Restless Legs Syndrome (RLS) Discussion Board

I have to stop pramipexole I think it went into augmentation. Could someone give me some idea of what my doctor could give me. He knows there in not too much that works for me. If anyone could give me an idea. If change can I go back to Mirapex but right now at 11.00 am but legs are causing trouble. My doctor would not now what to try. thank you so much, Maybe

There are several options. I used gabapentin and a narcotic when I stopped Mirapex. I'm not sure, but I doubt that you will be able to go back to it. Maybe alternate every couple of days with something else. Most people use an opioid during the transition. I take Methadone 5 mg, two or three tablets during the evening and night. I don't have any side affects. But if I took more than three tablets, then I would itch. I also had nausea for a couple of months, then that went away. I've been taking it for five years now. I have a few symptoms every couple of weeks, then go back to not having any. It's up and down. The day time stuff usually means augmentation. It might take a couple of weeks to go through it. You might feel pretty bad during this time. I'm sorry you will have to go through this.

If you can afford this book - it's about $30, I think - you can take it to your doctor and show him what to do. It's called Clinical Management of Restless Legs Syndrome, by Lee, Buchfuhrer, Allen, and Hening, second edition. It's written by doctors for other doctors and tells them how to treat the disease, including how to manage augmentation.

As Deb said, since you've used these drugs multiple times and have augmented (or at least it sounds as if you have), you likely cannot take them again. At your age - I think you said you were in your 80's - it may be possible that you shouldn't take opioids, either. If you can, those are the drugs most commonly used to help you get over the augmentation. Then, as Deb noted, you can try drugs such as gabapentin, pregabalin, or gabapentin encarbil. Or, you can continue taking an opioid.

My doctor at one time gave me gabapentin but only I in the am and 2 at night 300mg each, My understanding that is not enough, I know I should not a ask you all these things but I have got to start somewhere To start what is the correct I should start with ,If I have some information I can tell my doctor, thank you,. maybe

Askew, I bought the book now maybe I will not bother you so much,By the way I am from Chicago also. Maybe you can answer one. If I go to gabapinten do I start . low dose and work up, thank you it is no fun being this old and worry about meds.


Maybe

It surely isn't fun to worry about all of these meds, is it. Don't worry about asking questions - I suggested the book because a doctor will often take advice better from the book than if you say, "I heard it on the internet." Even though you know and I know that we're well educated here about the disease, your doctor doesn't know that!

Not many of us here from Chicago that I know of.

Yes, with gabapentin you start with a low dose and work your way up. The book you ordered says you can take as little at 100 mg and up to 900 mg each dose, and up to 3x a day. Many doctors start with either 100 or 300, then have you increase every 3-5 days, as I understand it.

Don't worry about asking questions. That's how we all have learned. If you are able to take the gabapentin, at first most people are very sleepy. That usually wears down, and you aren't as sleepy. Also when people take that drug, and stop, you have to go back down slowly. Wean down so to speak, while you start to add something else. You just can't stop it. Otherwise you can get sick.
Also, the older we get most people don't need as many medications or as high a dose. That's in general, not necessarily regarding restless leg.

Determining the correct gabapentin dose is difficult and is usually a trial and error process. Gabapentin is absorbed by the body only in a short section of the intestinal tract. The amount of gabapentin that can be absorbed varies from person to person and often from day to day. This means that there is a maximum dose, not due to side effects or the normal issues with a medication, but simply anything beyond what the intestines can pick up is just dumped by the body to no benefit. One person might max out at 300mg and another can go to 1200+mg and still get benefit. This is the reason why they developed Horizant, which is absorbed differently and then converts to gabapentin in the blood stream. Horizant dosing is therefore much more controlled and predictable. Unfortunately, Horizant is also many time more expensive.

Therefore, the normal practice with gabapentin is to start low and increase until you either reach the desired benefit or else you hit the max that the body can absorb so that anything else is simply wasted.

I was one of the fortunate ones who gets benefit from 1200mg of gabapentin. For others, 600 or 900 mg might be the max and if this is not enough to address the WED problems, then perhaps these individuals should consider Horizant.

Rustsmith, what kind of benefit do you get from your 1200 mg of gabapentin? Are your symptoms totally controlled, well controlled or what? I got sticker shock from finding out that Horizant will cost be $65 per month. I have been using Neurontin at 300 mg to supplement Mirapex for over a years with good results. But I need to get off Mirapex due to augmentation and impulse control. While waiting to get the Horizant I started the transition, with the aid of Ultram (Tramadol; an opiod-like med) that I picked up in Mexico a few months ago. I am currently down to 0.375 mg Mirapex, 600 mg Neurontin and 50 mg Ultram with some augmentation during the day but sleep is good. So I am wondering if I can save money by using Neurontin rather than Horizant which is why I am interested in your situation.

I get a dual benefit from the gabapentin, it helps address the insomnia part of my RLS/WED and it also helps me manage my migraine headaches. This is sort of a two birds with one stone approach of medication as the two conditions are not known to be related.

I also use the rotigatine (Neupro) patch to address the urge-to-move part of my RLS/WED. Rotigatine is an extended release dopamine agonist. I augmented on pramipexole (Mirapex) and transitioned to rotigatine in about a week. I am one of the very few who have been able to get off pramipexole without an opiate, but I had not been in augmentation for as long as most people.

As for gabapentin vs Horizant, my doctor tried to get me to transition to Horizant to avoid having to increase my dosage of gabapentin (to extend my sleep intervals). I did not see any benefit to the change, they seemed to work equally for me, so the dramatic cost increase was not justified.

Gabapentin is a strange drug in that some people can adsorb only limited quantities through a short section of the intestine. For these people, increasing in dose beyond a certain point provides not added benefit. The change they made to Horizant allows it be adsorbed throughout the intestinal tract and then once in the blood stream, Horizant converts to gabapentin once in the blood stream. It appears that I am adsorbing all of my gabapentin dose, so I do not need the increased adsorption benefit of Horizant. How the two would compare for you can only be evaluated through the same sort of test that I did. You cant try both and see how they compare. If you cannot get enough gabapentin into your system to provide the benefits that you seek, then Horizant would be the way to go.

Thanks to you I am considering now staying on Neurontin because I also am finding that I am getting very effective relief. I am down to 0.5 mg Mirapex and 600 mg Neurontin and doing well. So I want to see what does of Neurontin I need when I get completely off Mirapex in about 2 weeks. thanks for sharing.