Medication Timing

[TimG]

I've been taking pramipexole, 0.125 mg, as needed. Since achieving a ferritin level of 100, I have only needed to take medication intermittently. The problem I've had is that by the time I have restless legs, it is usually around bedtime and the med takes a couple of hours to kick in. Then I can't get to sleep until my legs settle down. Should I just go ahead and automatically take the med every night or will that risk augmentation, which I have not experienced in 10 years at 0.125 mg dose?

[Rustsmith]

That is the problem with taking pramipexole on an as needed basis. When you know that you need it, you have set yourself up for several hours without sleep.

As for changing to taking it daily, it is impossible to know how much that will increase the risk of augmentation beyond the obvious, which is that there is more risk. Having your ferritin level at 100 and keeping your dose at 0.125mg certainly helps, but I have to fall back on the old adage that "everyone is different".

[badnights]

I've been taking pramipexole, 0.125 mg, as needed. Since achieving a ferritin level of 100, I have only needed to take medication intermittently. The problem I've had is that by the time I have restless legs, it is usually around bedtime and the med takes a couple of hours to kick in. Then I can't get to sleep until my legs settle down. Should I just go ahead and automatically take the med every night or will that risk augmentation, which I have not experienced in 10 years at 0.125 mg dose?

Another option is to use Sinemet or a low dose of an immediate-release opioid (e.g. 1-2 mg hydromorphone), or preferably, both, so you could keep the total weekly dose of Sinemet low. I don't know how often you need help, though. If you need help more than 3 or 4 nights a week, you may be risking augmentation by taking Sinemet 5 or 6 nights a week. But it can be incredibly useful for intermittent use, and takes effect in 15 minutes for me. If you could also get a fast-acting opioid, you could use that some nights instead.

[TimG]

Thanks for the informative replies and options to consider