Fast Augmentation or Rebound

[Bannia]

I stopped taking methadone 14 days ago. For 7 days, I took Sinemet in higher than normal doses—4 pills—to stop the rebound RLS and get a little sleep. I stopped Sinemet 3 nights ago, and last night I had terrible RLS symptoms again, including in my arms, and it lasted into the morning. I also had it in my arms before taking Sinemet.

Is it possible to augment on Sinemet in 7 days? I augmentated on it years ago, but haven’t used it since. I also augmented on other DAs years ago. I am thinking that this is just the result of rebound and untreated RLS, but it did occur to me that I can’t discount augmentation.

[Rustsmith]

Yes, it is possible to augment on SInemet in seven days. You should only take it for a day or two at a time. It is actually dopamine (as opposed to a dopamine agonist, aka look alike). It works faster and lasts for less time than the dopamine agonists. You might have gotten away with taking one of the dopamine agonists for seven days, but a week on Sinemet for someone who has already been through augmentation was tempting fate.

I hope that you won't have to go through the full dopamine withdrawal period now. Withdrawal from Sinemet for someone who has already augmented is not something that I have ever seen discussed.

[Bannia]

When you say withdrawal period, are you referring to how long it takes to wash out Sinemet? Is that period proportional to length of time on the DA and dose? How long after stopping would the withdrawal be expected to start and can it cause chills? I don’t remember it being more than a few days when I stopped it years ago and I don’t remember getting chills.

Thanks very much

[Bannia]

One more question. How would I know if it’s withdrawal related or augmentation? Severe RLS is encountered in both. As I mentioned, my other symptoms are chills that come and go, exhaustion (haven’t slept in days), and pain in my lower legs that doesn’t always lead to RLS, only when it starts in my ankles/feet…sort of a burning sensation.

I sure don’t want to take any methadone if it’s withdrawal related restlessness.

Thanks for your thoughts.

[badnights]

Hi Bannia - -what a terrible time you're having! I hope it all resolves quickly!

There are two withdrawals here to consider - your withdrawal off methadone, which could last up to six months, and your withdrawal off Sinemet, wihch I am not sure how long it could last. Both withdrawals can also be over in 2-3 weeks. And I don't think anyone knows what determines the length of withdrawal. Both withdrawals cause intense RLS-like symptoms - the only difference is that the opioid withdrawal also includes gastrointestinal symptoms. As for chills, I suspect that is the opioid withdrawal.

Withdrawal from dopamine-type meds I think causes nothing besides intense WED/RLS (except in cases of Dopamine Agonist Withdrawal Syndrome, but you're not dealing with that).

Augmentation symptoms will only happen while you are taking the dopamine medication and for some short time afterward but I don't think anyone knows how long. After that, your symptoms are no longer being augmented by the medication, but you will still be in withdrawal. I don't think anyone would be able to tell the augmentation from the subsequent withdrawal, because the symptoms are the same.

When you say withdrawal period, are you referring to how long it takes to wash out Sinemet? Is that period proportional to length of time on the DA and dose? How long after stopping would the withdrawal be expected to start and can it cause chills?

In my experience listening to fellow members here, the washout/withdrawal period for Sinemet or the dopaminergic meds is not related to how long you were on it, nor to how long you were augmented on it. As above, no I don't think I've ever heard of it to cause chills, that's more likely opioid withdrawal. And I think the withdrawal would start with the first missed dose.