Requip Augmentation

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brownt
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Requip Augmentation

Postby brownt » Sat Oct 11, 2008 3:42 pm

Need help figuring out what meds I need to sleep at night. I developed severe augmentation from Requip after about 1 yr. on it. My doctor took me off Requip and prescribed Clonazapam to help me sleep at night. It doesn't help at all. I'm awake all night with my legs, arms, back, etc. severely thrashing.
Is there anything anyone has tried that helps give you a good nights sleep other than Requip. Leva-Dopa, Mirapex ect.
Sleepless Zomibie.

ViewsAskew
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Postby ViewsAskew » Sat Oct 11, 2008 7:20 pm

brownt, there is a specific protocol that the doctors have found is best to follow when you augment. I think if you read the Pharma sticky post, it will explain it. I hope there's enough info there for you.

Bottom line: only opioids (as far as I know) are strong enough to help you get through that period where you need to stop Requip (or Mirapex) and get back to your baseline RLS.

Then you can try other things, such as clonazepam. However, this isn't the first drug some docs recommend trying. It's half life is really long - increasing risk of being tired. A shorter acting drug in the same class is a better start. All in this class carry risk of physical dependence and going through withdrawal, however, so some doctors prefer to try gabapentin first. All of this is addresses in the algorithm. It's in the Treating RLS sticky in the New to RLS section.

Hope some of those help you.
Ann - Take what you need, leave the rest

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Helen518
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Neurontin/Gabapentin

Postby Helen518 » Wed Oct 22, 2008 5:39 pm

Five days after my last dose of requip my doc gave me Neurontin, an anti-seizure medication (10-8-08). It brings on a strong, deadening sleep in my case. I fell asleep on my FACE(!) on the family room floor in the middle of a TV program the other night (I took it a bit early in hopes that I could watch some TV in comfort).
The drawbacks for me are that I wake up feeling very groggy adn depressed. AFter about an hour, this lifts. Also, if something wakes me up, I am free of the creepy crawlies but I start up with the twitching and sometimes have to take more to get back to sleep. I am up to 900 mg/night and have been encouraged by the doc to go up to 1500 mg/night.

Sojourner
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Postby Sojourner » Wed Oct 22, 2008 6:18 pm

H, I have been on Neurontin for about 2 years (currently up 1800 mg (fairly steady at 1800 for the last year). It does a commendable job of controlling my rls/plmd. It does not make me the least bit sleepy so I am benignly jealous at your sleepy response. I guess you'll have to decide the pro's and con's of your side effects and/or how long you want to give it a try in the hopes that those things will moderate. I know, for me, my current worry is that the neurontin will stop working and what will I do then. Sound familiar? Ugh! Adjusting the dose etc may be worth considering if you have not already done that. I also take vicodin, as needed, to go along with the neurontin. Sometime I can go days and even a week or so without needed the vicodin. For you, maybe a cocktail or this sort may enable you to cut down on the neurontin or at least have something else to take on those break through nights. Just a thought.

Best wishes.

M.
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Helen518
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Postby Helen518 » Wed Oct 22, 2008 6:57 pm

M-
I am glad to hear from someone else on neurontin, and that it has so far continued to help you and that you can take breaks from the vicodin.

I have been wondering if there is such a thing as rebound from Neurontin in the morning . . . do you know? My mornings have been a bit rough since I went up from 600 to 900 mg.

Your worries about what you will do when/if it stops working definitely mirror my own . . . I try not to think about it if I can help it. I am only 36! On the other hand, perhaps I will be around long enough to see some additional therapies introduced.

Sojourner
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Postby Sojourner » Thu Oct 23, 2008 3:52 am

Regarding the rebound.... I have had periods or episodes lasting several days or perhaps even a week or so where I actually have felt worse after taking the neurontin (this also happened with Ultram which I have since stopped using). Terrible rls for several hours following my administraton. Each "episode" I am on the verge of calling my doc and asking to adjust the meds, the neurontin is not working, I want to take more vicodin then I should, blah, blah, blah. Terrible pain for several hours. This goes on for a few days or more (just in the evenings as I do not dose during the morning and early afternoon) and then, bam, it's gone and everything is back to "abnormal" or at least working relatively well again. Actually went through a bout a short time ago and it lasted about three days but not as severe as some others times. Sometime I think it's a weather related phenomenon as the last time we went from fairly warm weather to a cold spell. However, other times I cannot seem to make the connection. Anyway, this does not happen that frequently but it made me curious enough to send an email off to Dr. B. who also could not provide a good explanation. Not sure if this sounds like you or not.

I have had rls since my early twenties, at least. I have run the gamut of meds most here have tried. The good news is that with a good doc, education, and self-advocacy something generally can be helpful for most. You are right to have hope that new information and related treatments will be forthcoming. A blatant sales pitch follows.... which is just one good reason to join and support the rls foundation as best anyone is able.

again, best wishes

M.
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Neco
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Postby Neco » Thu Oct 23, 2008 10:17 am

Have you told your Doc about those episodes?

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sardsy75
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Postby sardsy75 » Thu Oct 23, 2008 10:31 am

Hi brownt

First, I echo Zach's question. Secondly, how much Clonazepam were you using?

I'm in a similar situation. I was prescribed Requip in mid-2006, but augmented badly before 2007 was even on the horizon.

I was unable to get down to see my Sleep Doc, so i did a bit of experimenting to see if I could find something that would work.

It turned out to be Clonazepam, and Codeine.

Ann is right that opiates/painkillers are pretty much the ONLY "drug holiday" drugs that those of us who augment on all the DA's can have.

However, Codeine is NOT my main RLS drug. Clonazepam is (Charlene, if you're reading this, don't have a heart attack, ok!).

My experiment was signed off as ok by my sleep doc and currently I take 3mg or 4mg of Clonazepam (to help me sleep), 60mg Codeine (to help with the pain) and 150mg Amitriptilyne (my brains' "off switch) at 8:30pm each night (or earlier if i'm just zapped). Depending on how wired I am from the day depends on how long I take to go to sleep; but once I'm asleep, that's it for at least 7hours now (yee-ha!). I ran out of my "off switch" drugs accidentally a few months ago ... holy moly, it felt like my brain was doing overtime!

Ropinirole (Requip) is now in my "back-up-box" for the times, like today, when I get side-swiped by an attack out of the blue. I can only take 0.5mg for up to 3 days in a row before I augment, but thankfully, I don't usually need the 3 days.

Hope this info helps you out.
Nadia

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Helen518
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Postby Helen518 » Thu Oct 23, 2008 3:05 pm

Sojourner-
My RLS is only worsened within 30 minutes of my feet hitting the floor after getting out of bed. I have not been taking neurontin long enough I think to know if it is periodic or not, like yours. However, I have experienced a periodic worsening of RLS when I was pregnant and after, when I was on requip. I also felt that the weather changes sometimes triggered it, but can't be sure . . . sometimes the worsening and the weather change did not coincide.
The cycle of your worry and your concerns about the vicodin totally sound like me . . .. I have days when I want to call either the psychiatrist or the neurologist and ask for changes in meds . . . and I go thru cycles of worry about taking more Lorazepam (ativan) than I am supposed to. both my doctors say that this med should not help my legs but I KNOW it does.
It's funny . . . being pregnant is what brought on my RLS but I know i would likely have ended up with it sooner or later even if I never got pregnant. I am so glad I have my son because I believe he is the reason that I keep hanging in there . . .
My BIGGEST concern right now is that I feel strongly compelled to try for another child. However, I know that I could be much worse off during and after another pregnancy. Why would I put myself through that? It's hard for me to answer that question. Compounding the problem is that I've been told by the reproductive endocrinologist that my ovaries are beginning to fail . . . so if I'm going to do it I need to act quickly . . . nothing like pressure when you're trying to make a difficult decision . . .

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Neco
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Postby Neco » Thu Oct 23, 2008 3:40 pm

Well I was responding to Soj's comment but I suppose it goes for brownt too.

Both of you should let your docs know about these incidents you're having if you haven't already..


Also... You could try Mirapex, but you might have the same results as Requip. That's not a reason not to try it though. Personally I augmented for 24 hours after taking 1 pill in the starter pack.

DON'T take Levodopa.. A lot of RLS experts are starting to shy away from prescribing it unless a patient is having RLS episodes maybe a couple times a month. If you take Levodopa for days in a row you are going to augment FAST and it is going to feel a LOT worse. I have tried it several times as a stop gap between painkiller refills and it was still horrible. I blew through 30 25/125mg tablets in less than a week the last time and I will never touch the stuff again.

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ctravel12
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Postby ctravel12 » Thu Oct 23, 2008 9:54 pm

sardsy75 wrote:
However, Codeine is NOT my main RLS drug. Clonazepam is (Charlene, if you're reading this, don't have a heart attack, ok!).

My experiment was signed off as ok by my sleep doc and currently I take 3mg or 4mg of Clonazepam (to help me sleep), 60mg Codeine (to help with the pain) and 150mg Amitriptilyne (my brains' "off switch) at 8:30pm each night (or earlier if i'm just zapped). Depending on how wired I am from the day depends on how long I take to go to sleep; but once I'm asleep, that's it for at least 7hours now (yee-ha!). I ran out of my "off switch" drugs accidentally a few months ago ... holy moly, it felt like my brain was doing overtime!
.


Hey Sardsy 75 I promise won't have a heart attack LOL. Like I have always said if this works for you go for it. I am glad that you are getting sleep especially 7 hrs what a wonderful thing. I do not remember the last time I slept for 6 hrs straight nor 7 hrs. If I ever slept for five (5) hrs straight I would probably think that I died and went to heaven. I am so happy for you. I wish that I could take codeine but it makes me violently ill.

You take care and have a good day.,
Charlene
Taking one day at a time


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