Opiates necessary for DA withdrawal....?

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superiorcynic
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Opiates necessary for DA withdrawal....?

Post by superiorcynic »

...if I've only been on DA for two months? Anyone have experience discontinuing a DA after such a short course?
Jason

Polar Bear
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Re: Opiates necessary for DA withdrawal....?

Post by Polar Bear »

I haven't had experience but would have thought that you would need something to take care of your symptoms when coming off or reducing a DA.
Betty
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superiorcynic
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Re: Opiates necessary for DA withdrawal....?

Post by superiorcynic »

Agreed. Just hoping that if I need to get off the DA, something less than an opiod will help me. I imagine that doctors aren't lining up to prescribe Vicodin, Methadone, etc.
Jason

ViewsAskew
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Re: Opiates necessary for DA withdrawal....?

Post by ViewsAskew »

Jason, if you haven't augmented, no need for an opioid. You'll have the symptoms you had prior to taking any medication. if you can live with them, you don't need to take anything. If you can't live with them, you can cover them with any other drug that works for you. If you haven't tried anything else, then it's just trial and error until you find one that does.
Ann - Take what you need, leave the rest

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superiorcynic
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Re: Opiates necessary for DA withdrawal....?

Post by superiorcynic »

Ok. Thanks again.
Jason

ViewsAskew
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Re: Opiates necessary for DA withdrawal....?

Post by ViewsAskew »

For what it's worth.... (all of this is in context of DAs for WED/PLM, not for other disorders)

Most important: get a ferritin test first and consider not taking a DA unless your ferritin level is at least 50 and better off if 100 or higher. The chances of augmentation seem to be related to how low your ferritin level is - lower lever, greater risk of problems.

DAs are not hard to stop most of the time, no matter how long you've taken them.

They are also substitutable for each other - meaning that you can substitute one for the other and most times you're fine.

When you substitute, it's 2.5/3:1 Requip to Mirapex. So, if you were taking .25 Mirapex, you'd probably need about .75 of Requip.

Averages of DAs- about .75 for Mirapex and about 2.0 for Requip (that is from memory that seems a bit hazy - check on it to make sure).

When you stop a DA and have not augmented, expect your symptoms to be the same as they were prior to stopping it, unless a significant time has gone by and you've had to increase your dose along the way.

DAs are hard to stop when you've augmented. That is when you'll almost always need assistance. The period of assistance is usually about 1to 4 weeks. Usually an moderate to strong opioid is the only thing that helps.

Augmentation usually occurs in the 12-18 month range. If it occurs earlier, as long as it's very mild, increasing the dose is considered OK, and so is switching to a different one. If the augmentation is severe or if it happens mildly more than once , you should not take another DA or increase your dose.
Ann - Take what you need, leave the rest

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Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

cornelia

Re: Opiates necessary for DA withdrawal....?

Post by cornelia »

FYI: As regards to the dose of Mirapex I saw an anwer from Dr B saying (page 98) that most experts try to keep the daily dose of it at a maximum of 0.25 mg.

Isn't that exceptionally low, even for not severe RLS?

Corrie

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Re: Opiates necessary for DA withdrawal....?

Post by Polar Bear »

So the equivalent dose of requip ( i.e. x3) - would be .75mg....... and that would be the daily dose.
I agree it sounds way too low ............
Betty
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rthom
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Re: Opiates necessary for DA withdrawal....?

Post by rthom »

my dose of mirapex started at .25mg and went up from there

badnights
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Re: Opiates necessary for DA withdrawal....?

Post by badnights »

I will add to Ann's wonderful list, a note that just because you've augmented on one DA does not necessarily mean you will augment on the other.

(DA = dopamine agonist; two are commonly used for WED, being Requip/ropinirole and Mirapex/pramipexole. First name is American brand name. Second name is the actual name of the drug.)
Beth - Wishing you a restful sleep tonight
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ViewsAskew
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Re: Opiates necessary for DA withdrawal....?

Post by ViewsAskew »

cornelia wrote:FYI: As regards to the dose of Mirapex I saw an anwer from Dr B saying (page 98) that most experts try to keep the daily dose of it at a maximum of 0.25 mg.

Isn't that exceptionally low, even for not severe RLS?

Corrie


That's at odds with what I learned several years ago at one of the Foundation's conferences. Could be that they've changed it....but seems unlikely.

In the Clinical Management of RLS, it lists the daily range as .125 to 1.5 mg for pramipexole, and the avg daily dose as .25 to .5. That is lower than what I remember them saying in 2005 or 2006 as the avg daily dose, though.

It lists the range of ropinerole as .25 to 4. and the aver daily dose as .5 to 2.
Ann - Take what you need, leave the rest

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Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
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Re: Opiates necessary for DA withdrawal....?

Post by Polar Bear »

It lists the range of ropinerole as .25 to 4. and the aver daily dose as .5 to 2.

Hmmm... my total daily dose is 4.25mg. of ropinerole.
Betty
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jy13131
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Re: Opiates necessary for DA withdrawal....?

Post by jy13131 »

I just got off my roprinole (sp) and I took 1-2 Mgs per day. Dr b noted that at 1 mg per day it was a relatively low dose. Hope that helps
jy13131

cornelia

Re: Opiates necessary for DA withdrawal....?

Post by cornelia »

This is dr B's recommendation nowadays (of course he will have many patients on a higher dosis as he treats the most severe ones). I think that the problems of augmentation are become more and more apparent and that is why I the experts have redevined their advice as regards doses of DA's (see below):


'It might be worth considering a change to Requip to see if that drug does not cause those strange side effects but the equivalent dose is 6-12 mg. That is a very high dose (as is your Mirapex at 3 mg) and we now typically recommend maximum doses that are much smaller (Mirapex at .25 mg daily and Requip at 1 mg daily). However, getting off the dopamine agonist drugs once on a high dose is very difficult (your RLS will go berserk for a few months) and should only be done by an true RLS expert'.

Corrie

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Re: Opiates necessary for DA withdrawal....?

Post by Polar Bear »

(Mirapex at .25 mg daily and Requip at 1 mg daily).

Yikes !! that is so much lower than previously thought.
Betty
https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

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