Opiods

[pjmccoy1]

6.5 weeks of low dose liquid methadone (I hate the name of this Rx, cannot get beyond the associated stigma, shamefully). I take my prescribed dose between 9 p.m. or 10 p.m. I've noticed in the last several days that it seems almost exactly at the 12 hour mark I get a little tingle of RLS flare ups. Does that mean I'm already developing tolerance so soon? Please bear with my blasted anxieties. Each of you have been so patient with my incessant obsessive thoughts on this new treatment. Anyhow View mentioned spreading her prescribed dose throughout the day. Did you tweak your dose on your own or did your physician direct how you should take it? My RLS doc just prescribed it all at once in the evening. Also wondered if anticonvulsants (Lamictal) augment? I've been on Lamictal for unipolar depression for 8 weeks gradually increasing dose. It was the only AD for treatment-resistant depression (as a result of long term non-treatment due to finding a RLS friendly AD). There are a few studies that have showed it has resolved depression, Parkinson's and RLS symptoms. Rambling and TMI, anyhow focus. Should I ask my RLS doc about spreading out the dose?

[QyX]

Spreading the dose might help or maybe you need a total higher dose. Same dose at night and a lower dose, maybe 1/2 or 1/4 in the morning. Talk to your Doctor. It is a trial and error thing.

Never heard that you can augment on anticonvulsants. For all I know you can only augment on Levodopa/L-Dopa, dopamine agonists and sometimes on Tramadol.

[Polar Bear]

Never heard that you can augment on anticonvulsants. For all I know you can only augment on Levodopa/L-Dopa, dopamine agonists and sometimes on Tramadol.

I would agree with this.

[pjmccoy1]

I forgot to add Psych added Zyprexa 2 weeks ago for insomnia (cause GI issues) then switched a week ago to Seroquel which is helping some with sleep but just learned both are dopamine agonists which may be the culprit instead of pain med for RLS flare ups. I will ask Psych about Trazadone or since the depression is somewhat better stop the sleep aide or move up pain med earlier maybe 8p.m. This is such a maze as you guys already know. When will big Pharma find a cure or for Parkinsons and RLS? My RLS doc has a 72 year old female patient who has been on methadone for 7 years with no side effects (or at least she doesn't report or complain with any). Not taking anything for insomnia either. Thanks again for your input and suggestions.

[QyX]

Seroquel and Zyprexa are no dopamine agonists, they are dopamine ANTAgonist with Zyprexa being the more potent drug. Both drugs also affect lots of others neurotransmitter. Hard to tell how RLS is affected by this. I need to take other drugs so that I can take Seroquel as a sleeping aid. Without other drugs I develop ugly feelings in my legs and Zyprexa causes depression within one night.

[pjmccoy1]

QyX, Why do you have to take other drugs while taking Seroquel? I thought Seroquel helped insomnia? I think I may not understand what the difference in a dopamine agonists and a dopamine ant-agonist as it relates to RLS? If I cannot get to sleep due to depression or pain med alerting I may ask about Trazodone, however concerned about GI issues (constipation since pain med already causes that but have it under control for now until I added Seroquel). Not sure which is worse for constipation. If I could just get to sleep I wouldn't have to take anything but Lamictal and pain med. Zyprexa wouldn't even get me to sleep. Remeron was great after 2.5 hrs of RLS horrific thigh pain (new side effect of RLS) then collapsed so stopped it. I had to try all of this because depression had gotten so bad and lost weight and doc's wanted me to get to sleep and gain some weight back. But as you well know (med student I think?) the antipsychotics cause rapid weight gain (mainly belly fat something I've never had). Sick of this maze. If blasted major depression disorder would subside wouldn't have to have so many med's. I was hoping wellbutrin would work but it wired me at only 37.5 mg in the a.m. I am the Queen of Rx sensitivity.

[QyX]

I can't just take Seroquel and Opioids. Opioids alone are not enough for my complex and severe RLS. I take dopaminergic drugs (Levodopa/L-Dopa and Dextroamphetamine) to block the dopamine antagonists effects of Seroquel. I think it is fair to say that dopamine antagonists (like all antipsychotic medications) are bad for RLS.

Dopamine agonists stimulate dopamine receptors and dopamine antagonists basically do the opposite. In reality it is much more complicated then that but it explains why these drugs in genral are bad for RLS.

[badnights]

Dopamine agonists stimulate dopamine receptors and dopamine antagonists basically do the opposite. In reality it is much more complicated then that but it explains why these drugs in genral are bad for RLS.

Clarification: "...but it explains why dopamine antagonists in general are bad for RLS." (Dopamine agonists are, in general, good for RLS.)

[QyX]

Oh sorry! You are right!

[pjmccoy1]

Okay now I'm really confused. So Seroquel and Zyprexa exacerbate RLS because are dopamine antagonists? Does anyone take Trazodone for insomnia? If so, does it make the constipation worse and is the dry mouth tolerable? Also, which has less GI issues, bloat and weight gain?

[Orrel]

I'm trying to get off mirapex using the Neupro patch which, being a DA, causes insomnia. I take 100 mgs of trazadone at bed time and another 100 mgs when I wake up in the middle of the night. I don't think that trazadone is very effective for inducing sleep for me, certainly not if I am awakened by rls, However, I seem to tolerate it okay (no constipation or weight gain.) I am not taking opioids

[ViewsAskew]

Okay now I'm really confused. So Seroquel and Zyprexa exacerbate RLS because are dopamine antagonists? Does anyone take Trazodone for insomnia? If so, does it make the constipation worse and is the dry mouth tolerable? Also, which has less GI issues, bloat and weight gain?

I did take trazodone for insomnia. No effect on constipation. I did not have a dry mouth or any other issues.

Most (maybe all) antipsychotic drugs, including both mentioned above, are dopamine ANTagnoists. These are very bad fro WED.

Other drugs taken for depression and other mood issues, may exacerbate WED, but for other reasons.

[pjmccoy1]

View: So I take it trazodone did not help your insomnia and you're no longer taking it?

[Joanie60]

How long does oxycodone last versus methadone? I know methadone has a longer half life. Does anyone take hydrocodone and how long does it keep the RLS under control?

Sorry pjmccoy1, I just saw this post. I have been on oxycodone for three years, started at 10mg a day, now up to 15-20mg. I have tried the long lasting type (oxycondone) but had awful side effects (huh?? Don't know how that happened). I have tried every drug manufactured for this *)$# disease and have symptoms whenever I am awake. My doc not happy that 15 mg is creeping up to 20mg (three 5mg pills every 6 hours or so with a fourth when I am going nuts) and tried adding on Lyrica (caused shortness of breath, scared me). Now we are going to try Methadone when I get back from a 2 month visit to Germany.

My experience with Oxy is up and down and up and down. Due to the short half-life, I have several hours symptom free, then they creep back till I take the next pill. If I wait until symptoms are bad to take the pill, it can take an hour or more to find relief. So I try to take it before it gets too bad. So my day is ruled by my RLS. Wake up, wait for the pain and discomfort to kick in (one hour usually), take a pill, couple hours relief, wait for symptoms to hit again, try to space out the pills to last longer balanced with taking the pill before pain gets bad, waiting for that one to kick in, couple hours relief, then the timing game of the next pill begins. I am exhausted just typing this out lol.

So we are going with longer-lasting methadone. I am a bit apprehensive, as Oxycodone is ONLY thing that has helped (other than Ropinerole..in the beginning, until it turned on me, like a freaking abusive boyfriend haha). But I understand my doc not wanting me taking more than 15-20mg and I would LOVE to only take two pills a day, with no rollercoaster of symptoms.

I return on Jan 26. Thanks also for all the support everyone, for helping me figure out how to be overseas with narcotics haha. Especially QyX. My doc wrote a three month supply, with letter to insurance co asking for vacation override. Had to pay 2 extra months health insurance premium in advance (those *($#*W()$), put the pills in a vitamin bottle, carried copy of the script, and sailed thru security with no problems. This is a beautiful country you call home QyX and our grandson was born healthy and happy

Happy New Years one and all!!

[pjmccoy1]

Joanie60: I am amazed at how so many RLS sufferers are able to travel, let alone abroad on such long trips. I am mortified to travel anymore. It's bad enough to make a 2 hour trip to my RLS doc and Psych for this blasted depression (which I am sure is not only from genetics clinical depression but also RLS daily horror). Most days I feel like such a crybaby wimp when I see how so many RLS sufferers (several with extreme cases) seem to keep such a hopeful, determined and positive attitude. Anyhow, I guess the scariest thing for me is I, too, fear tolerance knowing that RLS will progress and continuously require more and more and at 52 years old 25 - 30 years of this nightmare, is for me, beyond dreadful. And of course, the depression only makes things worse. Anyhow, I sincerely hope you have as much success on the longer life pain med as many have expressed on this RLS forum. I've only heard of a few that have been on pain med's for 10 years, so what do I do at 62 when I'm maxed out on safe limit. Also, do side effects worsen (GI issues, alerting, nausea, etc...) with increased doses? Once again, my anxiety and obsessive thoughts of a scary RLS future is taking control of my life. So many of the moderators and members have been patient and encouraging to me even with my extreme fears. One thing I've wondered about is are the pain med's in fact making the RLS worse (maybe not augmenting) but turning into RLS that is experienced by people who are coming off pain med's. In other words, our pain med dose starts to wear off or we build up a tolerance and then we experience both reduced effect and RLS withdrawal symptoms from pain med's. I ask this because I take the long term pain med at 9p.m. and within 30 minutes or so of taking it I start experiencing cold flashes/chills. This goes on even after I go to bed at night after taking the pain med. However I am also taking other med's for depression but they are in the morning. Anyhow just wondered if anyone else has ever experienced the cold flashes/chills on pain med's? Again, this mimics withdrawal symptoms from pain med's.