Time of day to apply Neupro Patch

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Werbers
Posts: 5
Joined: Sun Mar 17, 2019 12:21 am

Time of day to apply Neupro Patch

Postby Werbers » Sat Apr 06, 2019 10:37 pm

Does anyone have an opinion or experience on what is the best time of day to apply the Neupro Patch? It seem to me that late afternoon or early evening would be best. That way the highest concentration of drug would be available for nighttime when my symptoms are worse. The package literature just says to change it the same time each day. I just received a box of 30 1mg patches in the mail today and will probably start tonight. I’ve been on tramadol 100mg daily and oxycodone 15 mg daily for many years and I’m just getting over augmentation from 20 years of tramadol use. 2 months of pure misery. I think it’s almost over now. I augmented on ropinorole about 2years ago. That lasted about a month. I’m not crazy about taking another dopamine agonist. I don’t care to augment a third time. I’ve thought about rotating meds every few days. Oxycodone for a couple days, then Neupro, then kratom. That way I may lower the risk for augmentation and building up tolerance. Any ideas would be appreciated.

Rustsmith
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Location: Pueblo, Colorado

Re: Time of day to apply Neupro Patch

Postby Rustsmith » Sat Apr 06, 2019 11:06 pm

Although timing is a matter of what is most convenient to you, I think that may apply the patch shortly after getting out of the shower. Although it is waterproof and I never had one come off during the 15months that I used it, there have been a few who have had problems with it staying adhered to the skin. As for the dose, the idea is that it provides as close to a constant source of medication as is possible, so you probably shouldn't worry too much about when to apply/replace.

As for rotating, there are several here who do that. However, in most cases they are doing so because of a combination of issues, such as opioid tolerance problems (this doesn't happen to most of us) combined with rapid augmentation to any type of DA.
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.

Werbers
Posts: 5
Joined: Sun Mar 17, 2019 12:21 am

Re: Time of day to apply Neupro Patch

Postby Werbers » Sun Apr 07, 2019 12:05 am

Good idea about applying after the shower. How has the patch worked for you? Are you still using it? What dose are you on? Any problems with rash or augmentation? I haven’t had a problem with opiate tolerance. I’ve taken 10-15mg oxycodone for 20 years. Getting past this recent bout of augmentation I used a bit more but now I’m back down to my normal dose of 10-15 mg except for no more tramadol which was 10 morphine eq/day. I’d like to get mostly off of the opiates if possible but I’m running out of options. If the rotigotine fails, all I have left is Lyrica. Gabapentin did absolutely nothing and I augmented on ropinorole. 4 grams of Kratom works exceedingly well for about 3 hours but wears off about 2:00 AM. I guess I need to experiment with kratom dose and timing. Thanks for your response...John

Rustsmith
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Joined: Sat Sep 28, 2013 9:31 pm
Location: Pueblo, Colorado

Re: Time of day to apply Neupro Patch

Postby Rustsmith » Sun Apr 07, 2019 12:19 am

John, I was on the patch for 15 months after augmenting on pramipexole in a year. At the time, the patch was still new in the US and the experts were hoping that the time release nature would make it resistant to augmentation. Well, I augmented after 15 months going from the 2mg patch up to the 4mg before having to change medications again (complicated story that required a full six months to resolve). I have been on opioids ever since. Three years on methadone and now six months on 200mg Tramadol ER. I expect to switch back to methadone when I see my doctor again in September.

As for issues while I was on the patch, I only experienced mild skin irritation and not the rash. By switching between 14 different application spots, I was able to recover before re-using a site. I had to modify the suggested application sites because the ones on the front of my abdomen flexed so much that it was irritating (not in the inflammation way, but it was simply uncomfortable). I also found one unexpected benefit. I was an avid runner and on the days when it was applied to my shoulders, it was obvious when I was wearing a tank top. This produced a number of questions from my running buddies about whether this was a nicotine patch (they knew I didn't smoke, so I wondered). This gave me the opening to educate them about RLS and the problems that I was facing.
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.

Werbers
Posts: 5
Joined: Sun Mar 17, 2019 12:21 am

Re: Time of day to apply Neupro Patch

Postby Werbers » Sun Apr 07, 2019 2:30 am

Thanks for the info. I’m a bit nervous about this patch regarding augmentation and think that the very best thing for RLS is opioids but in the current climate of opiate scrutiny here in the US, I’m afraid my Doctor may decide it’s not in her best interest to prescribe them anymore. Nothing said yet but I can see it on the horizon.

I put the first patch on a couple hours ago. We’ll see how it goes.

BTW, watch carefully for augmentation from tramadol. It hit me after 20 years and was worse than augmentation from ropinorole. It took well over 2 months to clear up and I still have some residual effects. Too bad because tramadol worked very well for many years.

QyX
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Joined: Wed Mar 13, 2013 12:53 pm
Location: Berlin / Germany

Re: Time of day to apply Neupro Patch

Postby QyX » Mon Apr 08, 2019 5:07 am

Augmentation from Tramadol can happen because it also acts as an serotonin - norepinephrine reuptake inhibitor and can therefore worsen RLS symptoms just like any typical antidepressents (SSRi, SNRi, tri- & tetracyclic, most likely MAO-inhibitors, too).

That was also the reason why I had to stop Carbamazepine. It has some weak SSRi effects but I was taking it at a extremely high dose for about 6 years.

Tramadol is normally an okay opioid for RLS as long as patients don't have really bad RLS. Doctors like it because it because in most countries it is not classified as a Schedule II class drug and here in Germany can be prescribed with a regular prescription and does not need a narcotic script like the more powerful opioids.

And withdraw from Tramadol can often be a bit nasty .. because even when you have a potent opioid to replace it with ... there is no substitute for the SNRI effects of Tramadol. So nasty mood swings and in more severe cases anxiety and depression can be a consequence of stopping Tramadol too fast.

While it is most likely the opioid with the lowest risk of addiction, there is a population of patients who can have a really hard time stopping it. I saw some of those patients when I worked in a psychiatric hospital. Even really minor dose adjustments from like 12,5 mg to 10 mg were really problematic for the patient.

So while Tramadol is a weak opioid, it never should be underestimated and it is much better to use Codeine or Dihydrocodeine for RLS patients instead of Tramadol when a weak opioid is sufficient to treat the RLS symptoms.


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