Pramipexole

[mackmann]

I have severe RLS in my legs and occasionally right arm of about six years duration. Up until it has been pretty well controlled by Ropinerol .25 five times a day (1.25 total) and 300 mg. of Gabapentin taken with the Ropinerol (1500 mg.per day). I also stretch and massage my legs for about ten minutes 3-4 times daily especially before bed. Recently this protocol has become quite less effective so my neurologist suggested .25 of Pramipexole 2-3 times a day. The switch made me feel horrible but perhaps that was caused by stopping the Gabapentin cold turkey when I switched to Pramipexole. I felt so terrible I went back on Ropinerole and gaba. Now I’m going to try Pramipexole again and taper off the Gabapentin this time.

Any experiences, especially related to side effects as related going from Ropinerol and Gabapentin to Pramipexole,world really be appreciated.

Thanks so much,
Mac

[Rustsmith]

If your doctor prescribed 0.25mg pramipexole 2 to 3 times a day, I would say that your neurologist isn't highly familiar with treating RLS. The FDA max recommended dose of pramipexole for RLS is 0.5mg/day. Pramipexole and ropinerole are not direct mg to mg switch. Pramipexole is about 4x stronger is you just look at the mg dose. So this would mean that your 3x0.25mg pramipexole daily dose is comparable to about 3mg ropinerole.

As for side effects of switching, ropinerole and pramipexole are very similar meds, so any side effects of switching would be due to your own sensitivity to pramipexole (assuming roughly equal doses of each). That means that any issues that you experience would most likely be due to stopping the gabapentin.

[Polar Bear]

Just to note that your ropinerole daily dosage was too high as was/is your pramipexole daily dosage. To reduce either of these medications should be done carefully and under supervision.
Have you had your ferritin serum level checked? You would want this to be around 100 rather than around 20 which is accepted as normal.

[mackmann]

Thanks to both Rustsmith and Betty for their helpful replies

[badnights]

The terribleness you experienced was probably from stopping the gabapentin, as steve deduced. It should be tapered from higher doses like yours. It can cause horrible effects when stopped suddenly.

If your ropinirole+gabapentin regimen is ineffective, it probably means you have begun to experience augmentation of the disease from the ropinirole. Please look up augmentation on this board, and/or check the resources in my signature link. The signs are: symptoms start earlier in the day; are more intense; start sooner after sitting or lying down. I'm about to fall asleep here, I think I missed a sign. One or two of those probably mean you're augmenting. EDIT: the sign I missed is symptoms spread to other body parts.

Switching from ropinirole to a much higher equivalent dose of pramipexole (as Steve explained) is not the right approach to treating augmentation. There are still some specialists who will try switching you to another dopamine agonist (DA) but that never works for long, it at all. The only real solution is to come off the DA completely. And that causes symptoms that are even worse than the augmented symptoms, but they only last for a few days before slowly improving, and within a couple of weeks, you're back to where you were before augmentation (in most cases).

Since the problem with augmentation is the DA, I wonder if you should re-think coming off the gabapentin? If there is some other side effect you didn't mention, then of course do the taper and come off it, but I think - from what you;ve said - it's possble that your main problem is augmentation, in which case the DA has to be stopped, and that will be more than difficult enough without stopping gabap at the same time.

[mackmann]

Hanks to bad night for the helpful reply