Restless Legs Syndrome (RLS) Discussion Board

Too much medicine
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Post Fri Jul 16, 2021 1:13 am

This is working very good 1800 Gabapentin 2 mg Neupro patch. 0.125 pramipexole. Was tapering off Neupro but this is working great Should I enjoy or be scared of augmentation?
Have had rls for many years and took mirapex until it wasn’t working as good switched to Neupro patch 3 mg worked great until got severe skin problems started reducing patch gradually was then on 300-600 mg Gabapentin and gradually increased to 1800
After reducing Neupro to 2 mg skin problems are much less but the Gabapentin and reduced Neupro did not control so added .0125 of
Start reducing either Neupro or pramipexole?
Which one with Gabapentin would be most likely to work with less chance of augmenting?

mocha wrote: ↑

Fri Jul 16, 2021 11:05 pm

This is working very good 1800 Gabapentin 2 mg Neupro patch. 0.125 pramipexole. Was tapering off Neupro but this is working great Should I enjoy or be scared of augmentation?
After reducing Neupro to 2 mg skin problems are much less but the Gabapentin and reduced Neupro did not control so added .0125 of
Start reducing either Neupro or pramipexole?
Which one with Gabapentin would be most likely to work with less chance of augmenting?

It is generally thought that Neupro has less liklihood of augmentation compared to pramipexole or ropinirole, if worry about augmentation is the main consideration, I'd say reduce the pramipexole.

Should I be worried about augmentation? Or does this sound like a reasonable combination? If gabapentin won’t work by itsself and there is no opioid option , keep which one and can u alternate? And if low dose , how low of either one?

Augmentation is a side effect of DAs that varies from person to person. A very small minority can augment in days and others have gone for up to 20 years without any problems. At this point, if it works and you are not showing signs of augmentation, then don't try to fix something that isn't broken. There is ongoing research to try to better understand augmentation and there MIGHT even be a new med that will treat augmentation.

What you can do is try to manage your iron levels. Low iron is believed to accelerate the appearance of augmentation. So you may be able to extend your run with DAs before augmentation appears by keeping your iron levels up. This could also allow you to decrease your DA dose.

Thank you so much!

Any references on the iron? My sleep specialist, one of the most well known on RLS, says the data just isn't there and advised against it as my lab parameters are all normal.

MichaelSGeneva wrote: ↑

Wed Aug 04, 2021 12:09 am

Any references on the iron? My sleep specialist, one of the most well known on RLS, says the data just isn't there and advised against it as my lab parameters are all normal.

RLS is caused by BID (Brain Iron Deficiency). Many people with RLS can have their symptoms markedly reduced or even eliminated with IV Iron treatments. This is the only treatment that gets at the basis for RLS (low brain iron). It has almost no side effects. The International Restless Legs Syndrome Study Group has elevated IV Iron treatment to first line therapy. This means that IV Iron is one of the first treatments doctors should try, not one of the last (as has been done for many years). If you can get your doc to prescribe IV Iron treatment, that is the way you should go. Unfortunately this is fairly new information and most docs, even those that frequently treat RLS, are not aware of it. Note that the blood test doctors usually do to check for low iron (ferritin test) only checks for low BLOOD iron, there is no test available for checking for low BRAIN iron. Oral iron usually doesn't provide a high enough blood level increase to help, folks need IV Iron infusions. Here is a link to the recommendations:
https://reader.elsevier.com/reader/sd/p ... 40A179/pdf

Here is a link to the latest consensus guidelines for the treatment of RLS. It also shows where iron therapy should be the first line treatment for RLS and provides some of the details that your doctor may not be familiar with.

https://www.mayoclinicproceedings.org/a ... 0/fulltext