Ropinirole and Tramodol

helen1965 · Post by **helen1965** » Fri Nov 18, 2011 7:56 pm

I am starting Tramodol tonight along with my Ropinirole (Requip). The Ropinirole was wearing off at 4am every morning and I don't want to increase the dose as I have reduced it to help the augmentation go away. I'm a bit nervous as I have built my hopes up for getting a better night's sleep, and also with the help of Tramodol I'd like to reduce the Ropinirole a little further. Has anyone any thoughts/advice on this.
Also I visited my doctor today, and told her about the RLS Foundation and the Forum. She seemed very receptive and wrote the details down. She said she would look at it tonight , which has pleased me. She has two patients with severe RLS of which I am one of . So she agreed it is a good idea to become more educated about it. Fingers crossed she will help me and I'll help her.

Post by **Polar Bear** » Fri Nov 18, 2011 8:21 pm

Your appointment with your doctor sounds very positive.
Wishing you sweet dreams tonight.

I understand your nervousness.
My medication (for WED/RLS) is also Requip and Tramadol. I also would have symptoms around 4am or 5am, and as I always awaken during the night I take a smallish dose at about 3 am.

''''with the help of Tramodol I'd like to reduce the Ropinirole a little further''''
IMHO I would suggest that if you are waking with symptoms at 4am, that you should first of all try and get yourself sleeping through the night. i.e. with your Requip and Tramadol. If that is successful then it might be the time to try to reduce your Requip.

Post by **ViewsAskew** » Fri Nov 18, 2011 8:44 pm

Helen, when augmented, there really is only one solution....getting off the offending medication. It's not fun, but it's the only way to resolve it.

It's great that your doctor is interested in more information! Let's hope it helps you and all her other future patients.

Post by **Polar Bear** » Fri Nov 18, 2011 11:07 pm

Helen, I'm sorry, I had forgotten that you reduced the Requip because of augmentation. ViewsAskew is quite right and getting off the offending medication is a priority.

That's what I get for not reading back on the previous posts again. :oops:

veldon7 · Post by **veldon7** » Sat Nov 19, 2011 11:30 am

I am having the same problem with Mirapex. I am thinking about trying Tramadol and cutting back on Mirapex, I tried it before, but it didn't work very well. I wish something else would work that wouldn't make me so sleepy. I am going to a different Neuro. in Jan. good luck to you.

helen1965 · Post by **helen1965** » Sat Nov 19, 2011 8:26 pm

thanks everyone, and yes, I am going to get some good nights before I reduce Ropinirole even further. Last night was a good start, I woke every hour but not because of RLS. I don't know why I kept waking, maybe anxiety/nervousness, I don't know. But the thing is I got back to sleep every single time within minutes! And I reckon I got around 8 hours sleep. I felt so much better today, I had forgotten what it feels like to have a normal amount of sleep, I had got so used to feeling dog-tired all the time. I look forward to another better night tonight, and maybe I will feel better over the next few weeks. Then I will think about reducing the Ropinirole again when I feel ready (and brave enough). Thank you everyone for your advice, you are all invaluable to me.

helen1965 · Post by **helen1965** » Thu Nov 24, 2011 7:07 am

Hello again, just an update on my new experiences with Tramadol. Yes, it has stopped the RLS attack at 4 am, it has also had the added bonus of stopping the coughing attacks that I was experiencing every night, sometimes for an hour or so. That was an unexpected surprise. I do have insomnia, but I was already experiencing that with the Ropinirole. But was has started happening, after 3 really comfortable nights ( I won't say good, because I just don't have 'good' nights) I am now waking up (usually to go to the loo) and of course as usual spend a good while lying awake, and I have spasms either in a leg or an arm, and they are approx 3-4 minutes apart, they are not painful, and not violent. But it is enough to keep me awake for a few hours. Is this a side effect of the Tramodol, and if so does it eventually stop happening? I can't figure out why the first few nights were so good and then this started happening. Spasms aren't mentioned in the medication leaflet. I was sooo happy that the RLS had stopped waking me, and that the coughing had stopped too. I thought/hoped I had found the medication that would help me reduce the Ropinirole. Anyone have any thoughts on these issues?

Post by **ViewsAskew** » Thu Nov 24, 2011 7:52 am

Zach - you had seizures with it, right? So, not spasms, but I'd definitely call the pharmacist and ask if this is a known side effect if no one knows and you can't find it on an internet search.

helen1965 · Post by **helen1965** » Fri Nov 25, 2011 8:18 am

Well, looks like I gotta come off the Tramadol. Last night, awake from 1.20am after visited loo as usual, then the spasms/jerking started, and didn't stop. I'm a bit upset because otherwise the Tramodol does everything I want it to do. If it wasn't for these spasms, I would definately stay on it, and now I have a withdrawal to face as well. At least the withdrawal from Tramodol won't be as bad as withdrawal from Ropinirole....I hope! Back to the Doc to see what's next..

Post by **ViewsAskew** » Fri Nov 25, 2011 9:01 pm

Drat it!

Post by **badnights** » Fri Nov 25, 2011 10:12 pm

The usual method of dealing with augmentation is to STOP the med that's causing it and use a 2-week presciption for oxycodone or a similar opioid to cover the withdrawal. You stop cold turkey, and the oxy takes care of the worsened RLS/WED symptoms. You have to stop taking the Requip entirely once you've augmented on it; you're just abusing your body if you don't. (Personally I think augmentation can cause a permanent worsening, but that's not corroborated by any studies. )

After 2 weeks your body will be clear of Requip and you could start again with something else, even with pramipexole/Mirapex, the other DA, because you will not necessarily augment on one if you augmented on the other.

If not pramipexole, then you're probably stuck with opiods, or maybe opiods in combination with an anti-convulsant (gapapentin/Neurontin, pregabalin/Lyrica, or gabapentin encarbil/Horizant) so that you can keep the dose of each lower than otherwise.

The Tramadol problem sucks, but keep up the battle, there's an answer out there!

helen1965 · Post by **helen1965** » Sun Nov 27, 2011 10:16 am

Yes, thanks so much for the info. I will go back to the Doc (my neurologist has supplied a list of possible meds for me and the Doc has this same list ) and hopefully she will try me on the next on the list to help me come off the Ropinirole. I had a not too bad night last night, my first in 10 days without the Tramodol, and it wasn't as bad as I expected. I was only on 1 x 50mg per night, so it may be not as much of a shock to my body to stop it. So now it's Ropiniorole only until I find out what's next. If there is something out there similar to the Tramodol but without the side effects that would be great, but what medication doesn't have a side effect of some sort? It just depends whether I can put up with the side effect in order to treat the major problem...

Post by **ViewsAskew** » Sun Nov 27, 2011 10:36 am

As far as I know, there are only two options.

1) Tough it out - stop the ropinerole and deal with the increased RLS/WED. It can be as few as 5-7 days and as long as 3-4 weeks.

2) Use an opioid. Tramadol probably wouldn't have been strong enough to relieve all symptoms, but it would have helped. From what I've read, only the opioids appear to alleviate the increased symptoms that occur when stopping a dopamine agonist.

You can use other classes of drugs and they will help eliminate some symptoms, but not all.

As Beth mentioned, there are some cases of people with permanently worsened WED after they stayed on a DA after augmentation started. I am one of them. As far as I know, there are only 4 of us on this board that believe this happened to them.

The RLS/WED medical community says it's not possible, that it must be that the WED simply got worse on its own in during that period. Given that I had WED only a few times a month and only for 5 to 15 minutes and it never kept me from sleeping (was using the DA for PLMD) and now I have it 24/7, I find it hard to believe. But, of course, I can't prove it and I certainly could be wrong.

Post by **badnights** » Mon Nov 28, 2011 5:11 am

Point being, get off the ropinirole. Don't try to taper, it does no good once you're augmenting, and in fact only prolongs the agony. But if you have a reasonable doctor, you will get an opioid to cover the symptoms of withdrawal.

Then as for what you take after that, that's up to you and your doctor.

helen1965 · Post by **helen1965** » Mon Nov 28, 2011 5:53 pm

Oh Thank you, both of you for the advice. I am certain;ly going to get off this Ropinirole, I visit my Doc in3 days time, I am going to take this info to her, I hope the damage hasn't been done, I am worried now that I have stayed on Ropinirole too long now, I've been on it approx a year now and the augmentation started about 5-6 months after that. I'm praying.