Stainless wrote:
What to do now? A new doctor, a new med, back to the old med? I'm very frustrated and it is 3 months until I see a doctor again. Rick
I would look for a doctor who is willing to prescribe opioids for RLS. He doens't need to prescribe high potent ones like Oxycodone or Morphine. Codeine, Tramadol or Dihydrocodeine also work at the beginning very well and maybe you can rotate between low potent opioids and DAs?
Please note: Tramadol also inhibits the reuptake of serotonine. So in some cases Tramadol can worsen RLS.
I would prefere Dihydrocodeine because there are long and short acting pills available. It's also a cheap drug and double as potent as Codeine or Tramadol.
In Berlin I had to look for over an year until I finally found a doctor who was willing to prescribe opioids and when I lived in south Germany, I had to drive over 80 km to see my doctor. I know it is hard and difficult to find a doctor who is willing to prescribe opioids for RLS but I think it is really worth it.
I've tried Lyrica and Gabapentin before I went on opioids but I had horrible side accepts. I couldn't believe this drugs had so many side effects so I tried them over and over again.
And even if they work, they normally don't work as a monotherapy so the only real way to overcomve augmentation is going on opioids and avoiding DAs. Not that I hate DAs but sooner or later they cause so many problems.
DAs made me aggressive and impulsive. I got very sensitive to noises and after they stopped working, symptoms came back double and tripple as worse as before.
I think DAs only should be taken if you need them or irregular, like 1-3 times per week because augmentation will hit you. It is just a matter of time.
When you have daily symptoms, low potent opioids and antiepileptics should be 1st line treatment. (This is my personal opinion)
Okay, with this new opioid prescription guidelines in the U.S. .. probably most people will try to get the maximum from DAs before even to start thinking about taking an opioid.
What a mess. In Germany Oxycodon (but not any other opioid) is offically approved for RLS as 2nd line treatment when DAs didn't work. But because of Oxycodone is such an expensive opioid, insurance companies won't care if doctors use any other opioid.
And as for the guidelines: because Oxycodone is offically approved for RLS, it is generally accepted that opioids are an approbriate treatment for RLS. So no doctor has to worry when prescribing opioids for RLS. Of course not every doctor knows about this and likely the majority of the doctors would avoid prescribing an opioid as long as possible.