Considering the possibility of going back on Mirapex

[karalea]

Hi everyone,
I recently posted about the fact that I am taking about 8 meds for RLS. The med regime is working to relieve pain but I find that I get tired very early in the day (around 4pm) and I require very much sleep, including a 2 hour nap. I feel good in the morning if I have had up to 10-13 hours of sleep. Yesterday I had only had 6 hours and I was irritable and tired all day. 6 hours used to be great for me.

In addition, I find that I have depression which vacillates from being low level depression to severe, depending on the amt of sleep I have had. Other factors affect the level of depression. I don't seem to have any tolerance for stress. Stress can be anything from having a lot of housework to doing, bills etc. Things just pile up on me very easily causing me to feel overwhelmed and depressed. I never used to be like this.

I used to be a multi-tasker, managing a job, 2nd career, house, bills, daughter etc, all as a single parent. There are times now when just simply knowing I have to take a shower is hard. Many days, I just hate when I become conscious in the morning and I know I have to get up. The less sleep, the harder it is.

I have been thinking about going back on Mirapex again in a small dose to help eliminate the 10 mgs of Opana I am taking and possibly some other meds too. I am currently on Amantadine, Oxycarbazpine, Clonazepam, Opana, Nuvigil, Ketamine, Clonidine patch. I was taken off Requip and Mirapex in April because I had gained 60-80 lbs due to compulsive eating. I had been on Mirapex for approx 10 years prior to have Requip added with increasing doses, up to 4mgs with Mirapex also dosed out. I tolerated the Mirapex for many years without compulsive eating.

I am thinking that the Requip with the added doses put me over the edge. My Dr attempted a low dose of Requip just recently which started the compulsive eating again. I am thinking that since I tolerated the Mirapex for many years without the compulsive eating, maybe that would be worth a try.

I am so tired of feeling tired, irritable and depressed. I feel sorry for my 14 year old daughter that has to put up with a mother that finds life a drudgery and never wants to go anywhere or have any fun. There is only so much understanding that one can expect a daughter to have. What do you think about me going back on the Mirapex? Again, I apologize for such a long post! Thanks to anyone who reads though all of this!

[ViewsAskew]

My guess is that you'll have the same problems again...but you will not know until you try.

I've tried to take the DAs multiple times since I first augmented - the side effects are identical each time. For me, pramipexole (Mirapex in the US), causes depression, overeating, out of control emotions, and much more. I waited 4 years to take it....same thing the next time.

I also think that there is a MUCH better solution that all the drugs you are taking, but it won't be easy to identify. I'm not saying I know what it is, just that you shouldn't need all of those drugs. Go to a drug interaction checker, such as here, and put in your medications: http://www.webmd.com/interaction-checker/default.htm . Here is what I copied from it:

Significant - Monitor Closely: Potential for interaction
clonazepam Oral + Opana Oral; clonazepam Oral and Opana Oral both increase sedation and drowsiness

Significant - Monitor Closely:
Potential for interaction
ketamine (bulk) Misc + Opana Oral; ketamine (bulk) Misc and Opana Oral both increase sedation and drowsiness

Significant - Monitor Closely:
Potential for interaction
Nuvigil Oral + Opana Oral; Opana Oral increases and Nuvigil Oral decreases sedation and drowsiness
Significant - Monitor Closely:

Potential for interaction
clonazepam Oral + ketamine (bulk) Misc
ketamine (bulk) Misc and clonazepam Oral both increase sedation and drowsiness

Significant - Monitor Closely:
Potential for interaction
clonazepam Oral + Nuvigil Oral; clonazepam Oral increases and Nuvigil Oral decreases sedation and drowsiness
Minor:

Interaction is unlikely, minor, or nonsignificant
amantadine HCl Oral + Nuvigil Oral

amantadine HCl Oral, Nuvigil Oral. Either increases the level of the other by added drug effects

Additional Information: Combination increases stimulation of the nervous system.
Minor:

Interaction is unlikely, minor, or nonsignificant
Nuvigil Oral + oxcarbazepine Oral; oxcarbazepine Oral will decrease the level or effect of Nuvigil Oral by altering drug metabolism


To me, this is a bit worrying - here are 7 different interaction warnings for what you are taking.

In terms of WED/RLS, amantidine may help some, but it's main side effect is drowsiness. Oxcarbazepine may help, but I'd think that pregabilin, gabapentin, or gabapentin encarbil would work better. All of these drugs can cause drowsiness, however. If you are taking the regular oxymorphone (not the extended release), you're only going to get 2-4 hours of relief. There are better opiates to use - that last longer and provide more coverage. Clonidine is not known to provide relief to most RLS/WED patients. It sometimes help, but it seems dangerous to you to keep throwing more things at this without trying other options.

And, ketamine is just plain scary to take. I doubt my pharmacy would fill that for me if I was taking the other drugs on your list.

Since your doctor is willing to prescribe opioids, I'd find out if methadone is available in your area. I'd carefully and safely find out how to get off of amantadine, ketamine, clonidine (unless you are taking for another reason), and clonazepam and I'd start reducing them. I'd likely try to see a psychopharmacologist and see if he or she had any ideas for how to stop some of these safely.

You may find that you can take pramipexole for a day or two without major symptoms. You may not. If you can, you may find that you can take it one night, then take a long-lasting opioid, such as methadone or hydromorphone extended release, the next day. I've managed mine that way for several years. Eventually, I couldn't take the depression and had to stop the pramipexole. I'm trying it again now, but taking it every third day. It's enough to break up the opioid so I'm not so tired and one night of it doesn't make me too depressed. I can't take it two in a row or even every other day, though.

I think my point is that you may have to do some trial and error. But, I do have concerns about the number of drugs you're taking and unless there is something else I don't know, I can't see why you would not be able to try something else.

[veldon7]

I took Amantadine for about a mth to see if I could stop Mirapex, but the Neuro said he didn't recommend it, I guess because it has alot of side effects. I also have compulsive eating from Mirapex, but I can't stop it right now. I take Oxycodone sometimes for neck pain, but it doesn't stop the WED for the whole night, I would have to take too much of it, so I still take .5 of Mirapex for now.

[Chipmunk]

I agree with Ann. If you can take Mirapex, then I would do that and alternate with an opiate or anti-convulsant.

((hugs)) I know it's so frustrating but you WILL find something that works!