How are you doing on Horizant?

[Stainless]

I see generic Horizant will not be available until after June 10, 2029. It's about the only drug I've not tried for RLS, mostly because of cost but also I thought it was a patch, which does not appeal to me since I'm in the water all the time. I'm not sure how much my Medicare drug plan would cover, probably not much.

Has anyone had significant improvement moving from gabapentin or Lyrica to Horizant. Has anyone taken it while on clonazepam? I'm tilting at windmills and coming up empty. Thx, Rick

[Rustsmith]

Horizant is not a patch, it is a modified version of gabapentin. Gabapentin is only absorbed by a short length of the intestinal tract and if it moves past too quickly, you may not get much absorbed into the bloodstream. This makes dosing gabapentin inconsistent for some people. You get most of it today and very little tomorrow.

Horizant was modified so that it is absorbed throughout the intestines and the modification is such that the extra chemistry gets lost shortly after entering the bloodstream. This makes the dose you get more consistent day-to-day and also spreads the dose out over a longer period of the day as some gets picked up quickly and other parts get picked up as it moves through the gut. But once it is in the blood, it becomes gabapentin.

The extra bit of chemistry is proprietary, hence the extra cost and the fact that a generic will not be available until after the patent expires in 2029.

[badnights]

What are you on right now, Rick, besides the clonazepam? Did you try ropinirole or pramipexole back in the day? I know you've been on this board since before me but I forget your history other than the problems brought on by stopping clonazepam.

[Stainless]

Thx for the replies. I'm currently on 2 mg Clonazepam and 300 mg pregabalin. I have some ropinirole I was going to try occasionally but a seminar by the Harvard doctor made me think going on and off was not a good idea. So I'm thinking of taking 1/2 mg. a day and see how that goes. My doctor doesn't seem to have an issue mixing these drugs. My main complaint is I have RLS pain all through the night yet never in the morning and I can usually walk off afternoon symptoms.

At home we have a hot tub which usually calms my legs down enough to get to sleep. We desperately want to travel and I usually get a holiday respite but probably not 2 weeks worth. I asked about Horizant because of the extended relief. Neupro was the patch I was thinking of.

[Bannia]

Horizant works well for some people, but not others. I got very little benefit from it, other than it made me very sleepy at night. It is very expensive, but my doctor was able to set me up with a mail order pharmacy in Minnesota that made it much more affordable, although I think it was still around $50 for 30 pills.

It’s probably worth trying for you, if you can get it at a decent cost. The DAs will always end up causing augmentation, and the pain of coming off them at that point is crazy. Maybe you will be one of the lucky ones who gets good relief from Horizant. Other than initial dizziness for a day or two, I didn’t really get side effects.

Hope you find something that works for you!

[badnights]

I agree, Horizant is worth a try because you can't predict how you will respond to a medication. It's similar to pregabalin, though, so it may not be a big improvment.

The reason I asked it you'd even been on dopaminergic meds is because those of us who have seem to benefit less from alpha-2-delta ligands like Horizant & pregabalin. Since you have ropinirole hanging around, I assume you have been on them. 1/2 mg is still kind of high; 1/4 mg (0.25 mg) is the recommended starting dose of ropinirole for WED/RLS.

If you decide to take daily ropinirole, pay close attention to your iron status. You might be able to get away with such a low dose (0.25 mg) of ropinirole for years since you're also taking iron and your numbers (other Topic ) look good.

It might benefit you to get a prescription for Sinemet, if you can be sure you won't take it more than 3 times a week and not more than twice in a row (those aren't hard and fast rules, they're just the rules I follow, and they may be conservative). Sinemet is notorious for causing augmentation when used daily. However, when used here and there, it has a miraculous effect on symptoms, simply banishing them. It might be what you need on holiday - but you can't use it every night. It can't be your sole source of relief.