Ok to remove pramipexole cold turkey if starting pregabalin

[meiatflask]

Not to long ago I posted about pramipexole versus pregabalin/Lyrica. Got plenty of great replies, thanks. I see my doctor (a GP with limited RLS experience- no specialists in my area) in two weeks and I plan to make the change. I will start at 50mg, which also makes increasing by 50 easily done until I arrive at an effective dosage.

My question has to do with getting off the pramipexole. I read a great thread here about that, and how difficult it was to get off the pramipexole. I currently take 0.375mg. I am concerned about the overlap between the two meds, which was not specifically discussed in the thread. Several possibilities for me:

1-Can I cold turkey the pramipexole and immediately start the pregabalin?
2-Or should I taper the pramipexole while starting the pregabalin?
3-Or should I taper the pramipexole until completely off and then start the pregabalin?

I do have some Tylenol 3 with codeine (leftover from recent shoulder surgery) that I can use as a bedtime stop gap to get me through the transition if stopping pramipexole is difficult.

Thought? Recommendation?

Thanks,
Bill

[stjohnh]

Bill, There is no problem with overlapping pregabalin and pramipexole, they are commonly used together. Stopping the pramipexole at 0.375mg daily is probably ok, but Steve knows more about this than me. The main risk is DAWS (Dopamine Agonist Withdrawal Syndrome), but I think you are ok at 0.375mg.

BUT: in spite of your reviewing information here, you probably underestimate the horror of abruptly stopping the pramipexole. Lots of people have done it, and lots have failed after a couple of days. Not only that, pregabalin alone (no matter what dose) is unlikely to satisfactorily control your RLS symptoms. All of the gabapentin class meds (gabapentin/pregabalin/Horizant) take at least a few days to acheive whatever effect they are going to have, and the idea of starting pregabalin and soon after stopping pramipexole is likely to be about the same amount of misery as stopping the pramipexole at the same time as starting 50mg pregabalin.

Assuming Steve agrees DAWS is not likely, and you understand you will be more miserable for a few days than at any time so far in your life, I would recommend starting pregabalin and slowly increasing the dose, then stopping the pramipexole abruptly, using the Tylenol/codiene for a while, I guarantee you will need it. Remember that the absolute max dose of Tylenol is 4000mg daily, so be sure you remain under that as you proceed.

What is your plan if the pregabalin alone doesn't control the RLS symptoms? You should have this worked out in advance, as waiting until you have failed max dose pregabalin means you are trying to make a decision while severely sleep deprived.

[meiatflask]

Holland-

Thanks for the input. Makes me feel more confident.

As for a backup, Before I took pramipexole, I took gabapentin for about a month, leveled out at 1200 dosage and was effective, so I am expecting that pregabalin will be similar effective. Side effects of gabapentin (I experienced some tingling in my toes) and honestly the size of the horse capsules led me to pramipexole. So no backup for now.

I am anxious to hear Steve weigh in.

[meiatflask]

Holland-

As I wrote the last response, it made me think- pregabalin versus gabapentin? Same category, same results? Or is there a difference?

Thanks,

Bill

[Rustsmith]

Bill, although they are both in the same category, they are not interchangeable. Pregabalin does not suffer from gabapentin's inconsistent dosing problem. In that regard it is much more like Horizant. And of course there is also the issue of cost. And when it comes to side effects, every medication is different even though gabapentin and pregabalin have many of the same potential side effects.

As for your question about overlap between meds, that should not be a problem. I currently take both pramipexole and 900mg of gabapentin. Each addresses a different aspect of my RLS/PLMS and combining these meds along with an opioid is frequently done for those of us with very severe refractory RLS.

Finally, I agree with Holland's comment about stopping pramipexole. I was able to drop from 1mg down to 0.25mg while taking an opioid without much trouble. But going from 0.25 to 0.125 caused some problems and then trying to go from 0.125 to zero lead to "mild" problems for about a week. I say mild because I know that they would have been very tough if not for the opioid. I ended up going back to 0.125 mg because it was either that or increasing my opioid dose to cover my RLS symptoms and the increased opioid left me with a mild drugged feeling that the pramipexole did not cause. But those were my side effects and it is not something that I would suggest for everyone unless faced with the same problems that I was experiencing.