severe withdrawal from Mirapex

[SleepyCharlie]

I have taken mirapex or pramipexole for twenty years, the past ten at .25 mg once a day. I recently have had severe problems with postural hypertension at night and have just stopped taking the mirapex, suspecting it is the cause. I am having severe withdrawal. Cannot sleepat all due to magnified symptoms. D know what to do. Any suggestions? I also take 15 mg vicodin once daily. Doctor tried me last night on .25 ropinerole instead of the Mirapex. Not working. I can't last long without any sleep.Please advise.

[Rustsmith]

SleepyCharlie, it takes 5 to 7 days to withdraw from Mirapex and your sleep will be almost non-existent during that time. A dose of 0.25 ropinerole is not high enough yet to compare to the 0.25mg Mirapex that you were taking. The 0.25mg dose of ropinerole is just the starter dose for that med. You could try asking your doctor to increase the dose because you cannot sleep. For comparison, your 0.25mg Mirapex is sort of equivalent to about 1mg ropinerole.

Fortunately, between the Vicodin, ropinerole and time, you should start getting a little bit more sleep very soon. It can take as long as a month to return to normal following stopping Mirapex.

[ViewsAskew]

Do you work currently, SleepyCharlie? If so, can you take some time off? As Steve noted, this is not a fun process and you won't get much sleep for at least a few days.

[Rustsmith]

Doctor tried me last night on .25 ropinerole instead of the Mirapex

I have to apologize in that my previous message was originally posted with the wrong dose comparison between your old pramipexole and your new ropinerole meds. I corrected the numbers above. Your old 0.25mg dose of pramipexole is the max dose for RLS and that compares to a max dose of ropinerole of 1mg, not the 4mg value I mentioned before. I guess that I was just too tired to be entering those sorts of details from memory.

[badnights]

Doctor tried me last night on .25 ropinerole instead of the Mirapex. Not working. I can't last long without any sleep.Please advise.

You can last longer than you think you can. Accept that it's going to be hard for a few days, but rest whenever you can - whenever your body stills a bit, curl up in a ball on the armchair or on the carpet against a wall, or however works, to get a few minutes of rest. Even if you don't actually sleep, rest is helpful. It will start to come after a day or two! Keep your hope!

Your doctor seems to be ignorant of WED/RLS. I don't know if you're augmented on pramipexole but here is some information you (and your doctor) should have: Augmentation is a worsening of WED/RLS caused by dopamine-type medications (yes, the very ones intended to relieve the WED/RLS). Augmentation can happen in days or it might take decades, but eventually most people on dopamine-type meds will suffer augmentation.

Then there is withdrawal. You are withdrawing for reasons other than augmentation, but withdrawal is very similar to augmentation - it consists of a worsening of symptoms. It is hard - impossible - to describe the horror of this worsening, especially to someone who has never felt WED/RLS symptoms.

But for you to know: This worsening is temporary. It only lasts a few days. Then things start to improve.

Adding another dopamine agonists will not help! Your doctor needs to learn this somehow. (0.25 ropinirole - as Steve explained - is only about 1/4 as effective as 0.25 pramipexole so it's not surprising you wouldn't notice it.) In my signature is a link to a page that explains how to get access to the Foundation's many publications on WED/RLS - your doctor might respect these resources. However, the information brochure I wanted to suggest you get, on augmentation, is supposed to be free (available to non-members) but it is not, for some reason, it must be a glitch, so I've temporarily attached it to this post. It's about augmentation but the principles of treatment can be applied to withdrawal.

augmentation-diagnosis-treatment.pdf

(163.57 KiB) Downloaded 163 times

Short version is, anti-convulsants like Horizant, gabapentin, or pregabalin might help a bit, opioids would help a lot.

[Moonbeam55]

Hi I am new here. I have been on 1.5mg of pramipexole er daytime and 1mg at night for past nine years. Recently I have a new Neurologist and he has taken me off the 1 mg at night as it was not helping and i was going into augmentation again. He put me on the gabapentin 300mg. It is helping but he wants me to try and come off my daytime 1.5mg. I tried for 2 days and my legs were crazy so I went back on. I am afraid to try again. Also I never realized how high a dose it is. I do not know how confident I am in my doctor. My previous one had been listed on this web site.

[Polar Bear]

Moonbeam, as you have learned your pramipexole dose was much too high. It is also now accepted that pramipxole is not the best first line treatment for rls and you should indeed come off it altogether. You should wean off it. Did you come off the nighttime 1mg cold turkey.... which was too big a step. Gabapentin 300mg is not enough to deal with withdrawal symptoms. A low dose of an opioid will be of more benefit.

Read through the link in my signature. You could show this document to your doctor.
Most doctors need educated in treating rls, even neurologists.

[Moonbeam55]

Thank you Polar Bear. how would one wean off it? Not take it every day? I will read through the link, thank you.

[Rustsmith]

Moonbeam55, the normal procedure is to slowly reduce the dose. Since you are at a total of 2.5mg, you would go down to 2.25mg for a few days, then 2mg, and so on. Also, 300mg of gabapentin is the starter dose. I personally take 900mg and the max for gabapentin is 3600 (which will make you sleep for 24 hrs if you are not going through dopamine withdrawal).

The problem for you occurs when you get down to 0.25mg. At that point, you can divide the dose into 0.125mg or simply stop taking it. The problem will be that you will experience severe RLS and zero sleep (not even naps) for the next 6 or 7 days. When you get to this point, give any remaining pills to a family member to hide because around day 4, you will weaken and take one just to get some relief. Unfortunately, that starts the clock all over again. The only way to avoid this misery is to convince your doctor to give you about six days worth of opioids. Only opioids are strong enough to cover the withdrawal. Doctors worry about opioid withdrawal, but I can personally attest to the fact that opioid withdrawal (which you probably wouldn't experience with only six days) is much easier to go through than a week of dopamine withdrawal.