Reducing neupro patch

[mocha]

I was on 3 mg neupro patch, horrible skin problems and blisters, I’m coming off neupro patch this is 3rd night I’m now on 2 mg patch, I’m on gabapentin. Was at 1200 mg now at 1500 mg. Will go up every 4 days or so and will decrease patch slowly every week or so, last night took left over Percocet low dose 5-325mg (took 1/2 tablet). Slept 5 plus hours , I’ve had rls for 20 + years was on mirapex, started not working as good was switched to patch worked fine just lots of skin problems!! Am I on the right track? Any words of encouragement or information I need to know?
Thanks

[Rustsmith]

Yes, you are on the right path - sort of. First off, you are not alone with skin issues with the patch. Many people cannot tolerate the patch due to skin irritation. The concept of the dopamine treatment is great, but the adhesive or something in the patch causes skin problems for many.

As for increasing gabapentin, it is not a strong enough med to cover the symptoms that you will soon experience as you decrease the dose below 3mg. Although gabapentin may be enough to treat your RLS once you are over dopamine withdrawal, it is not enough to both treat your RLS and provide cover for the withdrawal symptoms. Only an opioid can do that, so using Percocet is a step in the right direction but you probably don't have enough left over pills to provide cover for at least a week of withdrawal once you finally stop using the patch (and as you wean down to zero). And depending upon how severe your RLS is (which you probably won't know until you totally recover from the dopamine) gabapentin may not be enough to treat your RLS by itself. If that is the case and assuming that your ferritin level is well over 100, then an opioid my be your only RLS treatment option from this point forward. Many of us have had to accept that we will be taking a daily opioid for the rest of our lives.

[mocha]

Thanks for your information I do have around
40 plus norco and Percocet. I’m taking half pill now. What pace would u reduce patch?
I’m seeing dr Walters at Vanderbilt maybe he will give something else as I go along.
Probably have to go a pain management to get opioids?

[mocha]

Ferritin was 46 in April. Trying to increase with meds.

[Rustsmith]

Mocha, the rate of reduction will vary from person to person. Your body will let you know if you go too fast because your insomnia will get much worse. You should be able to drop from 3 down to 1fairly quickly with the opioids. If I were in your shoes, I would take at least 2 or 3 days at each level (3, 2, 1, 0.5). It is the shift from 1 to 0.5 (you can cut the patch in half) and then to zero that can be tough, but a little more opioid if you have a horrible night would help. It is the people that don't have access to opioids that have to be really careful.

As for opioids and pain management, that varies from location to location and doctor to doctor. Dr Walters can prescribe them, but if you are not in TN, then it can get complicated if your GP isn't willing to prescribe them even with Dr Walter's instructions. My GP is willing to follow my RLS doctor's instructions and even calls the prescription in to the pharmacy across the street. But others have had to go to pain mgmt and then teach the pain doctors about RLS and that this is not something that their opioid reduction programs can help with.

[mocha]

Thanks so much, very encouraging!!

[mocha]

I am in Tennessee

[mocha]

How many opioids should I save for bad times in case I can’t get any more?

[ViewsAskew]

How many opioids should I save for bad times in case I can’t get any more?

It depends. They can be hard to save - I save as often as I can. My goal is always to have at least one to two week's worth so that I can make sure to get an appointment, or go on a vacation, etc.