Switching from ropinirole to pramipexole/mirapex Starting dosage?

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.
Post Reply
meiatflask
Posts: 31
Joined: Sat Aug 10, 2019 10:29 pm

Switching from ropinirole to pramipexole/mirapex Starting dosage?

Post by meiatflask »

I have been on ropinirole for a year and a half, playing with the dosage. Settled in on 1mg, as lower levels have not improved my symptoms. But I have struggled with the side effects, primarily sleepiness and dizziness at 1mg, and even at .5 mg. While the joy of no RLS symptoms is fabulous, my evenings are a daily struggle to stay awake through the side effects and just make it to bed time. I recently added oral iron supplements (was at 60 ferritin level) and have not been rechecked as it has only been two months on the iron.

I have decided to switch to pramipexole to see if the side effects are not as big of a problem. My doctor is a GP, so I have been directing most of the treatment. What do people recommend as a starting dosage, given my history of ropinirole dosage. I figure that starting at the lowest level will probably not work for me as the lowest level of ropinirole did not work for me. Or am I wrong in this assumption?

Any advice?

I have thought about waiting to make the switch for another month or so to see if my iron levels are improved, as to separate these variables (the scientist in me talking) to make sure I know if it is the iron level or the drugs that are making the difference.

Rustsmith
Moderator
Posts: 6476
Joined: Sat Sep 28, 2013 9:31 pm
Location: Colorado Springs, Colorado

Re: Switching from ropinirole to pramipexole/mirapex Starting dosage?

Post by Rustsmith »

Since you were found you needed 1mg of ropinirole, then you may need to switch to 0.25mg of pramipexole. Both are the max recommended dose for treating RLS, so you should not go any higher with the dose. It might seem to help (assuming no more side effects) but eventually stopping will only be that more difficult.

As for waiting or not, it is all a matter of how well you can continue to tolerate the side effects on ropinirole. Yes, changing one parameter at a time makes some sense, but extending the suffering time may not.
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
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.

badnights
Moderator
Posts: 6259
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Switching from ropinirole to pramipexole/mirapex Starting dosage?

Post by badnights »

Hi meiatflask

I too have that desire to change one variable at a time, but I have realized that I am not going to live long enough to try everything that way. There are just too many variables for one lifespan. However, you can switch now for another reason. The iron will not take effect for a month or so, and when/if it does, it will affect the severity of your symptoms (lessening them), not the side effects. So if you have a change in side effects, you can be fairly sure it was due to the change in medication and not iron.

My first thought on reading your post, was to ask you if you're familiar with augmentation? Definitely please read up on it if you aren't. Short version: all the dopamine agonist medications (ropinirole, pramipexole, rotigotine) will eventually, in most people, cause a worsening of the WED/RLS symptoms. Increasing the dose to deal with the worsened symptoms helps for a time then they worsen yet more. You can see where this is going... there is no solution but to stop the offending medication. Second point to know: there is a higher risk of augmentation if your ferritin is under 100, and the risk increases with dose increase. That is why the maximum recommended doses for WED/RLS are as Steve noted - though most doctots still think it's OK to go up to the FDA max, which is much higher.

There is something else you should know, too. Stopping a dopamine agonist, whether or not you have augmented, usually causes a temporary worsening of the WED/RLS symptoms. If you're augmented, this can be particularly bad.

Augmentation can be identified as follows: symptoms begin earlier in the day than before you started taking the med; they spread to other body parts (usually arms); they begin sooner after sitting or lying down; and /or they are more intense. If you've increased your ropinirole dose since starting on it, you;re probably augmenting. When did you start, and at what dose?

No one knows what causes augmentation, other than that it involves some sort of dysfuntion of the dopamine receptors (and perhaps other receptors). It is said to be temporary, but many of us have had ongoing worsened symptoms long after stopping the dopamine agonist. Some of us think these may eventually improve over many years, but there are so many factors at play in a life that it's not possible to say.

Switching to pramipexole might be a good idea, because the two meds are slightly different and you might be preventing more damage of whatever kind ropinirole does to our dopamine receptor system. But you might also be causing damage that wouldnt have happened if you'd stayed on ropinirole. There is really no information I know of to help with the decision. Thinking of side effects alone, then by all means switch now.

You should also request IV iron from your doctor. If you follow the link in my signature block below any of my posts, you will see, first item, a link to the 2018 consensus guidelines on treating RLS/WED with iron. It would be a good idea for you to print that, read the relevant parts, then highlight the few sentences that pertain to your situation, and bring it to your doctor. IV iron is the surest and fastest method of raising your ferritin -

in effect, any iron therapy for WED/RLS is designed to raise the iron in our brains. Even tho we might have enough in our blood & other tissues, something is wrong with the system that transports iron from the blood into the cerebrospinal fluid, and we have a deficit of iron in brain tissues, which somehow causes the symptoms of WED/RLS. You will probably run into doctors who don't know that the concentrations of iron can be different in different body tissues.
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.

Post Reply