Low Dose Dopamine Agonist Questions

[stockton2malone2]

I currently take Buprenorphine at 8mg and I still have a night or two a week where I can't get to sleep. Recently, 3 or 4 years after augmentation, I was finally able to take a low dose of pramipexole again without it turning me into a jitterbug all day. I've been taking 0.125mg at night, and I'm still far from back to normal but I'm able to sleep just about every night which is a win for me at this point. So, here are my questions:

1. Is it OK to use every night or am I setting myself up for problems down the line?
2. Would 0.1875mg or 0.25mg be too risky as a low dose addition to my buprenorphine?

I know that nobody has a definitive answer to these questions, but I'd appreciate hearing other's experiences so I can hopefully make a better informed decision.

Thank you!

[Rustsmith]

I haven't been able to try buprenorphine, but have been taking methadone on and off for about six years. About 2 yrs ago, my doctor wanted me to get off of pramipexole, which I was taking at 0.25mg daily along with my methadone. I was able to get off of it, but was getting a few too many breakthrough symptoms on must methadone (plus gabapentin). I had a choice of increasing my methadone dose from 5 to 7.5mg or adding back 0.125mg of pramipexole. I asked my doc for her preference and she told me to add back the half tablet of pramipexole. I was on that combination of 5 and 0.125 until last month, when I started getting breakthrough symptoms again. This time we decided to increase the methadone to 7.5mg and to stay with the half tablet of pramipexole.

So, based on my experience, I don't think that you are setting yourself up for problems by taking a half tablet, especially if you can do this occasionally, say four days/week. But I would also do everything possible to avoid increasing the dose about 0.125mg. Going any higher on a daily basis MIGHT be introducing a problem down the road that you will want to avoid.

[stockton2malone2]

Methadone is the only other thing that sort of works for me at this point, but opiates give me an alerting effect so the sublingual buprenorphine is nice in that regard since it takes effect a lot faster. Plus its schedule III so getting it filled is waaay easier.

Thanks for the input! I will probably need to slowly wean the pramipexole dose back down to nothing so I can take it only on nights I absolutely need it. After a while it was too tempting to take it every night preemptively and now if I miss a couple doses I start to feel horribly depressed.

[stjohnh]

I augmented about 4 years ago on 0.375 mg pramipexole, got off it (one of the most memorable and awful experiences of my life) and stayed off it for a few months. I was subsequently able to restart pramipexole at 0.0625mg daily (one half of the smallest size tablet). It helped a lot, and I never had to increase the dose. I would recommend getting off the pramipexole again, and take it as needed, or perhaps daily, but not any higher than 0.0625 daily. One aspect of RLS treatment that is crucial, and I haven't seen mentioned much the past few months, is never try to completely eliminate all RLS symptoms. I believe that attempts at completely eliminating all RLS symptoms is one of the reasons so many people end up augmenting.

There is some evidence suggesting that all people who augment on dopamine agonists have permanent damage to their dopamine receptors. Remember also that most (maybe all) RLS patients have normal to elevated dopamine levels. Dopamine agonists increase the RLS patient's dopamine levels to significantly higher than normal. This is why the the doses used for Parkinson's disease (a dopamine deficient illness) are so much higher than those used for RLS. AFAIK, Parkinson's patients never augment, in spite of taking doses up to about 10 times the doses RLS patients take.

[Frunobulax]

There is some evidence suggesting that all people who augment on dopamine agonists have permanent damage to their dopamine receptors.

I have suspected this for a long time, but never found anything to this effect in the medical literature. Do you know some references?

[stjohnh]

Hmmm... I'll see what I can find.

[Frunobulax]

I dug out an old thread of mine discussing this
viewtopic.php?f=5&t=9015&p=76797

[TimG]

I augmented about 4 years ago on 0.375 mg pramipexole, got off it (one of the most memorable and awful experiences of my life) and stayed off it for a few months. I was subsequently able to restart pramipexole at 0.0625mg daily (one half of the smallest size tablet). It helped a lot, and I never had to increase the dose. I would recommend getting off the pramipexole again, and take it as needed, or perhaps daily, but not any higher than 0.0625 daily. One aspect of RLS treatment that is crucial, and I haven't seen mentioned much the past few months, is never try to completely eliminate all RLS symptoms. I believe that attempts at completely eliminating all RLS symptoms is one of the reasons so many people end up augmenting.

There is some evidence suggesting that all people who augment on dopamine agonists have permanent damage to their dopamine receptors. Remember also that most (maybe all) RLS patients have normal to elevated dopamine levels. Dopamine agonists increase the RLS patient's dopamine levels to significantly higher than normal. This is why the the doses used for Parkinson's disease (a dopamine deficient illness) are so much higher than those used for RLS. AFAIK, Parkinson's patients never augment, in spite of taking doses up to about 10 times the doses RLS patients take.

This is the first time I've read this post, which I missed when it was written late last year. The subject of the pramipexole dose is of interest to me. I have never taken more than 0.125 mg daily, and since my ferritin has increased to 135, I've had fewer episodes of RLS. I've been taking pramipexole for more than 10 years and have never augmented, but the possibility is a scary thought. I'm considering lowering the dose to half the 0.125 mg to play it safer and see how that goes at relieving symptoms. I wondered about why Parkinson's patients can take such high doses of pramipexole and now I know.

[maulsby]

I have wondered why I have been able to take a high RLS dose of pramipexole for 7 years without augmentation. Maybe I have a low level of dopamine agonists in my system for an RLS sufferer. I have been taking 2.5 mg for 7 years. Recently I was able to reduce to 2 mg for a couple of days.

[Polar Bear]

I don't know why you have not augmented but wow... 2.5mg pramipexole is a very high dose. I think .5mg (stand to be corrected) is considered the daily max.

[Fly007]

I have wondered why I have been able to take a high RLS dose of pramipexole for 7 years without augmentation. Maybe I have a low level of dopamine agonists in my system for an RLS sufferer. I have been taking 2.5 mg for 7 years. Recently I was able to reduce to 2 mg for a couple of days.

I was up tp 3.75 mg of ER and was fine for years, then one day boom, augmentation hit. Weaning off of that was by far one of the most horrible experiences of my life, over 4 months since I took my last Pramapexole and I can still tell my Dopamine system is all out of whack. Thinking about getting back on an extremely low dose to see if it balances things back out and hopefully doesnt augment again.
I hope your run of good luck with it continues!