Is your DA causing augmentation?

Use this section to discuss your experiences with prescription drugs, iron injections, and other medical interventions that involve the introduction of a drug or medicine into the body. Discuss side effects, successes, failures, published research, information about drug trials, and information about new medications being developed.

Important: Posts and information in this section are based on personal experiences and recommendations; they should not be considered a substitute for the advice of a healthcare provider.
stjohnh
Posts: 1284
Joined: Sun Feb 14, 2016 3:13 pm
Location: Palo Alto, California

Re: Is your DA causing augmentation?

Post by stjohnh »

Welcome to the forum. Ask all the questions you like, and tell us a bit about yourself and why you are here.
DA is short for Dopamine Agonist. This is the most common group of medicines prescribed for RLS. The DAs are Requip, Mirapex, and Neupro patches. Most cases of augmentation are caused by these. They work very well for mild RLS and pretty well for moderate RLS, but the dose must be kept much lower than the official prescribing information. Besides augmentation, they have another occasional side effect that is very serious, loss of impulse control.This can devastate a family if a person starts unrestrained gambling, spending money, or having extramarital sex. All things most people would never do if it were not for side effects from these medicines. Many people feel they should no longer be first line drugs for RLS. Doctors should first be trying IV Iron or gabapentin (or it's relatives, Lyrica or Horizant).
Blessings,
Holland

Rebeccalee1991
Posts: 14
Joined: Mon Jun 29, 2020 3:56 am

Re: Is your DA causing augmentation?

Post by Rebeccalee1991 »

Hello,

I am looking for advice to find out what would be safe for breast-feeding. Opiates are out of the question I currently take gabapentin and have an appointment with the sleep disorder center doctor on March 17.
He pretty much said that if I don’t take the opiates there’s nothing else really that he could prescribe.
I’m looking to give him some suggestions.
My OB/GYN said find an alternative when it comes to Mirapex or Requip.
Do you have any advice thank you so much

Rustsmith
Moderator
Posts: 6476
Joined: Sat Sep 28, 2013 9:31 pm
Location: Colorado Springs, Colorado

Re: Is your DA causing augmentation?

Post by Rustsmith »

If opiates and the dopamine agonists are all ruled out, that leaves iron therapy, gabapentin, Horizant and Lyrica. There are also the non-pharmaceutical ways of reducing the urges, such as soaking your legs in a hot bath or in a shower. You might also find some useful information in the Special Populations fourm, which is where a number of pregnancy related questions are located.
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 16571
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Is your DA causing augmentation?

Post by ViewsAskew »

Rebeccalee1991 wrote:
Mon Mar 01, 2021 4:41 am
Hello,

I am looking for advice to find out what would be safe for breast-feeding. Opiates are out of the question I currently take gabapentin and have an appointment with the sleep disorder center doctor on March 17.
He pretty much said that if I don’t take the opiates there’s nothing else really that he could prescribe.
I’m looking to give him some suggestions.
My OB/GYN said find an alternative when it comes to Mirapex or Requip.
Do you have any advice thank you so much
To echo Rustsmith's post, I'd push for iron therapy first. Make sure your doc is up to date on the work done in that area. Make sure they tell you the actual value of your serum ferritin when you have the test.

Another option - and it doesn't work for all of us - is to look at diet. The gut is increasingly linked to many things, and RLS/WED is one of them. There isn't much available regarding it, but for years, some people have found that a special diet can decrease (and in a few cases, eliminate) symptoms. It's a lot of slogging through and some of us find it harder to do than others. Definitely worth a consideration.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
Moderator
Posts: 6259
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Is your DA causing augmentation?

Post by badnights »

I am looking for advice to find out what would be safe for breast-feeding. Opiates are out of the question
Hi and welcome. Why are opiates out of the question? Because there is a risk of respiratory depression in the baby? You would have to watch Baby carefully, but it is my understanding that opioids are the safest option available to pregnant WED/RLS women, safest for the fetus, that is. There have been board members who have been treated with opioids during pregnancy and given birth to healthy babies who were weaned off the opioid after birth. Other WED/RLS medications are less safe for the unborn baby.

If you're only concerned about the breast-feeding phase, dopamine agonists suppress lactation so they're not an option, but you may be able to use gabapentin. A pharmacy service in the UK says: "Limited data [suggest that] gabapentin use during breastfeeding can ..proceed, with adequate infant monitoring" and "due to limited data for pregabalin, alternative agents for which more data exists should be used preferentially" - from https://www.sps.nhs.uk/articles/gabapen ... stfeeding/

I checked to see if iron delivered intravenously enters breastmilk, and it doesn't appear to ("Limited data indicate that breastmilk iron is not increased after intravenous infusion of iron sucrose. Amounts of iron ingested by the infant would be normal and are not expected to cause any adverse effects in breastfed infants." - from https://www.ncbi.nlm.nih.gov/books/NBK501468/) . It takes a while before an infusion kicks in, though, possibly a month or more, so you need to have something to manage with during that time.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

beagleslp
Posts: 1
Joined: Sun Jan 10, 2021 8:48 pm

Re: Is your DA causing augmentation?

Post by beagleslp »

I have just upped my Ropinerole dosage from .5 mg to 1.0 mg. I could not tolerate the side effects of vivid dreams, sweating, and nausea so I cut back to .75 mg. It is effective 3 hours after I take it, but I'm still suffering from the same side effects. I have also recently weaned off Clonazapam and Gabepentin because these were no longer working. Does this mean that any DA will cause these side effects? I also realize that DAs can easily augment.
Any suggestions? Thanks ahead of time!

Julieod
Posts: 2
Joined: Thu Dec 22, 2022 4:24 am

Re: Is your DA causing augmentation?

Post by Julieod »

I’ve been on Pramipexole for about 4 years going from 0.125mg at the beginning up to 0.5mg now. I suspect augmentation is happening. My doctor added Pregabalin 75mgs however the side effects are uncomfortable. I have an appointment to see the sleep specialist in February, so hopefully he can come up with a solution. I live in Australia and have been reading about methadone as a treatment and not sure if its used here for RLS. I will do some more research before I see him. It’s getting really bad and some nights no sleep.

Polar Bear
Moderator
Posts: 8799
Joined: Tue Dec 26, 2006 4:34 pm
Location: United Kingdom

Re: Is your DA causing augmentation?

Post by Polar Bear »

Julieod - Having increased your Pramipexole, are you having the typical symptoms of augmentation, worse symptoms, symptoms starting earlier in the day, spreading to other parts of the body. If this is happening then there is really little doubt and you (and your doctor) need to be thinking of weaning off the Pramipexole. If you read some on the Augmentation Forum you will see that this is not an easy task but it is vital to come off the Pram. You will need support from your doctor to do this which generally means a low dose opioid to help you through the first week or so. It will still be difficult but so worth it.
I take Pregabalin for another condition but have the bonus that it will also help to ease my RLS symptoms. However my dosage is much higher that yours and I am unaware of any negative symptoms.
Take a look at the link in my signature and you should find some useful information to show to your doctor/sleep specialist. Highlight the most relevant and if you feel it necessary, just ask what they think of this information. Do Not say that you found it on the internet.
Betty
https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Rustsmith
Moderator
Posts: 6476
Joined: Sat Sep 28, 2013 9:31 pm
Location: Colorado Springs, Colorado

Re: Is your DA causing augmentation?

Post by Rustsmith »

Julieod, methadone isn't the only opioid that can be used to treat RLS. Any of them are equally effective so long as your doctor gets the dose right. Codeine is the weakest of the regular opioids, but works for RLS. Even tramadol, which is even weaker will work at near the max dose. I used to be a fan of tramadol, but have soured on it because it is also an anti-depressant and carries many of the typical anti-depressant side effects of putting a damper on sexual libido. The only thing to be careful of is that many of the typical "pain killer" opioids also include tylenol and tylenol can eventually cause liver damage if taken daily. All of those meds are available without the tylenol, so if your doctor chooses something else, make certain that it doesn't have tylenol.

Granted that you are in Australia and your doctor may be dismissive of any American medical literature or bound by Australian regulations may limit what your doctor can prescribe, but here are two publications that you should read, highlight the relevant sections and then ask your doctor for his/her opinion of them.

https://www.mayoclinicproceedings.org/a ... 0/fulltext
https://www.mayoclinicproceedings.org/a ... X/fulltext

If you have augmented, then you have Refractory RLS
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

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