<s>[INST] I am a nurse and have a patient who is unsteady on his feet and having miniblackouts. He has ESKD and has been on dialysis for 10 years. The medications I am concerned about are Lyrica 75 mg nocte, oxycontin 30mg nocte and cialis 5mg. I think the issue may be the lyrica as he sometimes takes double the dose at night. Any suggestions on how to manage this? He has quite severe peripheral neuropathy and chronic pain. tks [/INST] HIT hank for asking to ChatDoctorI have gone through the history given here, I think your patients main concern is blackout and unsteady on feet, If I would be doctored of your patient then I would reassess the case right from the beginning, I would stop all the medicine none of it would help the patient instead it may worsen the clinical condition, serum electrolyte has to be done in this case, so we can manage the HY Chat Doctor.  </s>