Restless Legs Syndrome (RLS) Discussion Board

I was on mirapex, then the other one(pram..) forever with severe augmentation. Been off all dopamine agonist for a year or so. My neurologist wants to put me on requip but I am resisting. When I ask her about augmentation she just shrugs her shoulders and says she doesn't know. Will I augment right away because of my past augmentation or will it take a few years??? I have tried some other things but ...no luck. She will not consider pain med. except tramadol which isn't working.

If you can sleep reasonably well without using requip or mirapex or other dopamine agonists, I would stay off them. However, the dopamine agonists are the best tolerated of the reasonably effective treatments for restless leg syndrome.

Generally once a person has augmented, restarting a dopamine antagonist is apt to cause augmentation fairly quickly, however there is tremendous individual variation. I augmented on mirapex, stopped it for 10 days or so and my dopamine receptors reset during that time, and I was able to restart mirapex at a much lower dose. I have been on that for quite a few months now and it remains fairly effective. Remember your goal is not to get rid of all symptoms of RLS, but to treat the symptoms to whatever level is necessary for you to tolerate. Treatment with the goal of removing all symptoms is likely to require much higher doses of medication, increasing augmentation and side effect problems.

Thank you Holland, I do need something very badly. I don't sleep, at all, until about 4 or so when I drink a cup of coffee. Then I sleep for an hour or two. Then eat and maybe sleep another hour or so.

Restarting the dopamine agonist at a low dose and keeping the dose as low as possible will make augmentation less likely. I take kratom along with mirapex and it helps keep my jumpy legs under control with less mirapex.

I waited a couple years before trying DAs again after augmenting. I augmented in about the same amount - really quickly. I increased my ferritin quite a bit - and recently took it for 4 times longer without augmenting.

Just my experience.

Skippy, I was on pramipexole for about a year and then I augmented. My doctor switched me to the Neupro patch because the thinking at the time was that a time release dopamine would be less likely to cause augmentation. I lasted on Neupro for about 15 months before I had to give it up as well. At that time, I was in the process of moving so my doctor (a recognized specialist) put me back on a high dose of pramipexole to keep my symptoms under "control" until I get in to a new doctor. It took several months of misery before I could get in to see a doctor who was willing to prescribe anything other than a dopamine agonist, Lyrica, gabapentin or Horizant. I now have to travel 100 miles each way to see my doctor (another RLS specialist and researcher) and it has been worth the pain and effort to get to where I am today.

So, if you have to change doctors and need to search to find either an RLS specialist or a neurologist/movement disorder physician who is willing to prescribe what you need, it will take some work and research on your part but will be worth the effort in the long run.

Thank you all who responded. I tried kratom but only took it a few times and it made me sick and effected my liver. My plan is to cry "uncle" to my neuro and take the requip long enough to get into a dr.either in Atlanta, or Houston. I do have so many questions concerning having a dr. 6 hours away from home. But first things first...sleep hopefully with the requip. I may be able to think straight again.

Fingers crossed it works.

Not sure how Dr Rye works - I see Dr. B. He works with me through email. The only issue I've ever had is when my insurance won't accept something he wants to do because he's not in our plan. I have to try to convince a local doc to prescribe it, for example, and that isn't always easy. Other than that, it's gone well.

I saw Dr Ondo in Houston for a couple of years before moving away from the area. Now I have to travel an hour and a half each way to see my doctor.

First, don't be surprised if you have to wait for weeks or even a few months to get an appointment. Dr's who "get it" are in high demand and their time available to see patients is often more limited than your local doctor. This just means that you have to plan your time during the appointments more carefully and then be willing to rely upon contact by email or phone for routine things like prescription refills and adjustments to your medications.