Withdrawal from pramipexole (mirapex) help please....

[18jeffries]

My dad started withdrawing from pramipexole a few weeks ago. At first he dropped half a tablet every 5 days and then when he got to his final tablet just over a week ago (he was doing well and going on holiday the following week) he dropped the whole tablet in one go. Since then he has been experiencing bad days and hellish nights. After researching on this site, he got some tramadol from the doctor which he was taking before bed, in desperation, after a hellish first few nights he reached for his new drug ropinrole and also began that. Unfortunately, things are still hard to cope with and yesterday the doctor explained he could take some tramadol at bedtime and some in the early hours and this would enable him to doze through the night.
I guess what I am looking for is some reassurance that all this will come to and end! It's such a long road and the strength needed to get through this hell unimaginable!
Thank you in advance.

[ViewsAskew]

So, let me understand - is he still taking the ropinerole? And, tramadol?

If so, it may not end until he stops taking the ropinerole - and then it may take as long as 3 weeks, but most people are much better in 5-10 days. It sounds as if he has augmented - which I think you figured out. Some people who are mildly augmented can switch to another dopaminergic drug and be OK for awhile. But, once someone has severely augmented, this tactic rarely works (to switch to another DA). The only way out? To stop ALL dopamine agonists - no pramipexole, no ropinerole, not rotigotine, etc. Then wait until the symptoms subside (or take an opioid to get through it), and then take another class of medication.

I'd suggest writing to Dr Buchfurher - somno@verizon.net. Give him exact dosages (tablets come in different doses) - what he was taking and for how long, how many times he increased the drug, what he is taking now - and ask him for advice. He usually gets back to people very quickly - sometimes even the same day.

If you tell us more, we can give you our opinions, too. Here is some info that would help us help you:

1. How much pramipexole was he taking in mg per day?
2. How much worse are his symptoms now compared to when he first started taking the pramipexole? How long has it been since he started taking pramipexole?
3. Did the doctor say why to stop the pramipexole before starting the ropinerole? When switching from one DA to another, he should be able to simply switch (normally, it requires 2 to 3 times the amount of ropinerole compared to pramipexole). So, if he was taking .25 pramipexole, he could simply start taking .5 mg ropinerole.
4. Has he ever taken any other medications for RLS/WED?

ome doctors, such as Lee and Buchfuhrer, suggest that we should be using much lower doses of DAs than are approved by the FDA. The FDA approved .5 mg per dose; these doctors believe that a maximum of .25 mg should be taken per day, and only once a day. For ropinerole, they suggest the max dose, once a day, to be 1 mg. See "The Clinical Management of RLS" by Lee, Buchfuhrer, Lee, and Hening.

[18jeffries]

Thank you for your advice. I now have a reply from Dr Buchfuhrer.