To Susan: Options

[ViewsAskew]

Hi Susan,

I thought your post was important and didn't want it to get buried in the other post about drug side effects. You originally wrote:

"I have been taking Mirapex for over a year now. It seems to be the only drug that calms my legs down and keeps them calm overnight. But, I have been developing some complications that I believe are due to the Mirapex. Some dizziness during the day, general sense of weakness, trouble sleeping, headache, dry mouth (in the AM) and most troubling recently, muscle stiffness in my fingers, toes and ankles. Any suggestions on where to go from here?"

I do think you have options. There are many drugs used to treat RLS and they work very differently on each of us. You may have tried some of the things I am about to list. Hopefully there will be something there that you haven't tried. Obviously, all of these require working with your current doctor or finding one that is more knowledgable, if that is a concern.

1. Stop Mirapex and just see what happens. It will take two to three weeks for the meds to wear out of your system and for you to be at a baseline level of RLS. For the first week, you can almost count on your RLS being truly horrible. From there, you might have a better idea of what is going on, how severe the RLS is now, how much the drug affected you, etc.

2. Verify you have all life-style changes done. Caffeine, diet, alcohol, smoking, good level of exercise (mild, but enough), eliminate all drugs that could exacerbate RLS, get all other conditions that could contribute under better control, take the supplements most likely to help (magnesium, a mega B-Complex that has folic acid, calcium), check ferritin levels and improve them if low, etc.

3. Switch directly from Mirapex to another dopamine agonist. The Mayo Clinic algorithm would say to try Requip. This has a completely different side effect profile than Mirapex and it's worth trying. However, some people do have problems making this switch. No one knows why (as far as I have read), however some people find their RLS goes ballistic when they try this switch.

4. Reduce the Mirapex and add one of two other drugs to make up for it. people take many combos. You could add Neurontin, Klonopin, temazepam, Ambien, tramadol, hydrocodone, and many others. Often people find they do much better taking a little bit of two or three meds than a lot of one med.

5. Stop the Mirapex and switch to Ultram, Methadone, or Levorphenol. These drugs will help get you through the withdrawal period a little better than other drugs. You can stay on them for a month before you have to make a decision about what to take next. You can stay on them, but many doctors don't like a person to try these until they have exhausted other options.

Hope this helps some. There really are a lot of options and you shouldn't compromise your quality of life over one of the drugs. Oh, and when I wrote to "stop" Mirapex, this cannot be cold-turkey. Most of the drugs we take do require that we taper off of them slowly.

Ann