Restless Legs Syndrome (RLS) Discussion Board

First - a bit of background. Have been using pramipexole for several years now, started at 0.25, now up to 0.375. No longer 100% effective - I have some tough evenings. And sleepiness side effect is constantly with me. Had tried ropinirole as well as gabapentin for a while. Both worked okay, but settled in on pramipexole. I have thought about revisiting ropinirole or gabapentin, but haven’t. (And with augmentation in my subconscious thoughts, I have been thinking about gabapentin as an better option down the road.) also, I take oral iron, and my serum ferritin is in the 175-200 range.

Just googling around, I ran across the New England journal article by Richard P Allen et al (https://www.nejm.org/doi/full/10.1056/nejmoa1303646) study that indicates pregabalin/Lyrica is more effective than pramipexole. Caught me by surprise.

So my question is - is it truly more effective? Or is it just like gabapentin? - should I expect similar results? Or is there something else I should know before I approach my doctor about switching meds?

Thanks. Bill

Pregabalin is similar to gabapentin, but has a distinct advantage in that it does not suffer from the dosing variabilities of gabapentin. Gabapentin is only adsorbed by a short length of the intestines and so sometimes you get most of the dose and sometimes you do not. This limitation is what lead to the modification that produced Horizant. Horizant is adsorbed by most of the intestinal tract and then turns into gabapentin once in the bloodstream. Pregabalin has similar adsorption to Horizant and thereby produces more consistent results while being less expensive (somewhat) than Horizant.

Thanks. Do you know the typical dosages? Or starting dosage? The nice thing about pramipexole is the tablet form, so one can cut and take half tabs while fine tuning the dose at the beginning. But it looks like pregabalin is capsules, correct? Also, is pregabalin significantly more expensive? Gabapentin and pramipexole are very cheap, I pay/paid less than $8/month

You are correct that Lyrica/pregabalin comes in capsule form instead of the tablets for pramipexole.

In studies, the most effective pregabalin dose for RLS ranged from 35 to 120 mg/day. I suspect that your doctor would follow the standard procedure for gabapentin, which is to start at the lowest dose available and titrate up until either you hit the max or get relief.

As for price, pregabalin is considerable more expensive than gabapentin or pramipexole. Pregabalin is not available as a generic yet, so it still carries a heft price when compared to gabapentin and pramipexole.

Finally, in the original study that looked at the effectiveness of pregabalin for RLS, they found that it helped about 61% of the patients compared to about 35% on the placebo.

Pregabalin is generic now or made under license. What I take it made by NOZADOZ. Pharmacist told me ask for it. When I did Dr. & office did not know. First time it was about 10% off. This time it was %80 less. No clue why. I asked pharmacist and she just shrugged.

Thanks. I have reached out to my prescription provider to get cost information on the generic. If “reasonable” I’ll talk to my doctor on switching.

Thanks!

Bill

I have tried gabapentin and pregabalin. Also Horizant. They did not work for me. The only med that works for me is pramipexole (unfortunately). I wish I could take something else. I desperately want off of the pramipexole because of the life altering side effects.
Best wishes, BBI

BBI, there is life after pramipexole for those of us who do not benefit from gabapentin/Horizant/Lyrica but unfortunately that is a lifetime of low dose opioids. The opioids work great for controlling RLS and the risk of addiction is virtually non-existent at the doses that are used, but the restrictions and red tape placed on doctors, pharmacies and patients can be wearing. And despite all the reported horrors of opioid withdrawal, I feel that withdrawal from pramipexole is far, far worse. And yes, I have gone through opioid withdrawal a couple of times now.

Bbiluvflorida wrote: ↑

Tue Apr 27, 2021 3:09 am

I have tried gabapentin and pregabalin. Also Horizant. They did not work for me. The only med that works for me is pramipexole (unfortunately). I wish I could take something else. I desperately want off of the pramipexole because of the life altering side effects.
Best wishes, BBI

I am another who found only pramipexole worked. And, like Rustsmith, found another way. I still do use it, but only for short periods and NEVER more than a small amount.