Step by Step - Augmentation & Requip withdrawal

[beccaapril]

Hi Everyone,

My apologies if this type of question has been asked before. I did many searches for key words, in order to avoid a repeated post, but was unable to find what I was looking for. Here's my question:

What is the most commonly prescribed opioid for dopamine agonist withdrawal? And what is the most successful amount prescribed, directed to be used for how long and to take how often?

My history: I have had RLS since 1988, diagnosed in 2007 (or so). I started taking Dopamine Agonists in 2007. It has worked really well until a year ago when I started to experience augmentation.

I also have significant mental health issues that require a high dose of an SSRI and other meds that aggravate my RLS. But at this time, those medications will not be changed.

Thanks to you all, I have successfully educated my PCP about the prospect of iron infusions for treating RLS. I had my first infusion last Friday and will have another this Friday. I also have an appointment with Dr. Buchfuhrer on June 30th.

Because I am experiencing severe augmentation, I would like to get off Requip as soon as possible and do not want to wait until June 30th. I believe I incorrectly posted my dosage of Requip on a different post. Currently, I am taking 3mgs of Requip nightly and have been for a year. Before that I was taking 1mg for several years. I worked my way out of carbidopa/levodopa years before that.

I have an appointment with my PCP on Thursday morning and would like to give her a step-by-step guide as to how to prescribe an opioid for withdrawal from DA's. I have already sent her two publications from the RLS foundation website about augmentation and DA withdrawal - hopefully she will have access to them by the time we meet on Thursday.

Thank you all and best wishes for restful nights.
-Becca

[Rustsmith]

Becca, the easiest answer to your question is that any opioid will work and the "best" one is the one that has the fewest side effects for you. Unfortunately, the only way to determine that is to try one and if you experience side effects, then try another. Since you will be seeing Dr. B, it is my understanding that his preference would be methadone. Methadone has a convenience benefit of being a once a day med instead of every four to six hours for some of the others. As for the dose, you should probably start with the lowest dose available to see how it goes. When I was augmented, I started with 5mg of methadone and had instructions to go to 10mg after a few days. After about 2 days on 10mg, I dropped back to 5 because the higher dose was making me feel groggy.

Another thing to think about is what you will do once you get off of Requip. If you are going to require an opioid, then you might as well start out with the one that you will stay on.

Finally, don't let your PCP prescribe an medication that is a mix of Tylenol and an opioid. The Tylenol doesn't help with your RLS and should not be taken daily because of potential liver damage. All of the opioids are available without the Tylenol that is mixed in for pain control.

[ViewsAskew]

Excellent advice from Rustsmith. I would add one thing.

My PCP started me on 10 mg of methadone and it resolved ALL withdrawal symptoms. I wish we would have started with 2.5 or 5, because it's much better to come up to the minimum needed to know your baseline.

About two weeks after you stop the DA, test the waters to see if you can back off to a lower dose. Do the same at 30 days. If you need, say, 10 mg at the beginning, you may only need 5 mg later on if you stay on it.

The best dose is one that allows you to sleep well without completely covering symptoms. If you have to spend 5 minutes doing stretches, good. If you never have any symptoms, back off until you have a few.

Why to these? Because some of us DO have tolerance. Not many, but you never know if you are going to be one of them. I found out the hard way that I am. For me, it's a constant battle to bring that dose lower.

[beccaapril]

Hi RustSmith and ViewsAskew,

My PCP was very hesitant, but in the end did prescribe me a low dose of methadone. I started with 2.5mgs, but after 2 hours, my RLS symptoms were still not manageable. After taking another 2.5mgs, my symptoms were all but gone. I have since reduced my nightly dose of Requip 3mgs to 2mgs and plan on reducing it by another single milligram this Sunday.

I must admit I was really nervous about starting methadone, but after the first two nights, I can hardly notice a negative difference in my presentation during the day. My symptoms are mostly controlled and I'm no longer frightened about withdrawing from DA's!

This discussion board has allowed me to present my PCP with lots of helpful information.

I hope you all feel the sincerity in my 'thanks'! Going to bed is no longer something I dread!

[Rustsmith]

Beccaapril, you are more than welcome. That is why we are volunteers here. Being able to share our experience so that others can both educate their doctors and avoid the many problems that can occur is what keeps us going.

[ViewsAskew]

Hi RustSmith and ViewsAskew,

My PCP was very hesitant, but in the end did prescribe me a low dose of methadone. I started with 2.5mgs, but after 2 hours, my RLS symptoms were still not manageable. After taking another 2.5mgs, my symptoms were all but gone. I have since reduced my nightly dose of Requip 3mgs to 2mgs and plan on reducing it by another single milligram this Sunday.

I must admit I was really nervous about starting methadone, but after the first two nights, I can hardly notice a negative difference in my presentation during the day. My symptoms are mostly controlled and I'm no longer frightened about withdrawing from DA's!

This discussion board has allowed me to present my PCP with lots of helpful information.

I hope you all feel the sincerity in my 'thanks'! Going to bed is no longer something I dread!

So happy to hear. It made mine completely manageable - so glad when it helps others, too.