Anyone use Carbamazepine(tegretol) or Ultram?

[permo]

I was at the doctors a couple days ago. He prescribed ultram, and carbamazepin, and i had already had gabapentin , which he refilled. Last night i had insomnia. It was the first night i took all my pills. My legs were great though. Just couldnt sleep. I would like any feedback on these pills he gave me, since im new to this. Ive had rls for years but just now am seeing doctors about it to get relief finally. I see that alot of people keep having to change their meds frequently and its seems like alot of crap just trying to find what works. The Gabapentin was working great, but i seemed to become ammuned to it. Please someone help me. I dont want to be on this rollercoaster like so many of you are. My legs also ache badly, therefore i need the pain killers. Any feedback would be appreciated. Does anyone use these meds.. what side effects should i expect?

[Polar Bear]

Hi Permo, and welcome.

I have never used these drugs, I use Requip. But someone will be along to give you advice soon.

Good luck in your journey.

[Neco]

Hi..

The insomnia was likely caused by the Ultram. Tramadol is psuedo-opiod, and you will see a lot of the same side-effects from it as you would with traditional painkillers.

There is also a seizure-risk with Ultram, if you are more prone to seizures than the typical patient, or taking an anti-depressant or another drug (I don't know the whole list), you should be VERY careful.

Many months ago, I had a seizure because my Ultram & Luvox interacted, and the tramadol built up to an unsafe level in my system.. (Ultram and a lot of anti-depressants compete for the same liver pathway)

I'm not trying to scare you off it or anything, just giving you some helpful info in case you weren't told about this.. I don't know much about tegretol or what its for offhand so I can't comment on it.. However depending on the severity of your symptoms you may be able to cut out the Gabapentin entirely, as it is usually redundant when taking Ultram. But if you're taking it for another diagnosed condition like neuropathy then keep taking it.

You should be careful about overmedicating yourself, just in general. As far as your insomnia goes, you may want to ask your doc for a couple samples of Ambien (or if you can deal with the taste that develops, Lunesta) and hope that it is only ocassional. The insomnia may go away once you adjust to your dose and it isn't high or increasing frequently.

[permo]

Thanks for the info. The doc put me on close to 400 ultram..i assume its for the pain and the tegretal (carvamazepine,mazepine,novo-carbamaz)other brand names is just one pill before bed and its an anti-epileptic drug and for restoring the normal balance of nerve activity. Im not sure why he refilled the gabapentin but i noticed some withdrawal symtoms when i ran out..i seem ammuned to it, but it must be doing something. Anyway ive just started all this but do notice a difference. I can sit at my computer for more that 5 minutes (thats most important ) Zach, what meds are you taking for your rls if you dont mind me asking..how are they working?
Permo

[Neco]

close to 400mg off the bat??

That is practically the maximum daily dose of the stuff... It's no wonder you have insomnia.. Are you taking Ultram ER? That is time released 100mg pills, otherwise you'd be taking about eight 50mg pills to get 400mg...

Either way, that seems like WAY too much just starting unless you are truly in severe pain, and in that case a better medication would be more suited for you... I would honestly try to get by on 50 - 150mg if you could.. Just to see how well you respond.

I've never dealt with (or heard of really) withdrawal symptoms from Gabapentin, however I'd still see if you couldn't at least reduce the dose to see if you don't need as much, and then work your way down to possibly eliminating it.. Chances are very little ultram should get you through 24 hours.. That could be either one large dose or 2 or 3 doses thruought the day.

Either way, whatever works best for you, within the confines of your prescribing insctructions, is up to you.

As for myself. I take 15mg of Methadone in the morning. It wains a bit over the course of the day, but overall I am able to sleep with little difficulty, if any related to RLS at all.. I have refractory primary RLS, which is pretty severe. I've been through almost every painkiller on the market, tried the other usual drugs, etc just to show that I tried, but in the end I developed an addiction problem and Methadone was my last chance.. So its kind of treating two conditions with one medication.

It's a really nice drug, because it lasts a long time, and when you come down off your peak level of effectiveness it is a very gentle and smooth transition, compared to the more traditional painkillers such as Tylenol #3 w/codeine, Vicodin (hydrocodone), Oxycodone, Morphine, etc.. (some have extended release versions but they are still way more addictive) Those are all short acting medications that have rapid onset and a half-life of only a few hours. (methadone has a half-life of up to 72 hours). But it is a drug of last resort for most people, and can be potentially dangerous to patients with minimal or no exposure to other lesser painkillers.

So around here we usually reccomend it as a last resort for the most difficult cases, where traditional DA's (Requip/Mirapex), Gabapentin/Lyric, or weaker painkillers have failed.

[permo]

I thought methadone was a drug that is used for addicts, to eliminate withdrawal symtoms and make it easier to quit certain drugs such as heroin etc. Is it also a pain killer?
The doc gave me tramadol hcl/acetaminophen...37.5 and 325mg. Take 2 tablets 4 times daily. So 37.5 x 8 is 300mg then the aceteminophen.
Have you heard of carbamazepine(tegretol)?
So you said you became addicted to certain pain killers...did your doctor cut you off them?

[ViewsAskew]

tegretol is in the same class as neurontin. It's not commonly used for RLS, but some docs like to try it.

The only drugs that seem to almost always work for RLS are the dopaminergics (Mirapex, Sinemet, Requip) and the opioids (wide range from oxycontin to methadone to vicodin etc.) The problem with the first class I listed is that they can have side effects, so they can't be used for everyone, even if they are working to stop the RLS. The problem with the second class I listed is perception. It's not a place most docs want to start, even though they work much of the time for RLS.

That leaves two other classes to try: benzodiazepines and anti-seizure. Your doc has you trying things in this second class. Keppra, Neurontin, tegratol, Lyrica, etc. are all in this class (among others). These tend to work best for people who have pain with their RLS.

[permo]

Thanks so much for all the information. I just cant understand why everyone seems to have the same symptoms (some more or less severe), but everyone is on a different medication. Its crazy!

[ViewsAskew]

Well, the main reason is that there isn't any medication that is specifically developed for RLS. Every medication we use has just been found by chance to do some good.

Until they know exactly what causes RLS, they aren't likely to get a medication that will work on all of us.

That said, we'd probably all be on dopamine drugs if they didn't have the side effects and augmentation, because they do tend to work for everyone. Oh, yeah, and if all doctors were educated about what to use.

[SquirmingSusan]

I was at the doctors a couple days ago. He prescribed ultram, and carbamazepin, and i had already had gabapentin , which he refilled. Last night i had insomnia. It was the first night i took all my pills. My legs were great though. Just couldnt sleep. I would like any feedback on these pills he gave me, since im new to this. Ive had rls for years but just now am seeing doctors about it to get relief finally. I see that alot of people keep having to change their meds frequently and its seems like alot of crap just trying to find what works. The Gabapentin was working great, but i seemed to become ammuned to it. Please someone help me. I dont want to be on this rollercoaster like so many of you are. My legs also ache badly, therefore i need the pain killers. Any feedback would be appreciated. Does anyone use these meds.. what side effects should i expect?

Hi Permo. Welcome. I've taken most of those that you've been prescribed (and a whole lot more, LOL). Gabapentin (Neurontin) is commonly prescribed for RLS, and is an anticonvulsant. Anticonvulsants can help with neuropathic pain (nerve pain, like shingles or diabetic neuropathy) and many of us have found that they help, one way or another, with our RLS. Neurontin doesn't do anything for my pain or creepy-crawlies, but it does help with the involuntary muscle jerking and it helps me sleep. Usually if people don't have success with Neurontin, they switch people to Lyrica, which has fewer side effects but works pretty much the same way. I was having great success with Lyrica recently with it helping me just relax in the evening, sit still, and not have the extreme jerking that I usually have. But it made my hands and feet swell.

I asked the neuro to find me a cheap, old anticonvulsant to try and she hasn't gotten back to me. I'm planning on asking about Lamictal or Tegretol because those seem to be very well tolerated. I read drug rating sites for fun, LOL.

The benzos like clonazepam and Ativan are anticonvulsants. Those come with other issues and side effects, and for me they don't do anything for the body jerks.

I'm guessing that your doctor is putting you on the Tegretol to replace the Neurontin, since it's in the same class of medication. Hopefully beween that and the Tramadol, you'll get some relief. Although as someone mentioned, tramadol can cause insomnia.

As always, talk to your doctor if you have questions.

[HeatherB]

I used Ultram for my tendentious before being put on Klonopin for the RLS. I'm a whole 100 pounds and the doc only had me on 50 mg, and the pain in my thumb was so bad I could not use it. I can't believe a doctor would put some one on almost 400 mg. Be careful of the side affects of it, please.

[Neco]

As has been mentioned, a lot of medications used for RLS have problems with perception, as demonstrated by your reaction to Methadone. Many doctors have problems prescribing opiates, even to patients who legitimately need them because of the small minority of addicts and the FDA making a big deal out of it. Methadone is particular seems to make some physicians recoil in fear for their life, which is sad and unprofessional at the very least.

It is true methadone is prescribed for drug addicts. This is called Methadone Maintenance Treatment, and basically it is prescribing a legal substance, to replace an illegal one. The idea being everything is done from a controlled environment.

Believe it or not, Heroin and other illicit drugs are all painkillers, as they are all derived from opium.. Poppy sap (as in the poppy plant, where poppy seeds come from) contains alkaloids of opium, codeine and morphine in varying quantities. Heroin was actually developed as a painkiller decades ago, but obviously became illegal for many reasons.

Methadone was developed in particular to block out the euphoric side effects of other drugs. So it is a particularly potent opiate, and the way it works is it basically binds to your bodies receptors stronger/better than the molecules of other painkillers/drugs. Essentially blocking them from binding and doing their work. However this effect can be overcome with a powerful enough dose of the substance you want to use, so it kind of works on a sliding scale. In general they give it to people and manage their dose up/down depending on how comfortable they are, and in theory if they were to take Heroin or another substance it would have no effect.

Methadone is also used in patients with chronic pain injuries, as well as cancer patients, and of course some RLS patients take methadone. But we are in the minority for various reasons. Unfortunately painkillers have such a stigma in our society, and methadone in particular, that it is very difficult for RLS patients who have tried practically every other medication, to get them. It's a sad truth that needs to be fixed, because painkillers are one of the single most effective treatments for RLS.

Maybe one day they will find out the root cause, and be able to develop a medicine for RLS, but until then all we can do is try many different medications, fight public and doctor ignorance, and hope for the best.

I got extremely lucky that I have a great doctor.. Because he could have kicked me out plenty of times because of my addiction problems, and even though I had to fight real hard to get it, he decided we could try Methadone. I'm not 100% happy about it all the time, but I am in a MUCH better place than I would be right now, if I didn't have methadone. The RLS is so unbearable without it, that I can honestly say it has saved my life.

Hope that answers your questions some.

And I do hope you can try and reduce your meds some, especially the tramadol dose.. Because the thing about RLS is as you age it also progresses and gets worse.. So it's always best to be on the lowest dose you can tolerate, so that in the future you can raise your dose several times to get the most out of your medications before having to possibly switch to something else

[Aiken]

Two things to add:

1) If you need 24/7 painkilling, I agree that methadone is an amazing painkiller. It works well when used correctly, has fewer addiction risks, and has a very long half-life, so you can generally avoid peaks and valleys. It's a shame that one of its uses, that being an addiction recovery aid, has given it such a negative reputation that its other uses are not well known and its benefits are lost to many.

2) If you're taking a high dose of Ultram, be careful if/when you need to come off of it. Ultram includes a weak SNRI, which is a form of antidepressant similar to SSRI's (e.g. Prozac). SNRI's are more difficult to stop, so you must take care to taper off of them. Even with a short taper, I found it emotionally difficult when I switched from Ultram to something else. It's not impossible, and it doesn't have to be painful--you just have to do it right.

[cmistaya]

I just was refered to a Nurologist. My family physician had me on Neurontin, 300mg X3. He kept me on that dosage and added Tegretol 100mg X3. He did increase my Neurontin to 4 times a day. Now my face is numb and I end up falling asleep a lot. Not sure which one is causing it. I took a Neurontin a while a go and the numbing got worse but I have taken this drug for quite a while now so why would this be the problem. I wonder since both are simular drugs if this is the issue. I can't call the Dr. for a couple of days since this is the weekend. By the way this is not helping my RLS at all. I am putting heating pads on my arms to get temp relief.

[ViewsAskew]

Yikes! That doesn't sound good! Tegretol is RARELY used for RLS. I guess he's trying to avoid using a different category of drugs?

Many of us are not helped by this class of drugs. And, like the OP upthread, many of us find temporary relief, but then we have to increase the dose. I never stopped being tired while on it, nor did it ever control my symptoms.

This class does seem to work better for people with achy/painful RLS. If you're not in that category, changing may be your only option.

I hope this neuro has better tricks in his bag than Tegretol...I can't remember the details, but it was talked about at one of the RLS conferences and not suggested as a primary treatment. It's one of those to try when everything else fails. I'm not sure how much you've tried so far, but checking out the Mayo Clinic Algorithm may be a good option. There is a copy of it in the New to RLS section under one of the sticky posts.