What DA to take

Use this section to discuss your experiences with prescription drugs, iron injections, and other medical interventions that involve the introduction of a drug or medicine into the body. Discuss side effects, successes, failures, published research, information about drug trials, and information about new medications being developed.

Important: Posts and information in this section are based on personal experiences and recommendations; they should not be considered a substitute for the advice of a healthcare provider.
jul2873
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What DA to take

Postby jul2873 » Mon Jan 07, 2019 12:13 am

I am scheduled for a knee replacement next week, and have been told to stop taking kratom. `I've explained to various medical people (cardiologist, primary care, physical therapist, etc.) that I take it to control the symptoms of RLS and ask what I could take instead of kratom. No one has any idea; just stop kratom!

But I don't know if I can. My RLS is quite severe. I tried to stop it for the night before my colonoscopy and did not do well. I was soooo uncomfortable, and finally took a little. I can't image stoping it for a whole week.

So I thought I might ask my primary care for a DA. I have never taken any, so I have no tolerance. Years ago a doctor prescribed the neupro patch, but I was too afraid of the DA's to try it. Plus I get rashes very easily and it didn't seem like a good choice. Of the other DA's, which would be a good one to ask for? Is there one that works right away and that I can just take a low dose of? My plan is to use it only in this next week, and then go back to kratom after the surgery.

I've already tried gabapentin when it looked like kratom was going to be banned. It didn't help the RLS feeling, just gave me some of the side effects.

Any ideas? Thanks so much!

Rustsmith
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Re: What DA to take

Postby Rustsmith » Mon Jan 07, 2019 3:22 am

Since you have not taken a DA before, the choice between pramipexole or requip would be a tossup. You could end up with nausea from either one, but augmentation for a short exposure is less likely, but not impossible.

But since you have been taking kratom for a while and it has been working, would any of your doctors be willing to provide you with an opioid for the week before the surgery? Your surgeon will probably provide you with one for afterwards, so they would just be jumping the gun a little bit.

Also, be sure to print off a copy of the Foundation's pamphlet on preparing for surgery, highlight the important part and then hand it to your anesthesiologist on the day of the surgery. None of you want to have your legs start their dance in the middle of the operation. I did this prior to having hand surgery last year and the anesthesiologist assured me that he did not plan to use any of the meds listed, but also thanked me for providing him with the info (which he kept).
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

jul2873
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Re: What DA to take

Postby jul2873 » Mon Jan 07, 2019 5:03 pm

Thanks, Steve. I read on some discussion board last night that since kratom affects the mu receptors, you build up a bit of a tolerance to opioids, which an anesthesiologist needs to know about. So I called the clinic doing the surgery and explained my issue to a nurse. She had an anesthesiologist call me back. She explained to me that they are afraid of kratom since so little research has been done on it--they don't know what other meds it might affect. So anyway, she is calling my primary care doc. to see what they can figure out. I suggested a Rx for an opioid or for a DA.

Printing out that pamphlet is a great idea. I will definitely do that. Thanks again.

Polar Bear
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Re: What DA to take

Postby Polar Bear » Mon Jan 07, 2019 6:53 pm

Jul2873.... wasn't it just as well you mentioned the kratom to the clinic, see how careful they are being. We are often unaware of what interactions might be occurring even with seemingly innocent over the counter stuff or natural products.
Betty
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Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

legsbestill
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Re: What DA to take

Postby legsbestill » Tue Jan 08, 2019 5:35 pm

If you have to discontinue kratom it might be worth starting to reduce now as there may be a slight withdrawal issue, especially as you have been taking it for so long. Your rls might be slightly exacerbated during the withdrawal process. I would have thought a dopamine agonist for a few weeks would be unlikely to cause augmentation (though apparently it can't be ruled out entirely) but again, it is probably worth introducing it a little while before the op to see how you get on. As you haven't taken one before it is likely to be effective against your rls (and may help through the kratom withdrawal process). I have only ever taken pramipexole. Although it can have dreadful effects when causing augmentation, I still find it the best drug for controlling my rls provided treated with extreme caution. I seem to recall some research that suggests a link between low serum ferritin and augmentation so might be worth getting serum ferritin checked and starting a supplement if less than 100 to minimise any risk of augmentation.

Regarding kratom related opioid tolerance, I use kratom - though not continuously like you - but I don't find that it has a huge impact on the effect of opioids when I use them. Currently I can get away with a fairly low dose of opioid (maybe 10 or 15mg of oxycontin) if I am using that to control symptoms so hopefully you wouldn't be too tolerant. In your shoes I would favour the temporary use of a dopamine agonist however.

jul2873
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Re: What DA to take

Postby jul2873 » Tue Jan 08, 2019 6:35 pm

Thanks to everyone for the good advice. My primary care prescribed ropinirole--.25 ms. once at night for the first two nights, and then .50 at night. So last night I took the .25 pill. The RLS was slightly muted but not gone by any means. So finally I took a little kratom with the idea that legsbestill mentioned, that I should be tapering off it anyway. And that got me through the night, sort of. I'll probably take a little kratom again tonight, and then hopefully the ropinirole at .5 will do the trick, as I can't take any more kratom by then. The anesthesiologist said that they just don't know enough about kratom, and worry that it may interact with other drugs they are giving me. And she was funny. She said no matter who you lie to in life, never lie to your anesthesiologist.

I will be so glad when this surgery is over, and I can go back to my nice, effective, side-effect free kratom. I did notice that without it last night my knee was much more painful, so the kratom has also been taking care of that pain as well. I wish the FDA would get their act together and do the tests to show it's safe and to show exactly what's in it, so people can use it without worry.

legsbestill
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Re: What DA to take

Postby legsbestill » Tue Jan 08, 2019 7:10 pm

Good luck Julie. I think it was your posts that first introduced me to kratom - I had never heard of it before and it has been a life saver for me over the last two and a half years. I don't rely on it solely but I don't know what I would do without it either. Thank you for your informative and encouraging posts. I hope your operation goes well.

badnights
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Re: What DA to take

Postby badnights » Fri Jan 11, 2019 2:50 am

If you can get by without raising it to 0.5 .... I hate to see you augment after being stable for so long.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

jul2873
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Re: What DA to take

Postby jul2873 » Fri Jan 11, 2019 3:54 pm

Thanks, Beth. I appreciate your concern, and that was certainly my original plan. The first two days, while I was taking .25 ms. of ropinirole I was also tapering off of kratom, and my symptoms were covered pretty well. Then I went to .5 ropinirole, with no kratom, and my symptoms weren't covered at all. I had very active RLS for 24 hours. Was just awful. It gave me new sympathy for people who cannot get adequate medication from their doctors. So last night I said, well, I'm almost 75, and no way am I planning to take this stuff after I get out of the hospital anyway, which should only be 2 or 3 days. So I took 1 mg. of the ropinirole, and had a pretty good night. The RLS is still quiet this morning. I'm so relieved. But I am determined to switch back to only kratom as soon as I can. It doesn't give me an uninterrupted night's sleep, but I feel much better on it, and I don't think it's as dangerous as Ropinirole is. So that's where I am.

But I do appreciate your concern. Thanks again.

badnights
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Re: What DA to take

Postby badnights » Mon Jan 14, 2019 6:59 am

I totally understand how awful it must have been. I hope things are going well. Are you still in hospital?
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

ViewsAskew
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Re: What DA to take

Postby ViewsAskew » Mon Jan 21, 2019 7:47 pm

Julie - great attitude (from my perspective, at least!). I think of all the people who aren't aware of the alternatives and feel stuck and horrible with their regimen. How grateful I am for you and all the other people here who continue to educate me and from whom I draw inspiration.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Stainless
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Re: What DA to take

Postby Stainless » Tue Jan 22, 2019 7:15 pm

There was a PowerPoint on this site mostly on RLS and Opioids. I think it was a Mayo Clinic physician. He stated that they had followed every RLS patient at their facility and pramipexole had the best record for length of DA treatment without augmenting. It gave me an instant headache so I went to Ropinirole which worked like the wonder cure for the first few days. It was all downhill from there. I was miserable on the extended release version of Ropinirole for a year until I gave up and went back to the Benzo Clonazepam. Now that is starting to fail me. Best of luck to you.

QyX
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Re: What DA to take

Postby QyX » Wed Jan 23, 2019 10:11 am

You can withdraw from Clonazepam with the help of Diazepam in case it is too difficult dor you to do it with Clonazepam itself.

Then replace the Benzodiazepines for 1-2 month with DAs / opioids or a combination of opioids with antiepileptics like Lyrica, Carbamazepine or Gabapentin.

Then after you removed your Benzo tolerance you should be able to go back to Clonazepam.


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