Prednisolone - Horizant?

[Lissa496]

Hi all,
In advance, sorry for the long story, but want to know if anyone can help with my problem!

I was prescribed prednisolone, methylprednisolone 4 mg 5-day course to be exact. I have just started taking a new script of 300 mgs of Horizantm, H. I was on 600 mg of H but it would take me out the next day, I took it at 5 pm at night and would have a hard time getting up the next day and my brain would be all foggy and I was falling asleep at work, it stayed in my system until about 7 pm. I asked the doctor to change the script to 300 mgs of H.

I am currently taking tramadol but I am augmenting it, I only have 4 each 50 mg pills. I need them all for nighttime, as my legs are driving me nuts all day. So I have been supplementing with krantom (sp), which works great! Thus the new script of Horizant.

I fell at work and my doctor prescribed prednisolone I started taking it the same day the 300 Horizant came. I took 300 H at 5pm and had taken the first course of 6 prednisolone. That night my legs went crazy. I took all 4 of my tramadol too, and my legs still were crazy so I took a dose of Krantom, the legs calmed down. That seemed like a lot of meds to me.

The next day I took a morning dose of 300 H and the prednisolone all day, my legs were going crazy so supplemented with the Krantom twice again, and then took the nightly dose of 300 H at 5 pm, legs were going nuts so about 8 pm took my 100 tramadols, then the other 100 tramadols and added the kratom again to get to sleep. I stopped the Horizant that night and have not had one all week.

I have been taking prednisolone, 1-2 pills of silver kratom during the day, 200 mg of tramadol at night with 1 tsp of red kratom before bed.

My question is has anyone had prednisolone make their legs go RLS crazy? I am hoping it is the prednisolone and the tramadol as I only have today and tomorrow and if it is the prednisolone my legs may calm down a bit and I can try the Hoizant again and maybe it will work.

FYI - I was on pregabalin and had terrible reactions and really fought to go on Horizant but when my legs got to the point of driving me batsh!t crazy I was willing to try anything, as I am sure you all have been there. I have a video call with my doctor in September, her office 2 hours away from my home, and if the Horizant doesn't work, my next step is going to another opioid. Does anyone have a suggestion for an opioid? I have been on hydrocodone and they keep me up at night so I am going to request a different type if possible.

Thanks for all your help, everyone!

[Rustsmith]

The usual opioids used in situations like yours are either methadone or buprenorphine. Both are once a day meds, so you can take them at lunch or even in the morning and they are still working at night. The "advantage" of buprenorphine is that it is Sch III, which has less red tape than methadone (which is Sch II). The main difference is that Sch II meds can only be prescribed for 30 days at a time with no refills, so your doctor what to call in a new prescription ever four weeks. Sch III meds are the same as what you had for tramadol (which is Sch IV).

The one word of warning about buprenorphine is that the FDA has a warning about it causing dental issues if you use the film that dissolved in the mouth. This doesn't hit everyone, just something to be aware of if you have dental issues.

[Lissa496]

Steve thanks for getting back to me. I worry about the next steps as I did take methadone and it did not work for me, they had to take me off it. It put me in a dark hole, and I felt like I was going to die, and I did not sleep for 36 hours. I was on 2.5 mgs, took the first dose at 8 am and the second dose at 8 pm and it was the worse day of my life. The doctor did not like that it put me in such a dark place. I cannot even remember if it helped my legs, it was last December when we tried this.

Buprenorphine scares me about losing my teeth. I had cancer as a teen and the chemo really messed with my teeth. I ended up with 18 fillings, and over the years they have broken down and I have either had to have crowns or root canals and crowns, so the amount of money I have spent on my teeth to have a drug ruin them scares me.

Have you heard anything about ketamine? I have heard some doctors have been using it, but I am not sure if it is helping anyone with RLS. It is supposed to be this new super drug for depression, RLS, and everything in between.

It looks like the Prednisolone did cause issues with my legs as the dose got smaller my legs did get better. But.... I restarted the Horizant when I stopped the Prednisolone, I started at 300 mgs as 600 mgs makes me sleep all day, that was the dose I originally started. I have been on the 300 mgs now for a week and it did well in the mornings until about noon then my legs would start u[ and I would need tramadol then I would come home and take the 5 pm 300 mg dose and at 7 pm my legs would go nuts and I would take 100 mgs of tramadol and by 9 pm they would still be going nuts so I would take the last 50 mgs of tram. I would then take my Xanax to help me fall asleep, I was down to 1/8 of a mg but since I have been on Horizant I have gone up to 1 mg as I cannot sleep on this drug, which is odd as it is supposed to make me sleep, as the 600 mg did make me so tired and I am tired in the day but not at night, crazy. I then wake up about 11 pm or 12 as my legs start back up and I get up and take 1 tsp of red Krantom, and that really helps my legs.

Do you think it is too early to stop the Horizag? It just seems like my legs are getting worse, not better on this medication, I am having constipation, sleep issues, and nerve issues like pinpricks in the bottom of my feet, upset stomach, hungry all the time, and gained 5# already, I also have this weird pain in my chest, like someone is stabbing me in the chest not all the time just periodically, I think it is a nerve issue, and I know this is supposed to fix nerve issues! I had nerve issues with pregabalin too. I am worried if I stay on it much longer the withdrawal issues will be terrible as they were with the pregabalin. It took me 5 months to get off pregabalin and I was only on it for 1 year.
I have telehealth with my doctor in September.

Thanks if anyone else wants to chime in feel free I will take any help at this time!

[Rustsmith]

I am very familiar with ketamine for depression, but have not heard any comments about it being used to treat RLS.

I was the victim of multiple psychiatric medical malpractice just before the covid epidemic and ended up with PTSD and no accesss to help for about a year. During that time, I researched everything. Ketamine was just starting to be used for depression. It seems to work well, but is given as an IV and has to be refreshed every three to six months. Research found that eKetamine is more effective, but is also substantially more expensive.

[Lissa496]

Thanks, Steve appreciate the quick response.

I did find this case report from the NIH, but it only has two cases with oral ketamine. Oral ketamine: a promising treatment for restless legs syndrome https://pubmed.ncbi.nlm.nih.gov/12032026/

"In these patients, who had type 1 RLS, ketamine improved abnormal limb sensations and insomnia. Both patients noted pain relief within 20 minutes of taking the medication. The dramatic response raises the possibility that ketamine inhibits neuroinflammation in the spinal cord or at higher centers. Within the spinal cord, RLS might result from NMDA receptor activation and production of inflammatory mediators that impairs blood flow in the spinal cord. Whether oral ketamine acts to improve local blood flow around damaged nerve roots or inhibits NMDA receptor-dependent transmission of painful nerve signals will require more study. Oral ketamine may offer another avenue of study and help to control the symptoms of this disabling and common condition".

And of course, there are treatment centers that are offering this treatment now but until rls.org recognizes it, or my movement specialist recommends it I would not want to just show up at a center and have a treatment!

Hopefully, more studies on this treatment will start to show up and maybe it will be a recognized treatment, especially if it can be taken orally.

[Rustsmith]

I noticed that the two authors are both anesthesiologists. I get very suspicious when I see publications written by individuals who are reporting on a medical condition outside the realm of their specialty without getting a co-author who knows more about the condition than they do.