DAs never ever again; now what?

[Bridgercan]

Hello All—many months since I last posted, which means my RLS symptoms were well managed. However, all good things must come to an end. Augmentation on Neupro hit me this winter. After two weeks of brutal, nightmarish misery, I’m almost back to “normal.” I say never, ever again to DAs! You would think I’d have learned my lesson after augmenting once on pramixepole and twice now on Neupro.

Now that I’m off rotigotine, my doctor has switched me from OxyContin 15 mg to 150 mcg buprenorphine film at night, which I’m really liking so far. I continue to take 1200 mg Horizant ER late afternoon. The catch is though, the films don’t seem to offer me any protection from midday to dosing at night. My iron and ferritin levels are too high for insurance to cover infusions.

However, I’m not sure what I might ask my doctor to discuss for warding off symptoms when opioids are not a good idea: long work meetings, flights over 1.5 hours, road trips, long movies and plays. Just the idea of not being able to stand up and move around can trigger symptoms! Perhaps tramadol even though it’s a weak opioid and has been know to cause augmentation? Experiences to share, anyone?

[Polar Bear]

I'm wondering about the timing of your medications, or splitting the dose of buprenorphine to give you cover from lunchtime.
Although Tramadol has been known to cause augmentation I believe this is not particularly common and could be worth a try.

[Rustsmith]

There are two opioids that provide 24 hr coverage, methadone and tramadol ER. In the case of the tramadol, it has to be the ER form and not the short release plain tramadol.

I don't know if the following also applies to buprenorphine since the manufacturer tried to get FDA approve for it as an anti-depressant (the FDA refused because it is an opioid), but tramadol also functions as an anti-depressant (it is chemically a close cousin of Effexor). This is important because you absolutely must taper anti-depressants when you stop. I was abruptly taken off of tramadol ER and suffered from that for months with severe depression, anxiety, nightmares and migraine headaches that were more severe than what I normally experience. The doctor who did this to me didn't realize that tramadol is an A-D and thought that he could simply increase my methadone dose to compensate -WRONG!!

[badnights]

@Bridgercan do you need coverage every day during the day, or only as-needed /sometimes during days when special things are happening? If the former, an additional opioid dose in the morning or at noon might be needed? I think Belbuca is supposed to last all day on one dose, so I guess it's like every other contin/ER opioid - - doesn't last as long as they say it does. If the latter, and if it didn't happen too often (no more than 3x per week) you might be able to get away with Sinemet. It's a thought. I wouldn't dare take it any more than 3 times a week though! If it happens often but not every day, an immediate-release opioid would be better, like Tramadol or hydrocodone or even codeine.