Restless Legs Syndrome (RLS) Discussion Board

Does anyone know how to stop gabapentin slowly? I take 600 mg per night.

You shouldn't need to. Just stop it. Remember gabapentin alone usually helps only folks with mild RLS. Your RLS likely has progressed (unless you have had an IV Iron infusion) and will require other therapy (dopamine agonists, IV Iron or opioids). If the gabapentin had been working well previously, but not so much now, one possibility to discuss with your doc is to keep taking the gabapentin but add a tiny (1/2 of 0.125 mg tablet) dose of Mirapex.

Another, and likely the best option, is to discuss IV Iron with your doctor. Print a copy of the paper at the link at the end and take it to your doc.

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 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 tests doctors usually do (ferritin test) to check for low iron only check 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://www.sciencedirect.com/science/a ... via%3Dihub

thanks St. John. I already had tests and have no iron deficiency. I have severe RLS, Every night leg twitching when I awaken during the night. Your suggestion of the small dose of mirapex is a good one. I really dont want to go to the next level of meds. The Gab. worked for the first 2 years but it a little less effective now. I also take ambian occasionally when I am really sleep deprived. I would take it every night and not even need anything else, but my Dr. says it can cause memory problems. If I could sleep 8 hours straight, I wouldnt need anything, but I wake up hourly. I am wired weird. Take care.

600 mg Gabapentin per night is not that much. There is a lot of room to increase the dose depending on how well you are tolerating the Gabapentin. In Germany daily doses up to 3.600 mg are approved.

So before adding a 2nd drug you can simply try increasing the dose. Of course you should talk to your doctor about it first and not try it on your own.

Most likely you would tolerate an increase of the dosage until you reach a point where you get more and more side effects.

If you want to stop Gabapentin, you can just reduce the dosage over a period over 2 to 4 weeks. While most people have no trouble stopping Gabapentin fast, some people have issues.

Try increasing the dose. I started out at 300 mg of gabapentin a night but gradually increased to 1200 - 1500 mg a night. 95% of the time I sleep very well.

It is not safe to stop gabapentin cold turkey no matter why you were taking it! For advice go to the facebook group Gabapentin Withdrawal Support. Great group.

I already had tests and have no iron deficiency. I have severe RLS, Every night leg twitching when I awaken during the night. Your suggestion of the small dose of mirapex is a good one. I really dont want to go to the next level of meds. The Gab. worked for the first 2 years but it a little less effective now. I also take ambian occasionally when I am really sleep deprived. I would take it every night and not even need anything else, but my Dr. says it can cause memory problems. If I could sleep 8 hours straight, I wouldnt need anything, but I wake up hourly. I am wired weird. Take care.

You're not wired any wierder than the rest of us here It's all part of the WED/RLS: the godawful twitching and the accompanying insomnia, so even if the twitching is under control, you never seem to get a good, sound sleep.

I am concerned that you said you "had tests and have no iron deficiency". Many standard iron panels don't test for ferritin. If they do, the lab might say "normal" for ferritin levels over 20 ng/ml. The problem is that WED/RLS patients need a level of over 75 and preferably over 100. We have a brain iron deficiency, probably caused by malfunctions in the way iron crosses the blood-brain barrier. We can have lots of iron in the rest of our body and still be deficient in parts of our brain. Low iron stores anywhere in the body can be reflected in low ferritin levels in the blood, so that's why we get the ferritin test. For most of the population, a level of 20 or 30 is not a sign of any problem, but for WED/RLSers it is much too low. So get the actual number for your serum ferritin level. If it is below 100, consider supplementing with oral iron.

Taking iron reduces my symptoms and I'm fairly confident of that statement, since I've stopped and re-started a number of times over the years, intentionally and unintentionally, with consistent results. It takes 2-4 weeks for the symptoms to worsen when I stop or get better when I start again.