Side effect of Mirapex

[JLS]

Does anyone experience facial twitches from taking Mirapex (Pramipexole). My right cheek and lower eye are twitching quite often. I have talked to my doctor, said I had read that this was listed as a possible side effect of the drug but she does not think that is what is causing it. She told me right out that she does not treat many patients for RLS so would like to find another more specialized but none in area. Nearest is an hour away, may have to consider the drive. Went today to get thorough eye exam and new glasses in case there was a problem there, but was told everything looked good, needed updated prescription but not the solution to the problem. The twitching last night was even while I was laying in bed trying to go back to sleep from usual symptoms of RLS. I have a combo of RLS and Osteoarthritis in my knees, so sometimes don't know where one ends and the other begins. I take .5 of the Mirapex every night sometime 1.0 if legs are really acting up. Have taken this for at least 4 years now and wondering if I should switch. I am starting to get self conscious of the twitching, even if sometimes other people can't see it I can feel it. Any ideas would be much appreciated!!

[sleepdancer2]

Interesting to me that you posted that. I used to get facial twitches a lot, but haven't in a few years. Just so happens I've been off Mirapex for 4 years. No way now to know if this is a connection or a coincidence.

[JLS]

Thanks for the reply. What are you taking now and does it work good for you? I tried Ropinirole, but I think the doctor didn't know how to make the change in medications the correct way, so I had really bad dreams and a lot of bad nights. So I went back to the Mirapex, with the theory even if face twitches at least I am getting sleep. But now it seems as though it is getting worse, so I know I need to find an alternative.

[Polar Bear]

Welcome JLS - I don't have facial twitches. I do have occasional random body twitches/jerks. Can go for days with none and then they reappear again. I've no idea if it is relevant to my ropinerole medication. I also have osteoarthritis and fibromyalgia.

You have mentioned your dosage of Mirapex as .5mg and 1mg on occasion.
Up to date research as per the leading experts in WED/RLS would indicate that the max daily dose of Mirapex should be .25mg. So please be aware that anything above this dosage may contribute to the onset of augmentation.
I also am on a much higher dose of DA (ropinerole) that is currently recommended, having started it many years ago when the accepted daily dosage was 4 times that currently recommended.

This book is excellent, it is easy to read and can be used for discussion purposes with your doctor.
Clinical Management of Restless Legs Syndrome by Lee, Buchfuhrer, Allen and Hening. Make sure to get the second edition. These Authors are at the top of the league when it comes to the treatment of WED/RLS. It can be found on Amazon.
At risk of boring everyone - I can't recommend this book highly enough.

Also, have you had your ferritin serum level checked, this is pretty important. It is a blood test that is not normally done with routine blood works and you need to ask for it. This tells the level of iron stored in your brain – and that is what is important to us sufferers of WED/RLS. We need a level of around 100, especially if we are taking a DA drug such as pramipezole or ropinerole. When getting the results of this test please ask your doctor for the actual level = do not accept ‘normal’ as an answer. Doctors and Labs may consider 20 to be normal… but it isn’t normal for us
Sufferers should not start a DA unless their ferritin is high enough.

[JLS]

Thanks for the helpful advice. Will check with my doctor when I have to return in a few months. I will also check into the book you recommended. I did state in error the dosage of Mirapex I am taking on occasion, if the .5 is not working I take only half a pill which makes it on .75. But as you stated that is still above what is recommended. Is there a good way to switch from Mirapex to Ropinrole? (and is it beneficial)? Do they both have the same side effects? I would try it again if I was sure of the correct procedure. What is the correct dosage they recommend for Ropinrole? Thanks again for any other advice you can give.

[sleepdancer2]

Because everyone's response to a med is different, it's hard to guess how another person might do on a med. The thing to watch out for is signs of augmentation. I went from Mirapex to Requip and got a degree of relief for maybe a few months before augmenting again. I agree with prior advice to have your ferritin level checked. I use a TENS Unit to treat my legs for PLMD to keep them quiet enough to sleep at night. Not everyone has success using a TENS. I have been fortunate and found it sufficient to avoid pharmaceuticals. Hope you find what works for you.

[ViewsAskew]

No question that I had odd jerks/twitches when I took pramipexole. They started immediately and stopped when I stopped it. Mine were in my fingers and hands. I noticed the first day when I sat down at the computer and put my hands over the keyboard and felt this odd tremor that would occasionally also twitch.

I also had neuropathy when on pramipexole - completely stopped when I stopped the drug.

If you are already taking over the currently recommended max dosage (and this is only recommended by the very up-to-date specialists - many doctors do not know about it), a switch to another drug in the same class may not be helpful for long (or at all). Here are the things a good specialist would want to know:

Have you always taken the same dosage or has it increased over time?

Have you always needed extra on occasion, or did that happen more over time?

If you started with less and have increased, it's most likely augmentation. If it is, then a switch to ropinerole may not help much. For what it's worth, it takes 2 to 3 times the amount of ropinerole as pramipexole. So, you'd likely need 1 to 1.5 mg a day - and the current rec is for no more than 1 mg a day, if I remember correctly. Side effects have some overlap, but aren't identical. As sleepdancer2 noted, we all react differently - and even more strangely - one person might have the same side effects on both drugs while the next person only has them on one of the drugs but not the other. They work on slightly different receptors.