Mirapex to Horizant

[mikereyes001]

Hi All,

I've been on 0.5 generic Mirapex for 3 years to control severe RLS (no augmentation as of yet). I went to a new Neurologist who said they preferred Horizant ER. I tapered off the Mixarex with my last dose 2 weeks ago and had been taking 600 mg Horizant ER. After a few days I had lots of withdrawal symptoms. The doctor said try 1200 mg Horizant... and 50 mg Tramadol (as needed). I was ok for a couple of days and then things went downhill. My dose of 50 mg Tramadol that I would usually take at 10pm wasn't working and my RLS was really bad. I've tried taking it earlier at 6pm and then 10:30pm and that wasnt working either. Last night I did 6pm, 10:30pm and 3am and finally got to sleep. It feels like the tramadol is losing effectiveness.

I ordered the book "Clinical Management of Restless Legs", but it will not be here until Wednesday. I'm getting married in 2 weeks and dont want to be screwed up with withdrawal symptoms. I'm not 100% sure whether it is withdrawal or just the Horizant ER/Tramadol cant treat my RLS alone.

My calls to my doctor have gone unanswered. I'm not sure if I should just give up and go back on the Mirapex after all my work thus far.

Can someone tell me how long Mirapex withdrawal symptoms usually last? I've been off for 2 weeks.

My prescription for Tramadol is 50 mg every 6 hours. It seems like I need more, but am afraid to go a little higher since I dont know what a safe dose is. I'd like to take it every 3 hours or just double my dose to 100mg every 6 hours. Does anyone have any thoughts?

[Polar Bear]

Congratulations on your up coming wedding, you certainly don't want to be suffering withdrawals or insufficient medication at that time,
If it was me ... I'd be working for control for the next few weeks and then reconsider the position.
Are you taking your 1200 Horizant as one dose, I wonder ... what if you took two separate 600mg doses.
One important thing about medication is to stay ahead of the symptoms. The med finds it harder to work effectively once symptoms are in full swing.

Regarding Tramadol. I used to take this as 50mg x 4 times daily. (as well as ropinerole which is similar to mirapex) The tramadol was recently changed to 100mg slow release x am and pm and appears to be somewhat more efficient. My understanding is that Tramadol max dose is 400mg daily - not all at once !!
Timing is important. If I take it too early of an evening then my morning symptoms kick off at around 8am. Which isn't much fun when I'm only getting to sleep at around 4 am.

A shame that you were doing ok on the mirapex and that the change has been troublesome.
It's debatable that your current medication would have been sufficient to cover the increased symptoms that would occur with coming off mirapex.

Being off mirapex for 2 weeks is excellent, it is such a difficult thing to do. It's reckoned that it could take 3 or 4 weeks for withdrawal symptoms to settle, and sometimes longer.
Tempting though it is, is would be a shame to undo your two weeks without mirapex.

Not good enough that your doctor is not responding to your calls for help.
It would be of benefit to get his confirmation that it would be ok to adjust your Tramadol, or provide an alternative that provides relief to at least get you through the wedding festivities.

The book you have ordered is well worth while.

[ViewsAskew]

The best advice I have is to email Dr Buchfuhrer - one of the authors of the book you ordered. He is GREAT about answering questions. somno@verizon.net

When you stop pramipexole and you have not augmented, as far as I know, most people do not have severe withdrawal symptoms. Some mild ones, but not that bad - the bad ones are with augmentation. The doc may know more about that.

As you noted, it is very possible that Horizant just won't work. That said, I do know that Dr B will go up to 1800 mg and possibly 2400 of Horizant (because I'm a patient and that's how high he was willing to go with me). If it's helping some, he may feel that you just need more. I got to 1800 and had NO response at all along with a lot of side effects, so we didn't go higher.

Let us know what the doc says. It must be terribly frustrating to be in this position, especially since it was working fine.

[Frunobulax]

In the short term it may help to add a smaller dose of Mirapex if withdrawal symptoms persist. This may prolong the overall withdrawal phase, but with a wedding coming up you might want to take the relief now and handle the withdrawal later...

[mikereyes001]

Thanks to all the nice responses. Interestingly enough, after making my post I friday I needed to go out of town for the weekend. There were storms in Michigan that knocked out the power to the hotel I was staying at. The elevators weren't working, so I made 4 or 5 trips up 4 flights of stairs during the evening to carry my luggage to my room, meet people and so forth.

I took the same meds that I described earlier, but this time I slept through the night with no problem. So I'm thinking the unusual exercise helped in addition to what I am taking. After the power came back on the next day, the elevators were back, but I decided to stick with the stairs. I went up and down another 4-5 times, but throughout the day instead of all after 7pm. That night I went to sleep ok, but was woken up by RLS symptoms a couple of hours later at 2:30. I took another Tramadol and that stopped the RLS, but gave me some alertness side effects from the increased cumulative dosage. It resulted in sub-par sleep for the next several hours. So I was pretty tired today.

I'm going to try 1800 mg of Horizant ER at 6pm with 50mg Tramadol. Then add another 50 mg of Tramadol at 9pm to stay ahead of any symptoms. Finally, I'll walk the stairs at home at 10:00 to give me the same leg workout I got in the hotel. Hopefully that will help. I might also try 1200 at 6pm and 600 at 10pm on another day.

If I still have trouble over the next few days, I may try a really low dose of Mirapex ever other day to get me through until after the wedding. I'll also check out the Doctor's book and email him with questions.

Thanks all!

Mike

[ViewsAskew]

Please let us know what happens!

And, congratulations on your upcoming nuptials.

[mikereyes001]

I got the doctors book. I will take a look. I think the Horizant just hasnt been working.

My doctor office finally got back to me and recommended I take Requip 2mg. That is a whole big other story (I just posted separately on this)

[ViewsAskew]

I got the doctors book. I will take a look. I think the Horizant just hasnt been working.

My doctor office finally got back to me and recommended I take Requip 2mg. That is a whole big other story (I just posted separately on this)

I answered there first - I couldn't remember if your username was the person getting married - I thought it was. As people have noted in this thread, switching to ropinerole may not help you in that regard, but since you completely stopped it, it's possible you will reset a bit and it will. Here's hoping.

People usually need 2 to 3 times the ropinerole as pramipexole. That said, since you were augmented, please do start with the lowest suggested dose as I posted in the other thread. You may find that you can take much less than that.