augmentation questions

walkindafloors · Post by **walkindafloors** » Thu Jul 12, 2007 10:27 pm

I've read a lot of posts about augmentation and experienced it myself twice now with Sinemet and now Mirapex...is there not some way to tell before it gets so severe to know that's what's going on?

Also wondering that after a med augments on you (or whatever the medical terms are!) can you go back to it later and it be as effective?

Today is the first day I've felt human again after getting 4 1/2 hours of sleep (in two segments) last night following 12 nights of 10 minute cat naps here and there at best. I'm now missing work due to the rls and my DH says he'll be glad to get his wife back. My doctor is working with me in attempts to change meds - 7 new scripts in 2 weeks - going now with Darvaset, Klonopin, and an older drug Amantadine (or something like that). I know none of this is new for any of you having endured these cycles of hell, but does it ever get easier to deal with?

Neco · Post by **Neco** » Fri Jul 13, 2007 1:12 am

Personally.. I never figured out a way to tell. With Sinemet it did gradually get worse and I didn't make the connection until it was WAY too late. With Mirapex I simply augmented on the first dose I ever took.

As far as I know, once you take a prolonged break from the medicine you should be able to resume taking it. Personally I won't touch anything that augments me, unless I am having real trouble controlling my pain killer supply. I was recently given Lyrica to try though and it seems to work well, so I may never need to consider DA's ever again

SquirmingSusan · Post by **SquirmingSusan** » Fri Jul 13, 2007 3:35 am

When I augmented on Requip, it was also way too late by the time I figured out what was going on, even though I had read about it on this forum. When I started having crazy leg pain about an hour after taking the Requip, I knew it was time to quit. But that was horrible. Fortunately my dh had some Vicodin around to help me until I could see the doctor, or I would have had to go to the ER.

So just be careful with those DAs. I'm glad most people get relief from them for a while, but some of us just seem prone to augmentation.

I'll be interested to hear how amantadine helps. That's a flu drug, like Tamiflu. I guess if there's a bird flu outbreak, you'll be all ready.

Post by **ViewsAskew** » Fri Jul 13, 2007 4:10 am

Once you know about it, it's easy to tell. It's hard to tell when no one every told you it can happen.

Kim, this is the rule of thumb the researchers told me to use when I was at the RLSF conference two years ago: if the RLS gets earlier in the day, lasts longer at night, or is generally more severe and this happened in a period shorter than 1 1/2 years, it's augmentation.

I read that to mean that if you got RLS at 6 PM for 12 months and now it's at 5:30 PM - it's augmentation. If you have it 24/7 and 25 mg 3 times a day worked fine for 6 months and now it doesn't, that's augmentation.

BUT - if you got RLS at 6 PM for 2 years and now it's at 5:30, if may just be the RLS getting worse.

So, ANYTIME that your RLS starts earlier, even a half-hour, or is more severe, or your meds don't work the way they used to and you are taking a dopamine agonist, it's time to re-evaluate your drug therapy.

Oh, and if you augment on TWO dopamine agonists, you should NOT try a third one - that's in the Mayo Clinic Algorithm. As Zach said, you then need a loooooooong time before trying one again. Similar to Zach, after the augmentation I went through I'd be hard pressed to EVER try one again. That new patch sure sounds promising, but. . . .man, was that a terrible experience augmenting on three DAs.

walkindafloors · Post by **walkindafloors** » Fri Jul 13, 2007 4:28 am

Thanks for the input. I questioned the Amantadine - knowing it is used for the flu...but was told it is an older parkinson's med. Anyway, none of them are working tonight as I stand up here typing this post cause my legs won't let me sit. I know my dr. is at her wits end with me after the past couple of weeks.

So if you augment on TWO dopamine agonists, you should NOT try a third one, where do you go next? I have a hard time because I'm on call with my job every other week and can't take a med that will knock me out in case I get called out and have to drive. Any suggestions to give the dr?

Neco · Post by **Neco** » Fri Jul 13, 2007 5:18 am

Most people who augment on 2 or more DA's try opiates next (at least that's my general opinion). You might ask about Tramado (Ultram)l, or Codeine (Tylenol #3), or Hydrocodone (Vicodin).

If your doc is a tight wad tho good luck with that.. Best to bring along some disarming information like the Mayo Algorithm.. I know its sitting around here somewhere but I never can remember where..

A note on Tramadol.. It is not technically recognized as a narcotic/opiate. However it DOES act on the opiod receptors (mu; I think). However it is NOT on the DEA Scheduling list, and thus is not a controlled substance and only requires a prescription to obtain. (it's OTC/"behind the counter" in many other countries).

There also is an increased seizure risk.. Usually this involves some antidepressants (and a couple other drugs I think), as they prevent the drug from being metabolized and you end up with a buildup in your system = twitching retard on the floor. (I've been there)

Post by **ViewsAskew** » Fri Jul 13, 2007 5:52 am

Look at the algorithm under refractory - that is where you go when you fail DAs or have augmentation AND have daily RLS.

This is what the algorithm says re: Refractory RLS:
Four different approaches can be tried. A referral to a
specialist in RLS management should be considered.
• Change to gabapentin (see subsequent comment 10)
• Change to a different dopamine agonist (see subsequent
comment 11)
• Add a second agent such as gabapentin, a benzodiazepine,
or an opioid (see subsequent comment 12)
• Change to a high-potency opioid or tramadol (see
subsequent comment 13)

Link: Mayo Clinic Algorithm

walkindafloors · Post by **walkindafloors** » Sat Jul 14, 2007 6:46 am

Thanks, everyone for your input. Zach, I've been taking the Ultram for several months now, throughout the day (normally releaving the restlessness enough to be functional at work) and doubling up at night.
I'm on call again so can't do the ambian or Klonopin this week so am relying upon only ultram and Darvaset which obviously are not working to calm one leg - slept 2 hrs. last night and it is not 2:45 am and haven't been down yet tonight.
I've got to find something that will knock out this pain in my knees and upper thighs at night without knocking me out so I can't hear the pager or respond if I need to drive out...
I know, the miracle drug we're all waiting for :cry:

!

Post by **ViewsAskew** » Sat Jul 14, 2007 7:08 am

Kim, I think Dr B's book says that Darvocet is for mild cases only. Sounds like you don't qualify, my dear.

Does a stronger opioid knock you out too much or cause problems for being on call?

Neco · Post by **Neco** » Sat Jul 14, 2007 10:36 am

Even stepping up to something like Codeine may show a significant improvement in this case.

walkindafloors · Post by **walkindafloors** » Sun Jul 15, 2007 7:04 am

I'm still learning drug stuff - what are some examples of opioids? I'm allergic to codine - took one dose. laid on the couch below the loft and could hear my DH talking to me but was like paralized and couldn't talk to answer! WEIRD.

This is really getting to me...going on nearly 3 weeks now of very, very little sleep. 3 am now and I've slept from 12:45 - 2:30, waking up with my legs in such knots it took severe jerking and stretching to get them to even allow me to walk and now sit to type this. I seem to fall asleep okay once the legs calm down but usually within 20-30 minutes I'm jerked awake in a severe attack. Routine is finally falling into a deeper sleep aroiund 5 to 5:30 am only to have to awaken for work. It han't been this bad EVER for this long and my dr is trying, changing me between 9 meds during this period but work on-call schedule permits me from taking anything that would knock me out. Frustrating thing was that last Wed. - Thurs. I took Klonopin which kinda mostly was knocking me out but my legs (and arms) were so bad they kept me up over the drug induced sleepiness, leaving me walkindafloors with my eyes shut.
About to decide to leave my beloved social work career and check into being a 3rd shift walmart greeter!

Post by **ViewsAskew** » Sun Jul 15, 2007 7:22 am

Codeine is an opioid - so is Darvocet, Vicoden, methadone, oxycontin, etc.

Josh can give you more specifics, and Zach, too, but I seem to recall reading that there are three or four basic formulations that all are derived from. So, you can be allergic to one and not another. For example, I can't take Vicoden - makes me ill immediately (as in projectile vomiting). But, I can take methadone.

Boy, don't you hate that walkindafloors when you can't keep your eyes open? :shock:

walkindafloors · Post by **walkindafloors** » Sun Jul 15, 2007 3:24 pm

Thanks for the info Ann. Someone mentioned Darvoset was for mild cases - would increasing the dosage work or not?

It is now Sunday am - I finally went down after 5:30 am and am just now reviving (11:15am). First time I've slept more than an hour straight in who knows. Hopefully I can "kick start" back to a more normal routine after getting the much needed rest...praying you won't see me posting at 3 am tonight!

Thanks everyone for being so caring and mostly for being there!

Post by **ViewsAskew** » Sun Jul 15, 2007 8:40 pm

Not sure, but I doubt you could increase the dosage enough to be safe and still help the RLS. I know it barely put a dent in mine. I then tried Vicoden - pojectile vomiting, so I don't know how it might have worked or not. Then methadone. Which did work. And, no high, no dysfunction in how I feel.

Neco · Post by **Neco** » Mon Jul 16, 2007 2:51 am

If you can't take COdeine, Hydrocodone (Vicodin) is the logical next step. Beyond that is Oxycodone, Morphine, Dilaudid (hydromorphone), etc.

Don't play around with Darvocet, you can end up dead pretty easily if you take enough.