Oxycodone dose, Sinemet questions

[Becan]

My RLS has been well controlled with pramipexole 0.5mg at bedtime and oxycodone 20mg in divided doses throughout the day. I've been on that oxycodone dosage for 4 years. Now I'm having RLS symptoms coming back and I'm not sure how to proceed.

My doctor said it would be okay to take an extra oxycodone now and then but then I'm out of it at the end of the month and the pharmacy won't refill it until a full 28 days have passed. So the RLS comes back with a vengeance for a couple of days. I tried taking more pramipexole but that doesn't work and I'd rather not do that anyway.

I'm reluctant to ask my doctor for a higher dose of oxycodone because I get all paranoid about red flags next to my name at the pharmacy. So a couple of questions:

Is 20mg per day of oxycodone a "normal" dose in RLS? Would a higher dose be unusual?
I know it's a terrible drug but would a Sinemet tablet taken very occasionally be a good idea for those nights when I'm flopping around like a fish?

Thanks

[Rustsmith]

20mg of oxy is comparable to 10mg of methadone, which is the normal dose of that med for the treatment of RLS (although many of us only use 5mg). So, a higher doses would not be considered all that unusual. You might check the chart in the publication titled "Appropriate use of Opioids for the treatment of refractory RLS" and maybe even share it with your doctor (and pharmacist if they give you grief).

As for Sinemet, it is acceptable to use it for no more than three days in a row, although that would be pushing it since you have already augmented on pramipexole.

[Yankiwi]

I would only recommend Sinemet to someone who is not taking any dopamine agonist but would occasionally like something for sitting in a concert or on a long drive or flight.
I augmented on it as my GP didn't know it should not be taken regularly.
Luckily I found RLS.org after months of vary hideous nights.

[Becan]

Rustsmith: I found the publication you mentioned. Thanks. Very helpful.
Yankiwi: I remember the first time I took Sinemet about 25 years ago. I went to bed and slept all night. No creepy crawly feelings at all and it was great...for two weeks. And then things got really bad, much worse than before.

[Yankiwi]

That's the way it is with Sinemet and other dopamine agonists. At first we think a miracle has occurred but then it turns to the absolute opposite—hell on earth.

[curqlink]

I use Sinemet two or three times a week and have done so for maybe a couple years. I never take it two days in a row. So far no problems.
I have in the past augmented on Ropinirole. Never ever want to go thru that hell again.

[debbluebird]

Is it possible you are augmenting from the pramipexole ? How long have you been taking it ? Augmenting feels like your RLS is getting worse.
I would not add Sinemet if you are starting to augment. It would make it worse.
I can only take oxy for a few days and it no longer helps. I took methadone for 9 years. I now take buprenorphine since I can't get methadone in NM. It's working the best for me. Far better than anything I've tried.
Good luck