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Posted: Mon Apr 18, 2016 1:13 am
by Travis294
I've read through these posts and referred documents and don't see anything about Gabapentin augmentation. I was taking it before my RLS along with Tramadol. My Dr recently increased my dose of Gabapentin and my RLS has gotten worse. Has anyone seen this effect with Gabapentin?

Re: Gabapentin

Posted: Mon Apr 18, 2016 8:50 am
by Polar Bear
I've never used Gabapentin myself but understood that augmentation does not occur with this drug.

However, I have heard of augmentation when taking tramadol. Not as often as with the DA medication i.e. ropinerole or pramipexole, but it has been known. Could this be possible.

Are you taking any other medications, either for RLS or for any other condition.

Re: Gabapentin

Posted: Mon Apr 18, 2016 7:19 pm
by Travis294
Yes, I have a long list of medications:
Gabapentin(currently increasing)
Tramadol(currently weaning off)
Hydrocodone(just started and it temporarily stops RLS)
Mirapex(just stopped)
Trilaptal(currently weaning off)
Clonazapam(currently weaning off)
Dexilant(for Gerd)
Renvela(phosphate binder)
Tums(phosphate binder)
Sensipar(for polythyroid hormone)
Vitamin D

Who knows what all these are doing to my nervous system. I have Intracranial Hypertension which could be complicating things, along with kidney failure and a very slow digestive process - I wonder if any of these meds are actually being absorbed since I take them orally and have problems with digestion. Anyway, this the list of my meds. It wouldn't matter much, but I've been on kidney transplant list for four years and hope to live a long life once I get one. I need to hang on until my match is found, but the RLS is making it difficult

Re: Gabapentin

Posted: Tue Apr 19, 2016 12:34 am
by Rustsmith
Gabapentin is not known to be associated with augmentation, but Tramadol and pramipexole are. If you are reducing your doses for both Tramadol and pramipexole, there is a very good chance that the increase in RLS symptoms that you are experiencing is the reduced dosage of one or both of these drugs. Gabapentin by itself is an effective RLS treatment for some people, but not everyone. It is also probably not strong enough to cover the increased RLS symptoms that arise when getting off of pramipexole. Therefore, there is a good chance that what you are experiencing is due to your reduced pramipexole dose. You might therefore want to think about getting off of one or the other but not both at the same time. However, this is definitely something that you need to work on in consultation with your doctor since you are taking so many different things and have the added medical complications.

Re: Gabapentin

Posted: Thu Apr 28, 2016 4:09 pm
by badnights
Just to add to what Steve said, the "ropinirole (Sometimes)" may not be a good choice to replace the pramipexole, since it also is a DA that can cause augmentation.

It would be good to know if you had already augmented from the pramipexole, and how long ago you went off it. If less than 10 days or so, you might still be augmented, and the ropinirole might be prolonging that. It can be hard to evaluate if you were augmented, though: you have to consider your symptoms when you first started taking pramipexole, and judge if they are more severe, have spread to other body parts, begin sooner in the day, or begin sooner after becoming still. If you were taking pramipexole for years, you have to try to distinguish that from how the disease would have progressed anyway. Progression can be fast in secondary RLS/WED, and yours seems to be secondary to kidney disease. (Unless you had it before the kidney failure?)

Since you are taking hydrocodone already, and it is usually effective at treating WED/RLS, you might want to ask about that or a stronger or longer lasting opioid being your primary defense against WED/RLS. If you and your doctor decide to use gabapentin for WED/RLS, you might want to ask about Horizant (gabapentin encarbil) instead; apparently it is absorbed more efficiently.

How are your ferritin levels? Not your hemoglobin iron but ferritn, which is a protein that stores iron in the body tissues. Its levels in the blood of WED patients should be over 100. Some of us need to supplement with oral iron daily to keep our levels up, which keeps symptoms at a lower level of intensity. Low ferritin also correlates strongly with the likelihood of augmentation from DAs. I am not sure if Sensipar is one of the thyroid medications that shouldn't be taken with iron; clearly you need to check with your doctor before adding or subtracting anything.

Re: Gabapentin

Posted: Thu Apr 28, 2016 5:21 pm
by stjohnh
A couple of points: chronic kidney disease changes the metabolism of many medicines. Not only that, ferritin is grossly altered by the kidney disease and it's poor utility in RLS is even worse because of the chronic kidney disease. In view of the large number and complexity of your medications I would suggest talking to your doctor about changing to methadone or another opioid. Doctors are used to dealing with the dosing changes needed for patients using opiates with chronic renal disease. Using an opioid for your restless leg syndrome would likely decrease the total number of medications you take and decrease the likelihood of unexpected medication interactions.

Re: Gabapentin

Posted: Thu Apr 28, 2016 5:57 pm
by Travis294
Yes, my plan is eliminate several of the meds by taking the stronger opioid, including the zolpidem, Tranadol, clonazepam, alprazolam and the Gabapentin, but only have enough hydro for nights. So the Gabapentin helps with leg and foot pain during the day and methadone might be better in eliminating this med.

My ferritin levels have all been in the 150-250 range and my doctors insist that isn't the problem.

Remarkably, I had the same RLS symptoms five years ago and suffered for weeks then tried Requip, and it immediately halted all RLS symptoms. So of course it was the first thing I tried this time but now it has no effect whatsoever. The only thing that has changed is that I'm on dialysis but Polycystic kidney disease progresses since birth until ESRD. It could be that the requip is dialyzed and fails to build up. Idk.

I know I have an absorption problem based on an endoscopy and the fact that the Hydrocodone generally takes 2 hours to take effect. My only option to correct this is another med, Reglan, or switching to methadone.

Re: Gabapentin

Posted: Mon Jan 30, 2017 12:51 am
by lsk1
Hello, I'm new here and this is my first post. I've been taking Ultram, and Requip for approximately 4 years and have been at the maximum dose for quite some time, on the Requip. My augmentation has now become unbearable. My MD has asked that I begin Gabapentin and I tried it today for the first time. I took 600mg and my symptoms are worse than ever. I've had some dizziness, so I'm a little fearful of taking more. My MD told me that he has some patients on 4000mg to control their symptoms, so I should not be afraid to increase. I'm so tired of it!

Re: Gabapentin

Posted: Mon Jan 30, 2017 1:04 am
by stjohnh
lsk1 wrote:Hello, I'm new here and this is my first post. I've been taking Ultram, and Requip for approximately 4 years and have been at the maximum dose for quite some time, on the Requip. My augmentation has now become unbearable. My MD has asked that I begin Gabapentin and I tried it today for the first time...

Welcome. Lots of smart and helpful people here. I assume you are off the Requip and Ultram and only on gabapentin. Gabapentin usually cannot control the RLS symptoms that universally worsen when withdrawing from a dopamine agonist (Requip is a dopamine agonist), no matter how much is used. Getting off Requip is done in one of two ways: 1. temporarily using a narcotic (opiate) to control symptoms or 2. Cold Turkey, which is sometimes faster, but is pure torture for at least a week. Your situation is a bit more complex in that Ultram (tramadol) can also cause augmentation.
Many docs have no experience with augmentation and may need help learning what to do to help you. Downloading a copy of the white paper on augmentation from the RLS foundation web site and taking a copy to your doc may help.

Re: Gabapentin

Posted: Mon Jan 30, 2017 1:40 am
by Rustsmith
In addition to Holland's comments, I would also like to offer this information about gabapentin.

Most people start with low doses of gabapentin (100 to 300 mg) and then build the dose over time. Many have side effects (such as your dizziness). The slow increase helps to lessen the severity of these side effects, which often go away with time. But be aware that gabapentin can cause side effects of depression and/or anxiety. If these occur, contact your doctor immediately.

As for your doctor's comment about having patients on 4000mg/day, there are some people with other conditions where that may be true. For RLS, it is unusual to find doses this high, partly because it causes many of us to become quite sleepy. Also, you should know that gabapentin is only adsorbed by a short length of the intestine. So taking higher and higher doses may not provide any benefit if only a small part of it is actually getting adsorbed into the blood stream. In these events, much of the gabapentin can pass through the body unused. This is the reason why gabapentin enacrbil (Horizant) was developed. More of the Horizant is adsorbed, so it can deliver more gabapentin into the blood stream where it is needed. Unfortunately, Horizant is also far more expensive than gabapentin.

Re: Gabapentin

Posted: Mon Jan 30, 2017 3:39 am
by badnights
Hi, welcome to the board. You must be in agony. I got the impression you were still on ropinirole? When you say maximum dose, what is that? If you're taking 4 mg, that's huge for WED/RLS. There is a point at which you shouldn't stop abruptly, and 4 mg is probably over that point. So I hope your doctor is supporting you in a taper.

That said, the whole time you spend tapering, and a good few weeks afterwards, will consist of the most insane RLS/WED symptoms of your life. It is worth it to suffer through this, to get a lowered level of symptoms, back to something you can live with, better than you've had for years, but you do have to suffer to get there. It's totally worth it, though; remember that.

So - if you just came off the ropinirole suddenly, or even if you just reduced it, you will be experiencing the dopamine agonist withdrawal symptoms that are unique to WED/RLS sufferers. And, as Holland says, most docs don't know anything about this. Get this pamphlet: ... 052016.pdf , it's informative and free, but it has no real advice on treatment. Also download the IRLSSG paper on Augmentation, which has a section on how to treat it - that paper can be downloaded by following the link in my signature line below, which leads you to a post with a number of links. The correct link is labelled "The International RLS Study Group's 2015 white paper on augmentation prevention and treatment".

Your doctor might be following those guidelines already, since he has started you on gabapentin - - - but be sure to tell him what your symptoms are, and how often and how strong - and include how much solid sleep you get. I have never known a case of severe augmentation to be dealt with solely by medications like gabapentin - they don't have the necessary properties. In fact, almost no one successfully treats moderate to severe WED/RLS with gabapentin or pregabalin alone. I'm not sure about people's success with gabapentin encarbil alone. (btw a possible side effect of gabapentin that might affect a small percentage of people is depression and suicidal ideation - watch out for moodiness and tell your doctor right away if you experience any).