Pramipexole

[TimG]

This question and its possible answer is probably embedded in another thread, but I'm going to start a new one so it doesn't get lost in the shuffle. I have been taking pramipexole for WED about a year and a half. It works well and I haven't had any augmentation or serious side effects. The dosage is 0.25 mg in the evening or at bedtime. It may be coincidental, but it seems that I am sleepier during the day since beginning to take pramipexole. I also take citalopram (Celexa) for anxiety, also at night, but no other medications. To your knowledge, or in your experience, would low-dose pramipexole cause next-day drowsiness? Thank you.

[ViewsAskew]

I experience it, but it's because I sleep VERY poorly when taking pramipexole. I awaken constantly, my mind whirring around. I rarely get more than 3-4 hours of sleep before awakenings start and some nights, get only an hour or so.

I do know that sleepiness is a side effect, but assumed them meant after taking the drug, not next day.

[jakesmom]

I did some research on Celexa. It affects your REM sleep and the amount of time it takes you to get there and how long you stay there, which would contribute to your tiredness. Also, it causes an increase in yawning. Both medications can lower your blood pressure, which will also make you feel tired.

[Chipmunk]

The citalopram will reduce the amount of REM sleep you get, but not enough to make you drowsy. It will make you drowsy as part of its primary mechanism though, depending on how much you are taking. Its job is to increase serotonin, which will make you sleepy. A few years back I went through a severe depression and my psych put me on a super-high dose of Lexapro. I was extremely content but could NOT stay awake!

I ended up trying a bunch of different doses and then different SSRIs and found Prozac to be one of the least sedating but it also had bigger side effects for me, even at low doses. I'm now on 10 mg of Celexa and it doesn't make me tired, at least not noticeably. I do think the tiredness got better after having been on it for a while, but it should at least start at a manageable level so you're able to stick it out.

[Polar Bear]

I take 20mg Citalopram daily in the morning, starting at 10mg and then after a month up to 20mg. There has been no noticeable sleepiness.

[badnights]

The pramipexole itself can cause drowsiness. I stopped taking it for that reason. It barely controlled my symptoms and was causing me to be stupefyingly tired all day. Looking back on it, maybe some of the tiredness was just a reflection of how much sleep I had lost in the previous year or so, and I was able to feel that sleepiness only when the pramipexole was subduing the symptoms - but I don't think so. I think most of it was "drug-induced" sleepiness. Anyway, whatever interpretation my personal story has, daytime sleepiness is a known side-effect of pramipexole.

If you think you're experiencing that, and are not willing to accept the resulting effects on your life, it would be appropriate to ask your GP about alternatives. I know you've been here for a while; are you yourself aware of what your alternatives are? There would be the other DA, ropinirole (which might have a different side effects in you even though it's in the same class of drugs); the anti-convulsants; the opioids. Probably you know a bit about the effectiveness and pros and cons of these that other people have experienced.

If you decide to stay on pramipexole, be aware of any changes in your ability to control your impulses (another known side effect, impulse control disorder; usually but not always at higher doses than yours). With either pramipexole or ropinirole, be aware of the signs of augmentation (usually, your symptoms will start earlier in the day - more info in my signature links).

Another known side effect of pramipexole is sudden sleep onset in the middle of the day without prior feelings of sleepiness, but this is rare, I think. (Yet another is insomnia, for some people!)

Probably related to the sleepiness, I am fairly sure that pramipexole slows my reflexes well into the following evening, even now that I only take it twice a week. (I am a goalie in a just-for-fun broomball league, which might not sound important but it's very important to me ; so I make sure not to take it the night before a game. )

[TimG]

Thanks for your replies. I may try to experiment first with not taking it every night, then see the effect, if any, on daytime sleepiness. I'm not averse to trying another WED med, but I want to make sure that it is a better alternative first. I posted elsewhere today that my current ferritin level is 38, so need to raise that. I'm not anemic, so I hope I don't get into iron overload.

[badnights]

Good call to supplement with iron. I haven't heard of any WED/RLS patients with low ferritin who took too much iron; I don't think it is common at all. Still, you should probably OK it with your doctor.

Your caution is appropriate; as you know, it's pretty easy to go from the frying pan into the fire with the current treatment options.

[Chipmunk]

The American Hemochromatosis Society (for people with genetically high levels of iron) sets their safe zone at ferritin under 150 and saturation percentage under 40%.

It took me at least 9 months to get my iron up to 125, so I don't think you'll be in danger of overdose, but I understand the worry. When I was trying to get my iron up, I went back for labs every 3-4 months. It put my mind at ease that it wasn't getting too high.

[TimG]

Tracy,

How much iron did you take daily over the 9-month period? Getting tested frequently sounds like a good idea.

[Chipmunk]

I am pretty sure it was 3 - 65 mg elemental iron pills per day. It was hard on my stomach and I was so happy to finally get my ferritin up so I could stop taking that stuff!

[badnights]

tracy how long have you been stopped and has your ferritin stayed high?

[Chipmunk]

Yes and no....on 4/22/13 it was 52 but I don't want to start on iron again. Sigh.

Here are my test results (and this was taking large doses of iron religiously with orange juice and extra vitamin c):

(I don't have access to my original tests as they were through a different clinic, but I believe my ferritin started at around 20?? And it would have been in the summer or fall of 2010)

3/3/11 ferritin 83 Vit d was tested for the first time 22
6/2/11 ferritin 97 Vit d 56
8/23/11 ferritin 119 Vit d 49 (I had stopped taking supplements in the summer, thinking I could get some Vit d from the sun....apparently not)

In April I got my Vitamin D tested again and it was back to 22 again...lol...this is after 2000 IU every day, so I started back on the 50,000 IU 1x a week dose.

Ok, I have just realized that I have been sleeping really soundly the last two weeks and I just commented to my husband that I have been sleeping like a log and it must be the new memory foam pillow from Costco. But I just put it together that today I took my fourth dose of my RX Vitamin D, so I started sleeping well right about the time of the second dose. I noticed the same difference the last time I went on vitamin d...

[doety]

I'm augmenting on Mirapex and need to quit, at least for a while.
I take one .25 mg. pill and a half of one at night (I don't know what that adds up to).
After taking it, I immediately get WEDS.
Should I try to get off slowly, or is that a low enough amount to just go cold turkey?

[ViewsAskew]

I'm augmenting on Mirapex and need to quit, at least for a while.
I take one .25 mg. pill and a half of one at night (I don't know what that adds up to).
After taking it, I immediately get WEDS.
Should I try to get off slowly, or is that a low enough amount to just go cold turkey?

I took a similar amount and still needed an opioid to help me stop it. I couldn't get past day 4 or 5 on my own. You can try to go cold turkey - Dr B contends that it takes longer to get through this nasty period when you do cold turkey vs using an opioid - not sure what he bases that on.