Is Tramadol continuing my Mirapex augmentation?

Use this forum to discuss any issues associated with Augmentation
Icantsleep
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Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Wed Sep 25, 2019 7:14 pm

Hi

Have now gone about 4.5 weeks without Mirapex after raising my dose to .25mg x2
Began tapering Mirapex while adding Tramadol 50mg x 2 about 6 weeks ago
Also take clonazepam .75 mg as usual and high THC medical marijuana was increased

Mirapex augmentation stopped and then went through Mirapex withdrawal

These RLS intensities have passed but I still get significant RLS that doesn't allow me to sleep for more than 90 minutes at a time (usually worse the later in the sleep cycle)

Last night (late this morning) I got woken up yet again, but this time the RLS was in my arm
.... this is the first time it's been in my arm in a good 4 -5 weeks .
I had been getting in my arm for 5(?) years prior and the augmented rls was the worst in my arms , but that stopped when I got off mirapex altogether.

Is tramadol the optimal transition med to use for augmentation management?

Now that I'm through the worst of mirapex withdrawal, should I stop or switch the tramadol because of its relation to augmentation and/or its relation to dopamine ???

I'd like to have a clean slate with my mirapex so I could perhaps one day in the near future try to resume at perhaps .0625mg
Would tramadol be getting in the way of that idea ?

QyX
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby QyX » Wed Sep 25, 2019 8:34 pm

Two scenarios:

a) either Tramadol is too weak or your dose too low to properly treat your symptoms. The maximum daily dose of Tramadol in 24 hours is 400 mg (which should not exceeded under any circumstances because of some problematic side effects that can develop in higher doses)

or

b) you augment under Tramadol. Tramadol is the only opioid where this can happen. One way to test for it would be to slightly increase the dose, let's say from your current 100 mg / day to 150 mg / day. When you have more symptoms afterwards, you certainly have some form of augmentation and when your symptoms improve, then most likely your dose is not high enough.


And of course you always have the option to stop Tramadol. If the symptoms improve, then it is most likely an augmentation issue, too.

So when you ask if Tramadol is the optimal therapy for augmentation management: the answer is a clear no, simply because Tramadol can cause augmentation issues. There are other opioids of similar strength who don't have this issue (Codeine, Dihydrocodeine).

stjohnh
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby stjohnh » Wed Sep 25, 2019 9:06 pm

Icantsleep wrote:
I'd like to have a clean slate with my mirapex so I could perhaps one day in the near future try to resume at perhaps .0625mg
Would tramadol be getting in the way of that idea ?


Everything QyX said sounds about right to me. One possibility, if you are augmenting on tramadol, is to switch to kratom if conventional opioids are unobtainable. Kratom works similarly to a weak opioid, and while definitely not potent enough for people that require strong opioids, it may be enough for someone who only needs lower dose tramadol. Doubly true if you plan on trying tiny dose Mirapex again. That is exactly what I did for a year or so after augmenting on Mirapex. After getting my dopamine receptors reset by getting off Mirapex for a few weeks and using kratom instead but not getting sufficient relief, I added tiny dose Mirapex. The combination worked very well to control urge to move. I subsequently added low dose gabapentin and THC to improve sleep.
Blessings,
Holland

Icantsleep
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Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Wed Oct 02, 2019 3:59 am

So it would appear I am on too low a dose or too early a dose of tramadol

I am not augmenting , but IMO experiencing rebound rls that wakes me up in the early and even late morning (when I keep trying to go back to sleep)

Easy answer might be more tramadol or take tramadol ER
..... problem is , either mirapex withdrawal, or the introduction of tramadol seems to numb my midsection (ie : my hips top to bottom and hips side to side, and everything in between)

This seems to happen every evening and overnight through the morning, after which point I can feel myself pee again (and I'm peeing more than usual as well) .... so I'm leaning towards tramadol being the cause of this unwanted side effect
My wife along with myself would like my midsection area to work !

Codeine is a possibility
I have some already
.... it seemed to sedate me much more, and I (we) may have been concerned about opiate/benzo/THC combo in respect to breathing
(I have been diagnosed with upper airway resistance syndrome, but have lost weight and it hasn't been an big problem lately)
... not sure how long I should take to withdraw tramadol, wait, then introduce codeine ....

I may entertain the idea of adding 50mg or even 100mg gabapentin as well.

It may very well be that I will need to resume mirapex at .0625, and never go over .125mg
It's really what made the rls go away (at least for a while )

I do know that it's nearly midnight, and merely a fraction of a bowl of a 15% THC sativa has kept rls away (first time trying without tramadol)
I'm trying to take tramadol later (midnight and possibly 5am)

.... and with that I just felt a hint
Yup ... there's my normal nighttime rls
Unreal
Just took my tramadol and turned on my vaporizer

badnights
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby badnights » Wed Oct 02, 2019 5:36 am

Hi ICantSleep
I've been flipping thru your posts and see only one reference to iron - a discussion missed with your doctor. If you've been reading around here, as you seem to have been, you'll have heard of the importance of iron in WED/RLS. The disease is actually caused by a deficiency of iron in the brain. This can happen even in people with high concentrations of iron in their blood. Substances in the blood do not just diffuse across the capillary walls into the brain; the brain is protected - everything that goes in has to be transported across by various molecular mechanisms in the cells of the capillary walls. None of these mechanisms are fully understood, but there is evidence that the iron transport mechanism is not working right in WED/RLS. We can have lots of iron in our blood and other body tissues, but still be deficient in the brain because of this.

The concentration of a protein called ferritin in the blood can be used, in a half-baked way, as an indicator of low brain iron. If blood ferritin is low, then you're lacking iron somewhere in your body. If iron in your blood is high but ferritin is low, the lack is probably in your brain. On the other hand, if blood ferritin is high, it's sort of meaningless - your brain might still be iron-deficient. It's very useful to know if you have low ferritin in your blood. WED/RLSers with low serum ferritin are more likely to augment on dopamine agonist meds, and are more likely to experience severe WED/RLS symptoms.

My advice, in addition to all the other advice you've received - and I think someone else has mentioned this to you, but I didn't see your response - is to please have that iron discussion with your doctor. Your doctor may or may not know where to go with it, but if you check the link in my signature line, you;l l find links to a number of articles on the subject, plus the RLS Foundation has a few pamphlets on the topic of iron that worth reading. Educate yourself on the subject first, then you can direct your doctor which way to look for more information.

It comes down to this: if you're not supplementing with iron, you probably should be. This brain iron deficiency we have is not something that can be fixed by jacking up our iron levels with supplements for a while, then walking away from it "fixed". We have to keep taking supplements. (But that's a lot better than to keep taking any of the medications.)

You can take iron orally (one or two tabs of ferrous sulfate or ferrous fumarate containing 60 or 65 mg elemental iron each, per day, with vitamin C to permit absorption, on an empty stomach) or get a prescription for intravenous iron. See the 2018 consensus paper on treating WED/RLS with iron (also in my signature link). Any doctor should be able to read the relevant parts of this paper and see fit to prescribe you IV iron if your serum ferritin is less than 100 ng/ml. (read it yourself first and highlight the parts you want your doctor to see.) More informed doctors will prescribe even if ferritin is higher than 100.

If you have enough iron in you,
1. you will need less pramipexole, and less of every med, and
2. you will not be as likely to augment, so your small dose of pram. might be sustainable.

So - make iron your priority if you want to get control of this disease. Get your ferritin levels up before you add any pramipexole back in.

Also - it's good to pay attention to medication interactions. But many of us have found that (safely) combining our meds is a good way to keep the dose of each of them low, and some combinations seem to have even more benefit, somehow amplifying the effects of each other. You're on the right track there.
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.

Icantsleep
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Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Wed Oct 02, 2019 6:19 am

I do really wish I had low iron

My blood iron was the only recent concern with my bloodwork in that it was too high

It's been a little too high for quite some time apparently

My family doctor ordered more fasting bloodwork , focusing just on iron etc ...
I see him tomorrow to discuss results , among other rls topics
He had suggested magnesium a couple times , but not upping iron
He was actually more concerned about maladies caused by high iron

I assure you , a fix involving no (or less) meds is EXACTLY what I dream of

I'll see how "too high" my iron is and discuss options

Polar Bear
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby Polar Bear » Wed Oct 02, 2019 5:45 pm

Did your iron bloodwork include testing your Ferritin Serum. It is not usually done until specifically asked for.
It is the Ferritin Serum that it important with regard to RLS. FS can be low without your bloods being low.
Please ask tomorrow at your appointment if your FS was checked, and if not, arrange for it to be done.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Icantsleep
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Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Thu Oct 03, 2019 2:35 am

Polar Bear wrote:Did your iron bloodwork include testing your Ferritin Serum. It is not usually done until specifically asked for.
It is the Ferritin Serum that it important with regard to RLS. FS can be low without your bloods being low.
Please ask tomorrow at your appointment if your FS was checked, and if not, arrange for it to be done.


September 4th non fasting bloodwork :

Ferritin 635 Normal 22 - 537 (high)

September 20th fasting bloodwork :


Iron 23 Normal 7 - 29
TIBC 46 Normal 45 - 77 ( on the low side )
Saturation 0.5 Normal 0.2 - 0.5 (on the high side )
Transferritin 2.1 Normal 2.1 - 3.6 (on the low side)
Ferritin 800 Normal 22 - 537 ( HIGH )

my doctor said that the spike in ferritin between the 4th and the 20th September was likely caused by the stress of the mirapex withdrawal . (635 up to 800)
Going back a few years , each bloodwork result shows high ferritin.

He prescribed tramadol 100mg XR , which I'm about to take momentairly
He did not suggest iron supplements at this time

He suggested seeing what tramadol does before considering resuming mirapex or adding anything else .

Polar Bear
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby Polar Bear » Thu Oct 03, 2019 10:38 am

Excellent that your Ferritin has already been checked.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Icantsleep
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Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Fri Oct 04, 2019 1:35 am

So tramadol ER 100mg sure didn’t do much

Had a horrible night and worse morning

Going to take same 100mg ER at 10:30pm then take 50 mg tramadol once or even twice more through the early morning
Both doctor and pharmacist said I could do this , but pharmacist told me to be careful with clonazepam and THC and tramadol combo with respect to respiration

I need some much better sleep SOON so am considering finding some Kratom or , and I’m hesitant, take 0.625mg mirapex at around 2am

stjohnh
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby stjohnh » Fri Oct 04, 2019 2:53 pm

Icantsleep wrote:So tramadol ER 100mg sure didn’t do much

Had a horrible night and worse morning ...
and I’m hesitant, take 0.625mg mirapex at around 2am


I hope this is a typo. If you take the Mirapex, likely you mean 1/2 of a 0.125mg tablet, which is 0.0625mg, not 0.625mg.
Blessings,
Holland

Icantsleep
Posts: 105
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Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Sat Oct 05, 2019 6:24 am

stjohnh wrote:
Icantsleep wrote:So tramadol ER 100mg sure didn’t do much

Had a horrible night and worse morning ...
and I’m hesitant, take 0.625mg mirapex at around 2am


I hope this is a typo. If you take the Mirapex, likely you mean 1/2 of a 0.125mg tablet, which is 0.0625mg, not 0.625mg.


Yes
Definitely typo

Good news is I got sleep with essentially no RLS last night
First time in months

tramadol 100mg ER plus a boost of tramadol 50mg and my usual 0.75 dose of clonazepam and LESS than my usual THC (especially once I felt the tramadol) got me sleep in a small chunk , followed by a big chunk

I felt overtired and a slight bit dosed still from tramadol when I woke up and all afternoon and evening
I still took my 100ER for the 3rd night about 3 hours ago, but over the last 2 hours I can't feel my midsection , and I feel like I constantly need to pee

Not pleasant

Icantsleep
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Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Mon Oct 07, 2019 1:30 am

Guess I'll post another update

I ceased tramadol 100mg ER last night because of above mentioned side effects and took tramadol 50mg then 50mg then 25mg about 5 hours apart respectively .
My RLS came back and woke me up a few times in the morning as the dose wears off in my sleep.
I already knew this would likely happen .

I woke up today and had difficulty getting out of bed
I felt a whole new kind of crappy

Long story short , I was withdrawing from the tramadol ER
This was confirmed when I felt "better" after taking 25mg tramadol a good 4 hours earlier than I had planned.

I've figured out I do not like tramadol

Perhaps i could handle 50mg with a combination of other things like THC , possibly mirapex again (gasp) maybe try small dose Lyrica or Gabapentin

What I'd like to know is how do I go from tramadol to codeine or tramadol to kratom ?
My kratom will arrive in the mail in 2 days

Polar Bear
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Re: Is Tramadol continuing my Mirapex augmentation?

Postby Polar Bear » Mon Oct 07, 2019 12:03 pm

I did a quick search on conversion charts and it looks like the Codeine is stronger than Tramadol by 25% to about 40% depending on which Conversion Chart.
There is also the factor that you may react differently to one opioid compared to another.

I successfully replaced one 30mg dose of my Codeine with 2 grams of Kratom which is one level teaspoon.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Icantsleep
Posts: 105
Joined: Sun Oct 16, 2016 6:07 am
Location: Ottawa Canada

Re: Is Tramadol continuing my Mirapex augmentation?

Postby Icantsleep » Mon Oct 07, 2019 12:57 pm

Polar Bear wrote:I did a quick search on conversion charts and it looks like the Codeine is stronger than Tramadol by 25% to about 40% depending on which Conversion Chart.
There is also the factor that you may react differently to one opioid compared to another.

I successfully replaced one 30mg dose of my Codeine with 2 grams of Kratom which is one level teaspoon.


Did you replace in one day ?
Or ...... take them in conjunction with each other , then ween codeine ?
Did you start at 2 grams of kratom the first night ?


Gosh I wish tramadol didnt give me that specific side effect , cause now it really works well for the urge to move


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