fuz_mind wrote: see his colleague who is a movement disorder specialist.... only to admit that his colleague is more familar with parkinson than rls...
Well see him anyway! He might know something about WED/RLS or be willing to investigate, and he might be willing to prescribe a real opioid.
Meanwhile, will your .. umm, whichever doc is prescribing the tramadol and ropinirole - will that one consider upping the tramadol to help deal with the lowered ropinirole?
I don't know a whole lot about your life but I think you did the right thing in lowering the ropinirole, and your doctor's lack of understanding of the horrors of augmentation is beginning to make you doubt yourself.
On another note, I won't be around for a while - I'm gone for 3 weeks in a place without internet. except tomorrow night I should be able to get online. So if I don't reply for a while, that's why.
been a while since i came to the boards.... hmmm i just found out that neurologists in my country are not allowed to prescribe real opioids...i will have to see a pain specialist for that..... the healthcare system in my country is just depressing
i haven't been able to go lower than 1mg ropinirole - after 6 weeks of being on 1 mg, my doc is pushing me to go up to 1.25mg again because he is more concern that my tramadol and clonzapam use is too high...
apparently i don't qualify for another iv iron because the numbers are borderlineish low but not low enough. just fighing the system to get a proper iron panel done was a nightmare in itself that i would like to forget
on a slightly more positive note, after struggling with mood for a long time and increasing of my bupropion to the max dose, I'm tapering it off now because it wasn't helping and I didn't get worse when I reduce the bupropion. my conclusion was that it was probably withdrawal from the tapering off of ropinirole and I actually found some information for my doc
Withdrawal syndrome when discontinuing drug treatment for
Parkinson's disease and restless legs syndrome
The European Pharmacovigilance Risk Assessment Committee, PRAC, decided in
November 2016 to update the summaries of product characteristics (SmPCs) for
pramipexole-containing medicines (Sifrol, etc.) with information that patients
discontinuing pramipexole treatment are at risk of developing dopamine agonist
withdrawal syndrome. Pramipexole is authorised for the treatment of Parkinson's
disease and restless legs syndrome.
Doctors are advised to be aware of the following:
Withdrawal syndrome may occur when treatment with dopamine agonists
(including pramipexole) is tapered off or discontinued. Symptoms of
dopamine agonist withdrawal syndrome include apathy, anxiety, depression,
fatigue, perspiration and pain. The symptoms could be severe.
Taking into account the PRAC Assessment Report on the PSUR(s) for ropinirole, the scientific conclusions are as follows:
- Dopamine agonist withdrawal syndrome (DAWS)
The occurrence of DAWS is described with other dopamine agonists (rotigotine, pramipexole): such syndrome seems to be a pharmacological class effect for non-ergoline D2/D3 dopamine agonists, and it is largely described in literature. This syndrome is associated with clinical manifestations that can be psychiatric, autonomic, gastrointestinal and sensory. As the MedDRA Preferred Term (PT) DAWS does not exist, it is difficult to find cases on it. A search can be done with PTs such as “drug withdrawal syndrome”, “withdrawal syndrome” and “drug dependence”. According to the data provided by the Marketing Authorisation Holder during the reporting period, at least 23 serious cases of drug “withdrawal syndrome” or “withdrawal syndrome” or “drug dependence” have been reported with ropinirole. In the view of the above, DAWS is considered to be an identified risk for ropinirole. Sections 4.4 and 4.8 of the SmPC of ropinirole should be therefore amended, in order to reflect such risk. Furthermore, in section 4.2 a cross-reference to section 4.4 should be added. The package leaflet should be updated accordingly