDS have a higher risk of gastrointestinal bleeding, as well as all the standard risks of heart attack, stroke, kidney failure and liver failure that you see with potent NSAIDs.
 
It's available as a gel in the US. Topical use isn't going to cause GI problems. Gabapentin isn't the kindest thing to your kidneys either.
 
All NSAIDS have kidney tox liability. Chronic use can and often will lead to loss of kidney function. No need to risk kidney failure in your golden years. So, use them only as needed. I take Etodolac 400 mg prn and use lidocaine patches regularly. Steroid injections are done infrequently and only to break a lingering pain cycle.
Gabapentin has a very questionable history, lots of safety issues annd occasional benefit, and I would never take it.
 
flyingron said:
It's available as a gel in the US. Topical use isn't going to cause GI problems. Gabapentin isn't the kindest thing to your kidneys either.
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Just to clarify, gabapentin doesn't have significant toxic effects on the kidney. The problem is, gabapentin is cleared out of your body only by your kidney. We all lose kidney function with age, some more than other. Anyway, we have to adjust gapapentin dosing for kidney function. Not because it hurts the kidneys, but because the side effects/toxicity on the rest of the body go way up for a given dose with reduced kidney function. If you give someone with markedly reduced kidney function a "normal" dose of gaba, it won't really hurt their kidneys, but they are way more likely to stumble and fall, or have some other side effect of gaba.
 
I was only describing NSAID toxicity. Use them only as needed. Gabapentin carries CNS liabilities that are unpredictable and can be serious. I would never take it and only a few weeks ago declined it when my neurosurgeon suggested it.
 
Gabapentin is a neurotransmitter competitor.
Since the brain has the "blood brain barrier" (which isn't perfect) there is some resistance to brain disruption but the goal of use is to interfere with peripheral pain transmission.

We pain docs use it a lot...but FAA isn't having any of a medication that can be "confusatory" or has very little margin of safety.
 
Having developed several CNS drugs and a few that are now on the market, my caution that the buyer should be aware. The prior comments are valuable considerations.
 
Interesting question. Another angle - does the history / length of time taken come into play? For example, you take it for a year and stop, no longer need it. Will the FAA say that you obviously needed it for something besides convulsions, and that history creates problems with your medical?
 
WDD said:
Interesting question. Another angle - does the history / length of time taken come into play? For example, you take it for a year and stop, no longer need it. Will the FAA say that you obviously needed it for something besides convulsions, and that history creates problems with your medical?
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Well, the answer is, "it depends..."

There are two FDA approved indications for gabapentin.
1-treatment of shingles associated pain
2-treatment of seizures.

Probably for number 1, once you recover and are off of it, I wouldn't imagine this would be a problem. for number 2, well, yeah, you have seizures. That's not going to work well for you and your FAA medical. Even if the seizures have a known cause and that cause is ameliorated, it's probably a lengthy road/challenge to get/keep your medical.

There are a number of off label uses, treatment of diabetic nerve pain, migraine prophylaxis, alcohol dependence/withdrawal, restless leg syndrome, fibromyalgia, other neuropathic pain syndromes. So yeah, even if you get off the gabapentin, you're still left with the underlying condition and having to deal with that and the FAA. I don't think the time you're on it would be as much of a factor. But you have to be off of it and, as you can see, some conditions would be naturally less of a problem, say, fully resolved shingles pain, than others.
 
WDD said:
Interesting question. Another angle - does the history / length of time taken come into play? For example, you take it for a year and stop, no longer need it. Will the FAA say that you obviously needed it for something besides convulsions, and that history creates problems with your medical?
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How would the FAA come to find out that you'd used it?
 
Lindberg said:
How would the FAA come to find out that you'd used it?
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Don't know. They seem to be able to find out things. Insurance records? How would they know you used it for seizures and not off label? Did I mention "I don't really know if they could or would".

In my past life, I did patient / doctor research. I know that a lot of doctors, with good intentions, do a lot of off label prescribing. Gabapentin or Pregabalin is prescribed for back pain for example.

Hence, my somewhat of a tangent question. If your PCP writes a script for an off label use - regardless of efficacy for your need - can it somehow trigger the attention of the FAA?
 
Appreciate the responses. On basic med. Bone pain appears to be secondary to lymphocytic leukemia. Not in remission, but it does not meet immuno-therapy or chemo-therapy treatment levels yet. Usually flying with another pilot, but not flying much at all in past 12 months .... debating a new hobby, feels like the flu for those of you wondering (body-bone ache-pain everywhere).
 
Pain Patient said:
Appreciate the responses. On basic med. Bone pain appears to be secondary to lymphocytic leukemia. Not in remission, but it does not meet immuno-therapy or chemo-therapy treatment levels yet. Usually flying with another pilot, but not flying much at all in past 12 months .... debating a new hobby, feels like the flu for those of you wondering (body-bone ache-pain everywhere).
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Sorry to hear, but sounds like you're keeping your head up. Best of luck.
 
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