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DA’s - If Augmentation from one, from all?

Posted: Thu Nov 15, 2018 12:36 am
by EdSoFlo
Hi all-

I have augmented severely - SEVERLEY - on Sinemet in the past. I tried it again recently and the augmentation effect almost felt instantaneous. Never EVER again. Would I be likely to augment on pranipexole? And would it be as immediate as it is now with the Sinemet? In other words, once augmentated on one DA, likely ditto for all? Much thanks.

Re: DA’s - If Augmentation from one, from all?

Posted: Thu Nov 15, 2018 3:38 am
by Rustsmith
Once you have augmented on one dopamine agonist, you will augment more quickly on another. Sinemet is the fastest acting DA and also causes augmentation the fastest. You MIGHT get away for a couple of months on the Neupro patch simply because it releases the medication over a 24 hr period instead of the almost immediate adsorption that you get with pills. But that said, you will augment again and it could be very quickly.

Your best bet at this point would be to forego any dopamine agonist and try gabapentin, Horizant or Lyrica. These may not work for you and they all come with their own different side effects, but augmentation is not one of them.

If they don't work, then you join those of us who have to rely upon an opioid to treat our RLS. These also have potential side effects, but due to the low dose required to treat RLS, true opioid addiction is very unlikely.

Re: DA’s - If Augmentation from one, from all?

Posted: Thu Nov 15, 2018 3:33 pm
by stjohnh
I noticed from one of your prior posts that you are being treated by Dr. Rye. What does he say about the Sinemet? I also assume he has discussed IV Iron with you. IV Iron was elevated to first line therapy in the recommendation paper published last year by the International Restless Legs Study group. Seeing as you had already been on oxycodone, I presume you are still on an opioid. If not, why not? Regardless, if you haven't had IV Iron, that is probably the next best recommendation for you.

Re: DA’s - If Augmentation from one, from all?

Posted: Sun Nov 25, 2018 3:17 am
by badnights
I agree. An opioid would work best, but the first thing to try is IV iron, assuming you've been trying oral iron. If you want to try one of the dopamine agonists, I would guess that you'll augment (note I'm not a doctor) - maybe not as rapidly as with Sinemet, but rapidly enough to dismay you.

Sinemet is not appropriate for daily use for anyone with WED/RLS.