Worsened mood with methadone 10mg/ rotigotine patch and impulse control disorders (ICDs)

[tea4one]

Hello, Been taking an opioid for RLS for a decade now. I’ve noticed that there is an impact on mood, especially in the early morning hours. I also experience some strange waking dream-like symptoms that I’ve been told are likely hypnogogia (?), when waking or falling asleep. Not to mention feeling slightly stoned every night/morning. Over the past two months I was able to reduce the methadone dose for a few days at a time and could see immediate benefits with mood, but could never maintain the lower dose due to refractory RLS.
My doctor, Bushnell, UW Harvorview Med, Seattle, has mentioned that we could possibly try rotigotine, but acknowledged the possibility of augmentation and ICDs, which I’ve experienced with mirapex with severe consequences. I’ve been reading what I can find on ICDs and rotigotine. It seems there are some small studies in Europe showing a lesser degree of ICDs with this med, but others state that the frequency is the same as mirapex and ropinerole.
Can anyone help to clarify the likelihood of rotigotine causing ICDs is similar or less than the other DAs? Thanks

JZ

[Rustsmith]

Rotigatine is a very new drug when compared to pramipexole (10 yrs vs more than 30). So, it isn't surprising that there is less research on rotigatine. I have taken both and augmented on both. The primary "difference" is that the patch spreads its dose over 24 hrs rather than one sharp spike when you take pramipexole. So, the concentration seen in the brain will be less for comparable doses. When the patch was re-released about 10 yrs ago (adhesive issues with the first form), the thought was that it wouldn't cause augmentation since you don't experience the ups and downs of dose. That idea was quickly disproven.