Clarification

[shinderlider]

I’m needing clarification on withdrawing from ropinirole due to augmentation. In many posts I have read, folks say that they started a new medication at the same time they began their withdrawal from ropinirole. Yet in the Foundation publication, “Medication Withdrawal Following Augmentation”, it talks of a 12 night drug free period during which one is on no RLS medication. I’m unclear now about the process. Can someone help clarify this for me?

[Rustsmith]

There are two approaches taken. The one that you saw in the Foundation literature is the one that Hopkins uses and has the patient get off of all RLS meds for 12 days so that the doctor can judge the patient's new RLS baseline. Unfortunately, this means a week of zero sleep (not even naps) and only small amounts starting after the sixth or seventh day. The idea is to know which approach needs to be taken next.

The other approach assumes that the patient is going to need an opioid as the next line of treatment. The opioid can be started immediately and covers the dopamine agonist withdrawal, so it is much easier on the patient.

Some doctors try to use Lyrica as the next line of treatment and start it when the dopamine agonist is stopped. Unfortunately, Lyrica is not strong enough to cover the withdrawal symptoms, so you go through the same period of zero sleep during the first week.

[shinderlider]

Thank you. That helps a lot. So if the patient will be starting Lyrica, do they stop taking the opioid or continue? Or can a low dose of Lyrica be introduced during the withdrawal then increased as needed?

[Rustsmith]

Lyrica can be taken at the same time as an opioid (and many do exactly that). If you are stopping ropinerole, you can still take Lyrica at the same time that you are stopping ropinerole, but the Lyrica will not cover the ropinerole withdrawal side effects nor help with your RLS until you have most of the way through ropinerole withdrawal.

The only RLS meds that should not be taken at the same time as Lyrica are gabapentin and Horizant, and that is just because they are all similar meds, so you would be doubling the effective dose.