Maximum Dosage Requip

[lynne]

At the current time, I have been on Requip for more than 2 years. Before that it was Mirapex for a year until the augmentation level maxed out. I am now up to 4 mg of Requip per night with .5 Klonopin. I see my Dr. every 3 months. Each time, my Requip dosage levels have increased due to augmentation. (I started at .25). The Doctor tells me not to worry - that I could be taking as much as 20mg of Requip each day without any bad side effects along with 1.5 mg of Klonopin. Now, I read the messages on this board and most of you are taking 1 mg - 2 mg per night of Requip. Am I the only one taking this large a dosage? Is anyone else taking this much - or more? Only side effect I have noticed is that the RLS is all over my body now (severe jerking in the neck and shoulder muscles, arms flailing about, etc.). The doctor does not like me questioning him about this and says if I am so concerned, he can put me on a 'drug holiday' ... whatever that is. So, what is the highest dosage level of Requip any of you are taking?

[D4]

I'm not a doctor, but this just doesn't sound right to me.

If you're really augmenting, you need to taper off Requip instead of taking higher dosages. (There is a lot of info on augmentation you can search for here.) The side effect you mentioned sounds like augmentation especially if you're having these problems earlier in the day than you used to.

Also a drug holiday means not taking your drugs for a period of time. From everything I've read, you should taper off Requip and not just stop it, especially at the high dose you're taking.

I think you need to find a doctor that will work with you to battle RLS. I had to switch to a neurologist to get a partner in this. We haven't found the right solution yet for me, but I feel he is working WITH me.

I switched doctors after I augmented on Requip (and I didn't even know what that was) and he was telling me to take more and more of it earlier and earlier in the day. I was going crazy. That's how I found this board. The people here instantly knew I was augmenting. I had to insist that he switch me to another drug and when I asked about tapering off Requip, he said at my low dose I didn't need to bother with that. That was a mistake and went through h*** because I followed his advice.

I've learned so much from these boards and the 3 books I bought on RLS. I think knowledge is power, especially with RLS since so many doctors know so little about it.

I wish you the best.
Diane

[ViewsAskew]

Lynne, I wouldn't agree with your doc. But, I'm not a doc. Just a fellow RLSer who listened to a doctor like yours. And I paid a horrible price. You are not me, and what happened to me may not happen to you, but you be the judge of what you think you should do.

I had mild, occasional RLS, but terrible PLMD. I was put on Mirapex at .125 mg. It worked for the PLMD, but within a week I had daily RLS. I mentioned it, he said to take it earlier. I did. Then I had more severe RLS, then earlier RLS. And he told me to take more. And I did. Eventually I had RLS all day, every day.

Long story short, I did this for 18 months. By the time I found this board and started educating myself, I realized that this might not be a good thing.

Here is what I learned in my quest to find relief. I read everything I could, went to an RLS Foundation conference, emailed Dr Buchfurer, etc.

-severe augmentation is now considered something to avoid, not promote. At the RLS Foundation's conference two years ago, the doctors I talked to (Earley, Buchfurer, Rye) said that you should stop the dopamine agonist when you have this type of augmentation. They only continue using the drug when it's very mild augmentation.

-after you augment on two or more dopamine agonists (you have on two), you should NOT take them anymore, at least for a long time. There is no consensus and no research, but it's possible you can take them in the future, but you should avoid them for the time being. The part about not using them any more is part of the Mayo CLinic's algorithm for treating RLS.

-in several cases I know (me and people posting on this board), the increase in RLS became permanent when severe augmentation was allowed to continue for long periods of time. No one knows how long this period is. In everyone I know of, it was quite awhile (two years for me). This, to me, is not an acceptable risk. Your RLS is miserable enough - I know you don't want it to be increased because of these drugs.

When the augmentation had gotten so it was 24/7, I made my neuro try something else. He first put me on Sinemet (immediate rebound), then Requip (rebound and augmentation). After I learned all of the things I listed above, I became determined to find another doctor and to stop Mirapex and to never try another dopamine agonist again. It took me a long time, but it was worth it. May doctors, many meds, and 6 or 7 months later, I was stable on methadone, but with permanently worsened RLS. I've been on it for two years now, and my RLS hasn't gotten worse and I haven't needed to increase the dose once I got it right.

I am glad you found the board. I hope that you find what you need here.

[stitch]

Hi Lynne,

I am getting ready to post sometime tonite or tomorrow but i was reading your post and I was up to 6mg's of requip a day. Between the van accident back at the end of the year when we jumped the curb and the start of my legs going 24/7 or my body, that is when my regular doctor said 6mg's was WAY too much requip in a day. We cut it back to 3 and at that time I saw the new pain doctor and he put me on Lyrica and wanted me off the requip and was not going to replace it with anything else. We seem to be doing just the opposite, I am going off requip and just started Mirapex - the starter pack. But I take 2mg's of clomazepam every nite for sleep. Don't know if I will stay on requip and mirapex together or get off the requip altogether.

I also had my ferritin checked and it is 10 and I told my dr that it's way too low so I am on iron pills. For me it's suspose to be 50 so maybe after taking the iron pills my legs will get better. But really I see now that no more then 3 mg's of requip a day. Augmentation will set in and maybe it will start at a lower dose. Good luck, Jeannie

[mcarlin]

I take 4 mg requip in the morning, 8 mg at 4:00, and another 8mg at bedtime. Recently it seems like the requip is not working. I was up until 3:00 am last night because of my legs. It is so bad. It makes me want to cry. Hang in there.