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Tramadol while tapering Sinemet

Posted: Tue Jan 23, 2018 5:46 pm
by Caitrin
My husband gave me one of his 50 ml. Tramadol last night and I did not need my usual dosage of Sinemet. I'm wondering if our primary might prescribe the Tramadol for my RLS thus eliminating the high dosage of Sinemet which I had recently increased after being in bed for one week. I had previously read several posts about Tramadol but never tried it. It worked great for me. Is it considered an opioid?
Thanks,
Caitrin

Re: Tramadol while tapering Sinemet

Posted: Tue Jan 23, 2018 6:47 pm
by Rustsmith
Yes, Tramadol is considered an opioid. However, it is on Schedule IV where many of the others are on Schedule 2. That means that although it is still an opioid, your doctor might be more willing to prescribe it than something like methadone.

Re: Tramadol while tapering Sinemet

Posted: Tue Jan 23, 2018 11:09 pm
by Polar Bear
Tramadol also works for me. I use cocodamol as part of my medication cocktail together with ER Tramadol 50mg x 2.
For any breakthrough a furthr 50mg tramadol works wonders - this 50mg Tramadol is not now part of my prescription but is part of my stash which is slowly depleting.
Previously I was using ER Tramadol 100mg. However, I developed random jerks and so the Tramadol was reduced.
I would still have occasional jerks but not to the same extent since the reduction.

Re: Tramadol while tapering Sinemet

Posted: Thu Jan 25, 2018 7:59 am
by badnights
It would be very good for you to make the switch. Bring your doctor some printouts about augmentation. Sinemet almost inevitably causes augmentation. No doctor should subject a patient to any cruelty let alone such an obnoxious torture - but of course, they don't do it on purpose, they do it out of ignorance. So it must be your mission to be sure your doctor knows what augmentation is.

Have you learned what it is yourself, and do you think it has happened to you?

Re: Tramadol while tapering Sinemet

Posted: Thu Jan 25, 2018 2:00 pm
by Caitrin
Thank you for sharing your experiences with Tramadol. I have an appointment with my primary next week and will bring her info on Tramadol as well as augmentation with Sinemet. She like most other doctors know nothing about RLS except that it exists. I did not think I had augmentation with Sinemet, thought only that it was brought on by inactivity, i.e. bed rest while I had severe bronchitis. Now I'm not sure. I do know that Tramadol is working for me and if she will not prescribe it I will find another doctor. The only side effect I have experienced is intense itching but I'd rather deal with that than jerky legs that I can't keep still while sitting or lying down. I have taken Sinemet for 30+ years, far too long!
Thanks again for your input,
Caitrin in New Jersey

Re: Tramadol while tapering Sinemet

Posted: Mon Jan 29, 2018 9:01 pm
by Caitrin
Tramadol caused such intense itching I went back to the Sinemet until I see my primary Wednesday. My entire body itched 24/7 and I was miserable. So I took 1/12 50-200mg. tablet Sinemet last night. I think my doctor mentioned Mirapex two weeks ago and will ask her for a script thinking the change in med may help. I did not mention that I get RLS during the daytime and have for the past month. I did some research on doctors in NYC who specialize in movement disorders including RLS. The four I am considering are located on Weill Cornell at 68th and 72nd East Side. If they will not take my case then I will try Johns Hopkins in Baltimore after my husband has his hip replacement end of February assuming I an wait that long. I printed another article discussing post menopausal women and increased incidences of heart disease. I had previously read about this and finally have a copy of the article from "Circulation" authored in part by Drs. Early and Winkleman.

Re: Tramadol while tapering Sinemet

Posted: Mon Jan 29, 2018 9:51 pm
by Rustsmith
I hope that the doctors in NY will take you and that you don't have to wait too long to get a "new patient" appointment with them. As for Johns Hopkins, I have heard rumors that the RLS clinic will soon have to stop accepting new patients from outside of Maryland. Even if that is not true, it can take four to six months to get an appointment with them. So, if the NY doctors do not work out, you might also consider Dr Winkelman, who is at Mass General in Boston.

One other option to consider if your PCP is willing to learn is to buy a copy of the book "Clinical Management of Restless Legs Syndrome", 2nd Ed by Lee, et.al. The book was written for doctors, but is easily understandable. It costs about $30 on Amazon. Many of us have a copy and take it to the doctor with us if our doctor isn't one of the experts.

As for the itching from the Tramadol, it is unfortunate that you ended up with that side effect. You might not have that with a different opioid med, but many non-RLS doctors hesitate to prescribe any of the others any more for chronic conditions due to the opioid hysteria going on in this country today.

Re: Tramadol while tapering Sinemet

Posted: Tue Jan 30, 2018 12:20 am
by ViewsAskew
My experience with opioids and itching...for what it is worth.

All opioids make me itch. But, it always goes away in a few weeks. The first few days, it is almost unbearable. If I reduce and then increase, it comes back, every time.

I do find that a newer generation antihistamine helps reduce the itching enough for me to tolerate it.

This is just my experience - may not work for others.

Re: Tramadol while tapering Sinemet

Posted: Tue Jan 30, 2018 6:09 pm
by Caitrin
Thank you both for your input.
I did take ZYRTEC while on tramadol but it did not help with the itching. I too tried decreasing and then back to the usual dose and the itching increased. I may try taking it once more. Can you tell me what the newer generation antihistamine is? I did take another opioid for two years with no side effects such as itching. Of course, I cannot get a script for that opioid here in New Jersey.

Thank you for informing me about the 4-6 month waiting list at Hopkins. I cannot wait that long. If I cannot get an appointment soon with one of the NY doctors then I will consider making appointment with Dr. Winkelman though Mass General in Boston would have to be an overnight trip. I am retired so am able to travel if necessary. I will be calling the doctors in NY tomorrow.

Re: Tramadol while tapering Sinemet

Posted: Tue Jan 30, 2018 7:02 pm
by Rustsmith
The second generation antihistamines go by the trade names of Zyrtec, Claritin/Alavert and Allegra.

Re: Tramadol while tapering Sinemet

Posted: Tue Jan 30, 2018 9:06 pm
by ViewsAskew
For me, it definitely takes about 2 weeks before the itching subsides. I also find that I need to take the antihistamine hours before I take the opioid - if I wait until I take it, it is as if it cannot help. And, for the first few days, it doesn't help all that much to begin with! I was desperate at the time to make the opioid work since I had exhausted all other options.

Re: Tramadol while tapering Sinemet

Posted: Wed Jan 31, 2018 7:32 pm
by badnights
just a note of caution, if you switch to Mirapex while still augmented from the Sinemet, you will most likely remain augmented. IF you give yourself a wash-out period, then you will be able to start the Mirapex at a lower dose and hopefully therefore take it for a longer time before you augment on it.

To give yourself the best chance possible to not augment on Mirapex, you might need to take iron supplements, A lot of us have low ferritin (an iron storage protein in the blood). We should have at least 75, preferably 100. If you get lab work that says "normal" ask for the actual number, because 20 or above is normal for people without WED/RLS but we need more. Symptoms are more severe when ferritin is low. Augmentation is more likely when ferritin is low. So please get it checked.

Re: Tramadol while tapering Sinemet

Posted: Mon Feb 12, 2018 8:01 pm
by Caitrin
Any thoughts on the Neupro patch? I was given samples by a neurologist and have read the leaflet on side effects. The one that disturbs me most is that the it could raise one's blood pressure and I am currently taking two BP meds. I am still taking carbidopa/levodopa, one and one-half 50-200/day. I have read here on the discussion board that that the Neupro patch in time will cause augmentation. The doctor who prescribed the Neupro said he had no problem as a last resort prescribing Tramadol. He also informed me that New Jersey doctors no longer prescribe opioids if they did not want to lose their licenses. I assume it may be difficult if not impossible to obtain an opioid prescription in any state, including Dr. Winkelman at Boston Mass and the New York doctors I previously mentioned. I had contemplated making an appointment with Dr. Winkelman as he is an expert in RLS and is conducting various studies on the effectiveness of opioids but probably cannot prescribe them.

My ferritin level is 75.

Re: Tramadol while tapering Sinemet

Posted: Wed Feb 14, 2018 8:42 am
by badnights
It would be worthwhile to see Dr Winkleman whether or not he will prescribe opioids.

Get off the Sinemet, Neupro is a reasonable alternative but the same precautions apply - you will start on a too-high dose if you don't wash out first.

Ferritin of 75 is too low for a person with WED/RLS. If there is no reason for you not to take iron, you should start supplementing with ferrous sulfate or similar pills, one or two if they have 60 or 65 mg elemental iron in each pill, taken with vitamin C on an empty stomach (empty if it doesn't hurt you, but for some people it causes cramping). The vitamin C is necessary for the iron to be absorbed. Check with your doctor before you start the iron - the question you want to ask is not "do I need iron" but "is there any reason it might be unhealthy for me to take iron".

There are some links in the page linked to below my signature that talk about iron and WED/RLS. There are also two very good webinars on the Foundation website, members-only area.