Quetiapine Fumarate

[Jpex]

I feel like I am making confessions of a doper, but I have serious RLS issues. I take 1mg Mirapex plus 1-2 Gabapentin per day. My augmentations occur one to two times per month and are almost intolerable with all the maladies that have been listed before on this site. I have weened myself down from 2.25 mg Mirapex and 600mg Gabapentin per day. I seem to know more about this disease than my physician.
I recently switched over to a new health care provider and mentioned my insomnia problems and possible treatment. She prescribed Quetiapine Fumarate, an anti-anxiety medication. One 50mg tablet before bed. Then something unexpected occurred. I have no RLS symptoms since starting the drug. I admit, it has only been a couple of months. As most of you would know, this so far is a life changing event. This disease started when I was in my 30s, now 75. I have never known life without this disease that I can recall now.
I stopped taking the Gabapentin completely but afraid to drop the Mirapex. Has anyone else used this drug? Thoughts out there?

[Rustsmith]

That is the first time that I have ever heard of quetiapine fumerate. The PubMed document that I found from 1999 describes it as an "atypical anti-psychotic" and one line states "quetiapine's effects on the nigrostriatal dopamine system", which seems strange since this is the part of the brain where RLS originates.

Regardless, I am happy that you are doing better on it.

But I hope that you also understand that you are still at 2x the FDA recommended max dose of pramipexole for treating RLS. Also, you need to keep in mind that insomnia is a part of RLS that involves the glutamate neuroreceptors as opposed to the dopamine receptors that are responsible for the need to move symptoms.

[Jpex]

I don't know what to make of this drug yet, but I slept 8.5 hours last night. Been sleeping 6-8 hours a night. I wake up at times and look at the clock, but go back to sleep. If this keeps up, it is a complete lifestyle change.
In contrast, last December I ended up in the ER for treatment. Had been up for three days and had to stand while I was being treated. Good dose of narcotics finally got me over the hump. By the way, the only other medications I take are for high blood pressure and some vitamins, but there has been no change there recently.

[Jpex]

I researched both drugs and they have conflicting actions. Mirapex is a dopamine agonist and Quetiapine is a dopamine antagonist. In reality, they should cancel each other out. Reality is the combination cancels out RLS! It is the 19th today folks, I have no RLS symptoms. Really should have a specialist take a look at this, perhaps the combination could help others. By the way, I went to bed at 9:30 last night and woke up at 6am today.

There is something special going on here.

[Polar Bear]

I have no idea why this is working for you but you are sleeping and this is wonderful. I reiterate the comment of Rustsmith that you are on twice the recommended RLS dose of mirapex.

[Jpex]

I realize that I am above the recommended dosage on Mirapex. It is fantastic that I have been able to get to that level in the last year. I am down from 2.25mg. Dosage depends on the severity of the disease and mine is pretty severe. At least until recently. I take 0.5 in the morning and 0.5 in the evening. Not sure which one to drop if I try to go a little lower. My issues are not just during the night.

[Rustsmith]

The fact that your symptoms are not only at night is one of the symptoms of augmentation. If I was in your situation, I would probably drop the morning dose first, since that way you can still get to sleep at night. Dropping the evening dose would result in broken sleep, which would also impact your daytime performance.

If your RLS is as severe as you suggest, now is the time to start the discussion with your doctor about eventually switching to an opioid.That is a difficult discussion that often requires changing doctors or seeing an RLS specialist, but it would also make the next part of your mirapex reduction that much easier.

If it would help, here is a publication that explains why opioids are the next appropriate treatment for your RLS. https://www.mayoclinicproceedings.org/a ... X/fulltext

[Jpex]

Coming up on the first of April, no RLS. I mean, no RLS. No need for opioids. This has to be important for other sufferers as well. I makes no sense biochemically, so where are the medical professionals on this?

[Stainless]

Wow! Good for you. Hope keeps working and you can get off DAs.