Augmented

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Gloriamitt
Posts: 1
Joined: Tue Dec 29, 2020 2:32 am

Augmented

Post by Gloriamitt »

New member.70 years old. Diagnosed with sleep apnea and rls 18 years ago. After unsuccessful treatment with sinemet started on primapexole with augmented symptoms starting at .75 mg dose. Given clonazepam for attempt at Drug holiday to decrease dose. Had to stop because of confusion. Did get dose down to .25 mg but this only lasted for short time. Started on gabapentin nov,2020 at 100 mg now taking 600 mg but still need the .25 mg of primapexole. If I take gabapentin at 8pm I don’t fall asleep until 5 or6 am. Any thoughts on taking earlier or splitting up the dose. Feel like a zombie.

Rustsmith
Moderator
Posts: 6476
Joined: Sat Sep 28, 2013 9:31 pm
Location: Colorado Springs, Colorado

Re: Augmented

Post by Rustsmith »

Gloriamitt, neither gabapentin nor clonazepam are strong enough to cover the withdrawal symptoms from that final 0.25mg of pramipexole. The only thing that will cover pramipexole withdrawal is a low dose of an opioid. You only need about five to seven days of opioids to get through the pramipexole withdrawal. If your doctor won't provide an few opioid pills, then getting off of that final 0.25mg will result in five to seven days of absolutely no sleep (not even naps) and the worst RLS urges that you have ever experienced. After about a week, then you can finally start to get a bit of sleep with increasing amounts over the next few weeks. After about a month of this, you finally return to whatever your post-augmented normal RLS is like.
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

stjohnh
Posts: 1284
Joined: Sun Feb 14, 2016 3:13 pm
Location: Palo Alto, California

Re: Augmented

Post by stjohnh »

Steve gave it to you straight. Unfortunately, without opioids, getting off the pramipexole is an awful experience. I, and many others here, have done it. The good news is that once you are off the pramipexole, your RLS may be easier to control with lower doses of drugs. Unfortunately, however, there is also a good chance that you will need opioids long term. If you haven't checked into iron, you should do so.

RLS is caused by BID (Brain Iron Deficiency). Many people with RLS can have their symptoms markedly reduced or even eliminated with IV Iron treatments. This is the only treatment that gets at the basis for RLS (low brain iron). It has almost no side effects. The International Restless Legs Syndrome Study Group has elevated IV Iron treatment to first line therapy. This means that IV Iron is one of the first treatments doctors should try, not one of the last (as has been done for many years). If you can get your doc to prescribe IV Iron treatment, that is the way you should go. Unfortunately this is fairly new information and most docs, even those that frequently treat RLS, are not aware of it. Note that the blood test doctors usually do to check for low iron (ferritin test) only checks for low BLOOD iron, there is no test available for checking for low BRAIN iron. Oral iron usually doesn't provide a high enough blood level increase to help, folks need IV Iron infusions. Here is a link to the recommendations:
https://www.sciencedirect.com/science/a ... via%3Dihub
Blessings,
Holland

badnights
Moderator
Posts: 6259
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Augmented

Post by badnights »

Hi and welcome

It is true what Steve and Holland have told you, so I won't belabor those points.
But I want to emphasize two things:
- stopping pramipexole is the only way to get a better life, and
- it's totally worth the agony of the withdrawal.

It is not unreasonable to print a couple of papers and take them to your doctor. It would be good to print the one Holland linked to. Also, click the link in my signature, and click the first item in the list to download a good paper on opioid use for treatment of WED/RLS. Those are both scientific papers that your doctor will respect (if he has time to read them).

Let us know how it goes with your doctor! I am so very sorry that you have to endure this. But hopefully your doctor will see the light, and prescribe enough opioid to get you thru the withdrawal .
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

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