I was at the pulminologist's with my wife, because she snores loud enough to peel paint, and we thought it was a good idea to get it checked out. Doctor said, I'm a sleep specialist, so I asked her, if I developed augmentation with Mirapex, would she feel comfortable helping me sort out what to do next? She looked at me like I was a doofus, and said, with great authority, "Dopamine agonists don't cause augmentation."
Educate, educate, educate, right? So I've printed out a study of people on Mirapex that shows 37% develop augmentation, 46% tolerance. I'm going to give it to her when we go back after the sleep study. Chances are she'll be nasty about it, but hopefully she'll read it.
I'm not going to say, "Who's the doofus now?" But I'll be thinking it.
fenris
Another clueless doctor
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"tis truly amazing. Thank goodness we've got that Algorithm and other studies that can educate them since we're just humans, not doctors, and couldn't possibly know something that they don't know...
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Re: Another clueless doctor
fenris wrote: She looked at me like I was a doofus, and said, with great authority, "Dopamine agonists don't cause augmentation."
Educate, educate, educate, right? So I've printed out a study of people on Mirapex that shows 37% develop augmentation, 46% tolerance. I'm going to give it to her when we go back after the sleep study. Chances are she'll be nasty about it, but hopefully she'll read it.
I'm not going to say, "Who's the doofus now?" But I'll be thinking it.
fenris
Exactly what happened to me. Could you post a link to that article? I'd love to fax it to the sleep doctor I fired after he told me the same thing.
KBear wrote:See, the problem is that most of them get their drug "education" from the drug companies. KBear
Exactly. That lunch at Ruth Chris and the lifetime supply of pens courtesy of the pharmaceutical rep doesn't really do us, the patients, any favors.
Could you post a link to that article?
I'll do better than that - here's the abstract:
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Sleep Med. 2004; 5(1):9-14 (ISSN: 1389-9457)
Winkelman JW; Johnston L
Departments of Medicine and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1400 Centre Street, Suite 109, Newton Center, MA 02459, USA.
jwinkelman@sleephealth.com
BACKGROUND: Dopaminergic agents have become first-line treatments for restless legs syndrome (RLS). The most common serious complications of L-Dopa treatment of RLS are "augmentation", in which RLS symptoms appear earlier during the day, and tolerance, in which medication effectiveness wanes over time. The aims of this study were to assess rates of augmentation and tolerance, and their interrelationship, with pramipexole treatment of RLS.
PATIENTS AND METHODS: Retrospective assessment of all patients (N=59) treated for RLS with pramipexole for at least 6 months (mean duration=21.2+/-11.4 months) by the senior author. Pramipexole dosing and clinical follow-up were performed in a standardized fashion. L-Dopa was discontinued and other medications for RLS were tapered as tolerated. Rates of augmentation (need for earlier administration of the same dose of pramipexole) and tolerance (need for an increase in pramipexole dose) were determined.
RESULTS: Augmentation developed in 32% (19/59), and tolerance occurred in 46% (27/59), of patients. These two complications were statistically related (P<0.05). The only clinical predictors of these complications were previous augmentation or tolerance to L-Dopa.
CONCLUSIONS: Augmentation and tolerance are more common with extended pramipexole treatment of RLS than has been previously reported in preliminary studies. However, these complications are generally manageable by earlier dosing or small dose increases of this agent, and only rarely require medication discontinuation.
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