Expert: Eric Brandt - 6/27/2009

Question
hello and thank you all for your valuable time and expertise. I am a 47yr old HVAC tech and My 1st Question is I am currently on a 10mg's (x8 daily) dose of Methadone  (at my request instead of Roxicodone)to control pain caused by exposure to a nerve agent(phosgene gas) that has resulted in a problem similar to diabetic nueropathy compunded by 2 collapsing vertabrae(t5-6) the methadone has worked wonders and despite everyone's taboo's about it I much prefer it over the cloudiness of Roxicodone, i prefer a clear head. My problem is as I have been feeling better I am more active and am experiencing periodic (severe) breakthrough pain and have been self medicating with 8 to 12 200mg Aleeve (Naproxen) and it has been working well other than stamach upset, well upon informing my pain Mgmt Dr. today he nearly fainted over concerns about cominations with IV allergy meds i recieve, He decided he would script me Cymbalta to replace it(as there has always been some concern over Fybromyalgia) but when I got home I opened the package and found Gabapentin (Neurontin) instead, Did he the Cymbalta replace with this because my insurance doesnt cover Cymbalta and he tried to save me a few bucks? (He knows I'll pay if its needed) and 2nd question is related, I took this once 3 years ago(same Doctor) at a Higher Dose and was hospitalized 8 hours later becuase of an erratic Heart rate that coulodn't be controlled & lasted 24 hrs (30beats Min that jumped to 300Bpm then down again) 5 confering Dr's never confirmed a cause (there was also a missing P-wave)
Has anyone heard of a similar reaction to Neurontin? and if it was a replacement for the Cymbalta, isn't there a clsoer replacement or a generic? thanks for any and all suggestions, Mark Stevens, Tampa, Fl.

Answer
Hi Mark,
Gabspentin is not an alternative to Cymbalta. They have different indications and mechanisms of action. I am not sure why the switch was made but gabapentin makes more sense to use for nerve pain then Cymbalta.
Gabapentin can cause increase in heart rate.
Thank you for using Allexperts
Sincerely,
Eric Brandt, B.Sc. Pharm