Ropinirole to Neupro patch

[jamesrobvin]

I am new to the RLS discussion board. I have suffered with RLS all my life. I had been on ropinirole for past 8 years, 4 mg for past 3 years. After RLS symptoms starting during day I visited my GP and he put me on Neupro patch 2 mg. After the first night of unbearable discomfort, I took 2 mg of ropinirole and was able to sleep. I spoke to doctor and he increased my patch to 3 mg. It has been two weeks now, and I have not been able to go one night without taking at least 2 mg of ropinirole in addition to my patch. A couple of nights, I had to go back to 4 mg dose of ropinirole to relieve symptoms. The patch has relieved my symptoms during the day, but at night my legs are "wild." Does anyone know how long this process takes, to transition from ropinirole to the patch? Does anyone also take ropinirole in addition to the patch on a regular basis? Thanks

[Rustsmith]

Ropinerole and the rotigatine on the patch are both dopamine agonists (DA), so it will normally be a smooth transition from one to the other so long as you are using comparable doses. However!!!, your dose of ropinerole is the maximum recommended dose for treating RLS. The max dose for the patch is 3mg, so the 3mg patch is essentially providing the same level of treatment as your ropinerole except that it is spread out over 24 hrs instead of one big jolt at bedtime.

Since you were on the max dose of ropinerole for 3 yrs and were having symptoms during the day, it is highly probable that you are experiencing augmentation. This is a side effect for the DAs that comes after using them for an extended period of time. It is also something that many doctors are not familiar with because it is exclusive to RLS patients. If you are augmented, you have to get off of the DAs (both ropinerole and the patch) and switch to one of the other classes of meds used to treat RLS. You can learn more about augmentation by reading through some of the info in our Augmentation forum.

There are two approaches used by the experts to treat augmentation. One approach is to have you reduce your DA dose and then stop. During this time, your RLS will be the worst that you have ever experienced and when you stop, you will not get any sleep at all for 4 or 5 days. After that, you will gradually be able to get some sleep until you finally return to your normal RLS baseline after about 4 weeks. The doctors that use this approach like it because it allows them to find out how severe your untreated RLS is, but they also admit that it is pure torture for the patient.

The other approach is to give you a low dose of an opioid to help cover the DA withdrawal effects. This can provide a fairly smooth transition and is therefore the one that most patients favor. The problem is that you are trading one drug (the DA) with another one (the opioid). For those of us with severe or very severe RLS, we were going to end up taking an opioid anyway, so we argue that the DA washout approach only makes the patient miserable and unable to work and to barely function for several weeks.

I should also add that the other class of meds (not DA or opioid) that can be used are the anti-seizure meds (gabapentin, Horizant and Lyrica). These work well for some people, but are not always as effective alone against severe RLS are not strong enough to cover the effects of DA withdrawal.