Is Tramadol continuing my Mirapex augmentation?

[Icantsleep]

Experiencing EXTREME rls since bedtime 3 hours ago.
Equal to first night without mirapex iirc
Took only 15mg codeine at bed
Have since vaped a bunch strong indica
Taken a bit over a gram of kratom
Only 0.5 mg clonazepam

I cant wait until I can take more of something

Gotta figure out the rls part
Probably take more codeine
Yup just took 15mg (wish I knew I could take more)

[stjohnh]

Experiencing EXTREME rls since bedtime 3 hours ago.
...
Taken a bit over a gram of kratom
...

I cant wait until I can take more of something

Gotta figure out the rls part
Probably take more codeine
Yup just took 15mg (wish I knew I could take more)

1g kratom is still a small dose.

[Polar Bear]

I take Kratom as a dose of 2mg. On occasion I take 2mg at bedtime followed several hours later by a further 2mg.
I take my codeine as a dose of 60mg i.e. 15mg x 4 pills. I am prescribed this dose, no more than 4 times daily.

[Icantsleep]

I went back to tramadol for bedtime dose as per pharmacist suggestion

Have failed moving over to codeine for now

Rebound RLS from lack of tramadol is not tolerable at all.

Pharmacist says try codeine evening then tramadol bedtime for a few more days to bring down the overall tramadol dose
(The goal still being to get off tramadol)

I also bumped up the kratom dose to about 2 grams, but that was about 6am and rls symptoms are not as bad at that point
(I also took clonazepam around 330am to get back to sleep)

Should I perhaps take clonazepam and kratom in one shot when rls wakes me up overnight ?

[SLEEPY ANGEL]

To : icantsleep-- I haven't been here for a couple years because all was going well, but now seems to be Augmentation. But, enough about that for now. I was reading your posting of OCT. 8th 2019 at 7:57 AM. I just can't imagine going through what you are going through, namely with SO many medications and substances that aren't prescriptions...? Kratom is so foreign to me and my own experiences, and then you also take Tramadol and Clonazepam....plus "what else"? I feel so bad for your situation. Is all of this done with the supervision of a good Neurologist? Or are you experimenting a lot with things you've read about in these postings? Seems to me that a BIG expert needs to help you find a simpler course of action, but if you reply to me, I'll know if you went on that route and it failed you. By BEST! --sleepy angel

[Icantsleep]

So to answer my own question first , clonazepam and kratom havent seemed to like each other in close proximity (they sure didnt this morning)

I am currently in between big experts
.... the last one bailed after prescribing me my mirapex augmentation dose (and originally prescribing it to me 13.5 years ago .... he was also the first to prescribe me an opiate for rls . FACT.)

He was my expert for nearly 15 years

The plan was to go on low dose opiod if augmentation occurred .
Only problem was when I needed that opiod , he was nowhere to be found
He avoided me , and now doesn't want to do his job
(Yes this still upsets me)


I am starting over with a new neurologist

I need to keep a sleep/wake diary , medication diary , separate marijuana diary, a very detailed and elaborate rls diary and headache diary for the next couple months to give him a picture of what I go through
.... nothing like keeping track of everything shitty in your life every day and then reviewing it again for accuracy.
(Yup , it's super depressing and essentially consumes my life)

So ya ... so other than a GP who finds me these experts, and a pharmacist , and with all of you guys of course ,
I'm on my own until I see new expert right before Christmas

[Icantsleep]

Yet another update for anyone interested

Switched back to tramadol 25mg 6pm instead of codeine
Did not take any kratom overnight
Did the usual otherwise

Had no RLS whatsoever

Daughter #2 kept us up until 3am (fun)
I had very very limited sleep, but I was able to rest still for hours with the help of strong indica , clonazepam , and tramadol (my bowels still hate tramadol)

No RLS is probably something encouraging.
Thought I'd share

[SLEEPY ANGEL]

To icantsleep
Thanks for the description of who was helping you out (for years) until a low-dose Opioid was the next step. If that would work for you, then that Neurologist was a big jerk to abandon you. Personally, I'd be afraid of Opioids, even low-dose.

Because of some Augmentation, I got in touch with my Neurologist's Office but the message I got the next day was only to take one of my Mirapex earlier in the day; this message did not say what to do when the tablet ran its "life" of about 6-7 hours...because then there's a gap of a few hours before I'm supposed to take the next dosage. I was hoping to be told to add another dose of one tablet in there somewhere. These experts just don't think through their advice at times.
Keeping a sleep/wake Diary is a real pain in the butt. Hope you have reams of paper! I've done it in the past and it takes so much time! I'm close to doing it again to show this Neurologist where she's not giving good advice...

Hope your new Neurologist is really good! Much luck to you,
sleepy angel

[Polar Bear]

You say you have augmentation but also say you were hoping to add another tablet of mirapex. I assume It is mirapex that you mean.
If you do have augmentation then increasing your DA medication i.e. Mirapex is not the answer.

The answer to augmentation is to get off your DA, your mirapex.
Augmentation is when the drug itself is causing the problem.
Your neurologist was correct not to offer an increase in the mirapex. Though he should perhaps be considering what actually causes the augmentation. Perhaps he is trying a change in the timing first to see if it helps.

I have been augmented for some time and have been slowly weaning myself off my DA.

[Icantsleep]

If you could tell us what meds you take, along with dosages and time of day , that may be helpful

I'm no expert, but you almost certainly need to be taking less mirapex (if any)
Unfortunately, this is not something that is easily accomplished, but many of us have done it .
One alternative is to resume mirapex at a much lower dose after you've let your body reset itself

Your doctor was not telling you to take an additional dose
If she was, she's a bit behind the times when it comes to mirapex augmentation

[SLEEPY ANGEL]

Hi all-- Well, I'm certainly not in as horrid a condition as "icantsleep" is in--- Mirapex/Pramipexol is what I take : The directions were to take .125 mg at 1 PM in the afternoon and then twice that at about 7 PM. But, surely Augmentation has happened and my legs felt squirmy at 10:30 AM. That's when I called the Neurologist's Office.

Also have 600 mg of Gabapentin to take at bedtime. I go to be early, so that is taken around 8:30 or 9 PM....My Neurologist gave me that Rx because it would make me sleepy, or sleep better. I actually am sure it makes me sleepy BUT I DON'T SLEEP very well (insomnia, not the RLS keeping me from a deep sleep). I can only guess, but think I've been getting 5-6 hours of sleep up till NOW when Augmenting.

I have a 98 year old friend who has takes=n Mirapex for MANY years and her doctor tells her to take one anytime she pleases!... perhaps she had Augmentation and he didn't want to fiddle around with other solutions---so she takes the tablets all day long I think. That was why I wondered if my Neurologist would allow an extra tablet earlier in the day, such as 10:30 AM....

[SLEEPY ANGEL]

I should add that I am scared silly about what I could be told to take NEXT, if told to get off Mirapex. I'm just going to have to trust my Neurologist's expertise. I hope I'm a LONG way away from being on an Opioid. That is not something I want to try.
---sleepy angel---

[SLEEPY ANGEL]

Oh dear! I keep thinking of something else I should SAY!
I CANNOT take any strong pain-killers such as Darvon or even codiene in cough medicines...they all make me barf up my meals. If something gets dripped in my veins, it's fine...but a tablet or liquid into my stomach isn't good! So, I even wonder if a low-dose Opioid or codiene, or whatever, could ever be prescribed...

[Icantsleep]

You definitely cannot take mirapex like your friend

You might be able to get away with .375mg total , assuming you have or would have symptoms all day .
It would still be more ideal if you could reduce it a tiny bit

If you dont want to add any more meds for rls (which essentially no one really does) I would strongly suggest you work on your general insomnia.
The more sleep you get, the less RLS you will have .

Literally make your sleep your absolute number 1 priority in your life for the next few weeks
Inform people close to you of this necessity

[SLEEPY ANGEL]

Hi icantsleep---
My PCP told me to make an appointment with a "Sleep Medicine" doctor and that is January 14th; yes, MONTHS away... but doctors get booked up so far ahead! I will tell him that I do NOT want any more meds...and whatever he feels I could take just might not be good & interact with the Gabapentin, in my opinion. Anyhow, I am trying to get as much sleep as I can; I was in bed when you wrote your advice. I thank you!

I didn't do too badly as far as RLS yesterday by taking the 3 tablets I'm "allowed" of Mirapex at Noon, 5 PM, and 7:30 PM---- then the Gabapentin at 8-ish and IN BED by 8:45. I slept OK but always wake by 3 AM and maybe get to doze 2 hours, but no more deep sleep (added to whatever I MAY have gotten overnight.) Yeah, I hear you about NOT asking for MORE Mirapex and will see if I can manage with what I get in refills.

I hope you are doing OK with juggling all you've been taking! I can't imagine being in your situation, but I realize I am SO MUCH better off than most who come to this site, including you!
My cat is named Angel and I keep HIM awake when I can't sleep, hence my choosing the name sleepy angel. Has nothing to do with me considering myself an angel! Your name is totally understood, of course.

Off to an appointment for a lovely Mammogram... I'm not very well endowed, so they always have to squeeze and pull to get enough of a grab on my breasts. Not fun.