Is going back on a DA an option after having experienced impulse control disorders with Mirapex and Requip?

[tea4one]

Hello Brothers & Sisters,

I would like to change the methadone (10mg) that I take for rotigotine, but I've done some research and have found conflicting accounts about impulse control disorders (ICDs) and this med. It appears to be as risky as Mirapex or Requip but wanted to see if anyone may have some experience with this. Thanks for any feedback. I'm interested in hearing from anyone who's ever stopped a DA due to ICDs then went back on the same or differing DA.


Jayson

[Rustsmith]

I am not sure that I understand the preface to your question. Are you considering switching to methadone from Requip?

As for ICDs, they are generally associated with the dopamine meds. I have not heard of anyone on methadone having issues with ICDs, but 15% of patients on dopamine meds develop them. Often the "treatment" when an ICD arises is to get off of the dopamine med ASAP and switch to an opioid, such as methadone. If you have seem something about methadone and impulse issues, could they be talking about addicts who are taking methadone to get off of harder drugs and are experiencing cravings for those old drugs? If so, remember that the standard methadone dose for drug rehab is about 10 times what is used to treat RLS. Also, although 10mg of methadone is the "standard" dose for RLS, many of us only take 5mg and a few go as high as 20.

[tea4one]

Hi rustsmith,

I’m looking for an alternative to methadone, but have experienced ICDs with DA’s in the past. Just curious if anyone has had to go back to a DA after having stopped it due to ICDs etc. My doctor floated the idea of trying rotigotine.

[Rustsmith]

Everything that I have ever seen on the topic of ICDs caused by dopamine agonists says that the first step is to stop the dopamine med. Treatment with an SSRI can then be used, but these have their own laundry list of nasty side effects with triggering restlessness at the top of the list for us.

I would personally be very hesitant to try rotigatine if you had an ICD when you used Requip. Rotigatine is the newest of the DAs and is time release, which was originally thought to reduce the chance of augmentation (it didn't as I quickly found out).

If you have reasons to try to get off of methadone, you might want to consider one of the opioid/naloxone medications or buprenorphine. Both are used to treat RLS and are even less likely to result in addiction than methadone.