augmentation

[maybe]

I am on Mirapex for a long time. It does not seen to work as well. I take 1MG a day. At night I will take half but it does not seen to help .I walk the floor before Mirapex works. I also take 1mg clonazepam. It does not help my legs but it will help me sleep. I would like to go off Mirapex Some days are better than other but Mirapex does not work as well. I would like to know what I could take instead of Mirapex. during the day sometimes I will .sit in a chair and I have to get up, Please help me how to get off of Mirapex and on to something else. My doctor is a GP and tries to keep me on Mirapex. I have trouble with medicines

[debbluebird]

There are several discussions going on regarding this subject. You are probably augmenting and it won't get better until you totally stop the Mirapex. Cold turkey is the best way. It's hell for about a week, but then starts to get better. Most people get opioids while they are going through it and stay on them. Also you can add gabapentin or lyrica. That might help. Good luck.

[Polar Bear]

If you look at the signature of any post of badnights she has a link to a document regarding augmentation. This would be good to discuss with your doctor to try and discover if augmentation is the cause. As debbluebird says, you will need help from your doctor if you want to come of your medication. It is a difficult thing to do.
Also, have you had your ferritin serum level checked recently, it should be up near 100 for people who suffer from WED. Low ferritin iron can be a trigger.

[EeFall]

1 mg a day of Mirapex is a huge dose. It worked for me for years at .125 and I take .25 mg now. There have also been discussions on this board about the dosage of Mirapex, my sleep doctor does not get anyone more than .75 mg a day of Mirapex. If you do get off of Mirapex and you end up going back on it someday you should try the smallest dose that works first, start at .125 mg. Several other drugs may work for you including Neupro and Requip.

[ViewsAskew]

If you are augmented, here are the options.

To get off the pramipexole.
1. Stop pramipexole, use an opioid to reduce the increased symptoms over the next 1-4 weeks.
2. Stop pramipexole and just live through the difficulties. I understand that this may take longer and be harder than using opioids.

What to do regardless
You need to know your serum ferritin.

Once you are off, what you can take
You can try pregabalin, Lyrica, and similar drugs.

If it is, or once you can get it to be, over 100 (your serum ferritin), you can try other dopamine agonists, such as Neupro. You may or may not have difficulty with them.

You can use pramipexole for short periods - say 1-5 days - and then use an opioid for 1-3 days. Then back to the opioid.

[badnights]

Hi maybe

We're assuming you need to stop pramipexole because you're augmenting, but I realize you haven't actually confirmed that.

To know if you are augmenting, you'll have to remember back before you took Mirapex. Do your symptoms start earlier in the day now? Are they more intense? Have they spread to other body parts (eg. arms)? Do they start as soon as you stop moving, or sooner after you stop moving than before? If these changes have happened relatively recently, and can't be accounted for by normal progression of the disease, you are probably experiencing augmentation. That's when the medication makes the disease worse. The drug helps while it's in your system, but you need more of it, more often to control the symptoms.

Most importantly, your doctor needs some more information. If you can print these two things to bring him, it would be very useful:

WED/RLS Medical Bulletin

Strategies for the Treatment of Restless Legs Syndrome, by Mark Buchfuhrer, Neurotherapeutics (2012) v9 p776-790

The latter paper can be downloaded by following the second link in my signature below. It will lead you to a post with a number of links; one of them is the paper by Dr B.

It might sounds crazy to bring papers to your doctor, but a number of us have done it with good results. Do you have access to a printer? If not, copy the "Strategies" citation above, and bring that to your doctor. He/she can find the paper himself, and hopefully will.