Mirapex to gabapentin

[Aipulu]

Views askew, it seems to me that my withdrawal symptoms are almost entirely in the hands and wrists and they are stronger and more painful in the withdrawal from Mirapex. The normal creepy crawly sensations that I experience in the lower legs and arms are still felt if I a, late on a pill. So I usemaugmentation pains to differentiate between the normal rls symptoms and what I am currently experiencing.

[ViewsAskew]

Many of us have increased arm and hand symptoms during augmentation, so that makes sense.

[Aipulu]

I have been shifting form Mirapex to gabapentin for over 5 weeks, using ultram to help with the withdrawal symptoms. I may have plateaued at 1500 - 1800 mg gabapentin with 100 - 150 mg of Ultram(tramadol). for about 3 days I wa taking 1200 mg of gabapentin and 100 mg of tramadol at 9 pm. But each of those nights I increased the gabapentin by another 300 mg and tramadol by an additional 50 mg at around 11 - 11:59 pm. since my symptoms had not gone away entirely within 2 hours. Then 2 hours later I still had enough symptoms to keep me awake so took another 50 mg of tramadol. Last night I tried to keep the tramadol at 100 mg and needed to increase the gabapentin to 1800 mg. So change is now very very slow. Or there is the possibility that gabapentin alone isn't going to be sufficient for me and that I will need a second medication. Any thoughts out there on this?

Richard

[Rustsmith]

Richard, gabapentin is a bit unusual in that the amount that is adsorbed by the small intestine can change from day to day. You might be able to get all 1800mg today and then tomorrow you get 1200 and the other 600 passes right on through. So what works today might not be effective tomorrow. This also means that there is a maximum "effective" dose. Beyond this point, everything else is simply lost. Horizant has a modification that allows it to be more easily adsorbed and then it converts to gabapentin in the blood. Unfortunately, Horizant is currently several orders of magnitude more expensive.

As for a second medication, that is quite possible. I currently use Neupro to address the urge-to-move side of my RLS/WED and gabapentin to help with the insomnia. I also get migraines and gabapentin does double duty by helping reduce the number and severity of my headaches.

I know that there are others who also used two different medications. Some alternate between the two to reduce unfavorable effects and some are like me that double up.