Mirapex/Augmentation

[Love7]

HI Everyone,

This is my first post so I am new! I have had RLS since I was young, I'm now 49 yeras old. I need to get off the Mirapex at night because of augmentation!! I believe the augmentation has worsened my symptoms during the day. My back burns, right leg and arm have RLS feelings and my overal skin feels antsy all over!

I'm very healthy otherwise, and have been taking Mirapex for 10 years, .250 at night. Has anyone out there had to get off Mirapex after taking it that long? I can take Methadone at night but don't want to take too much? Does anyone know what a normal amount of methadone at night would be?

Suggestions?

Thanks,

Love7

[rthom]

Hey Love7
Sorry you are having so much trouble. Have you had your ferritin levels checked, Just something to consider. There is a lot of information on here about what others are taking but I'm sure someone will leave a more helpful message.

[Love7]

Thank you....I have had ferretin checked....I feel like i have to get off Mirapex but I have to find something other than that to take at night.....

[rthom]

It does sound like augmentation but if you had a good result before i have heard of others having a good result from taking a drug holiday and changing between drugs after--one day on the mirapex and the other on methadone or something else. I have no personal experience with this though. I think you might be well off to re-post your question on the just joined page. Was your ferritin level 100 or better?

[ViewsAskew]

Many of us have had to stop Mirapex or Requip.

To find out if it's the drug or the disease (gotten worse over time), stopping the Mirapex is the only way to tell.

Most people use an opioid instead of the Mirapex for 2-6 weeks. Methadone is very common, but not all doctors will prescribe it. If you have augmented the WED/RLS will be worse initially, then slowly lessen.

[badnights]

Yes, augmentation has happened to other people after 10 years. It does seem like most of the people on here who've augmented have it happen within the first 5 years, but not all, and certainly not all in the literature. The longer you're on the drug, the more likely it is to happen. It's something to be thankful for that you lasted as long as you did, but now if it's time to move on, the first thing is to educate yourself as you're doing, then next, are you going to have to encourage your doctor to get educated too?

To come off the Mirapex, especially if you're augmenting, you will probably need an opioid, as Ann said. You will need to see your physician and his/her response will depend on how much he/she knows about WED/RLS. If he's really familiar with treating it, in all its manifestations, he will know an opioid is necessary; if not, which is more commonly the case, you should print out the 2011 RLSF Medical Bulletin (http://www.rls.org/Document.Doc?id=2112) and highlight the section on Augmentation that begins on p.6, and the section of Table 5 called Refractory RLS (because management of augmentation is similar to management of refractory RLS). However, the best information on treatment of augmentation isn't in that publication; it's on the website maintained by one of the co-authors of the Bulletin, Mark Buchfuhrer, and in another book he co-authored, which you might also want to print and bring to your doctor.

Augmentation from Hening Buch Lee 2008.pdf

Click the link to download this scan of two pages from the book, about treating augmentation.

(592.42 KiB) Downloaded 157 times

A medium to high potency opioid is probably going to be necessary. Codeine is low potency; if your doctor is only willing to go that far, tell him/her you'd like a fall-back position (eg. is he open to phoning you to discuss a change, if you request it during the withdrawal). I think tramadol is considered medium potency. Oxycodone and hydromorphone are high potency. Methadone is also high potency but is in a class by itself for some reason (in Canada at least, doctors need a separate license to prescribe it); it's pretty much the last opioid a doctor would prescribe.

In case you want to comb through it, Buchfuhrer's website (actually, the website of the Southern California RLSF support group, but maintained by him) is at http://www.rlshelp.org .

[Love7]

Thank you all for this info! Dr. Buchfurer is actually my Dr so I know he will be able to help me with this. I actually believe I augmented from the Mirapex after about six months but I have been taking it for 10 years"! Just sort of dealing with the augmentation symptoms because at least I could sleep! You all have helped me realize that I need to go off Mirapex for a good six weeks, using methadone at night to help me do it. Hopefully my daytime symptoms will then ease up because the augmentation will be gone...thanks

[badnights]

Well, there are plenty of things you could use besides methadone (eg. oxycodone, hydromorphone, perhaps even hydrocodone would do, or tramadol). That's up to your doctor to decide, and I feel happy saying that for once! knowing that it's Dr B:)

[debbluebird]

I just got off Mirapex due to augmentation. I'd been on it since 1996. Was off a few months in 2010, but couldn't find a balance with other drugs and went back on Mirapex. Well it happened again this year, so I decded to get off of it. The first week I cut my dose in half, then after that, off altogether. I had to increase my methadone, used my TENS unit and used ativan more frequently. Two weeks were hell. The week after that was better. It seems like to me it took about 4 weeks. My original dose of Methadone was 5 mg, half tab early and half tab later. No I'm taking 2 1/2 tabs altogether, plus the ativan 2 mg and my TENS. Last night we added gabapenten 300 mg, It was a better night. I had been up 2 to 4 hours in the middle of the night, but last night I was up, but got back to sleep. Still used my TENS. It does help. So I"m looking forward to see what tonight brings. I'm hoping to reduce the methadone. DEB

[rthom]

[jy13131]

I just finished my withdrawals from stopping requip and dr B is also my dr. I used (and still use) a combination of tramadol, methadone, hydrocodone and oxycodone to manage symptoms. Just when I feel like I have the dosage figured out I get a "flare-up" and I have to increase meds. Then after it calms down I wean back down. It is an ebb and flow but is going better than I expected. I like the results from methadone the best as it is most lasting and consistent. It has a bad reputation and after taking it find it's unfounded in much truth. I no longer feel lethargic or nauseas. I am back to all normal activities. The first week (or two) is not something I am ever interested in doing again. I felt like I was crawling out if my skin and basically had to go into a mild state if anesthesia to get relief! But day by day it got better. I will have to manage these symptoms for life based on my baseline symptoms off the DA but Dr B always tells me I could be MUCH worse. I'm grateful that I can once again enjoy my bed and all that it has to offer me! Good luck and coming on this board for support was really helpful(thank you regulars!) and really helped me through.

[rthom]