Augmentation

[rlsidaho]

Has anyone experienced RlS augmentation to the point where the RLS symptoms (mostly the aches and pains similar to the feeling of growing pains) begin in the late morning and don't stop until you fall asleep (hopefully) in the evening? I've been on virtually every type of approved and non-approved RLS med but most recently a combo of Requip XL and Hydrochodone. This combo works well but I'm wondering if the Requip is causing the augmentation? I'm currently taking 4mg in the morning and 8 mg in the evening.

I had RLS for over 5 years before augmentation set in. It first went from beginning in the evenings, to beginning around 3pm three months ago, and now it is starting around 10am every day. Any feedback from people who have successfully dealt with this would be much appreciated. Thank you

[badnights]

That is clearly augmentation, classic earlier and earlier onset. Also undoubtedly caused by the Requip, which you are taking WAY too much of. RLS/WED prescriptions go up to about 4mg. You are on a Parkinson's dose.

Stopping the Requip completely, right now, is the best idea. But you have to do this with your doctor's support! Warn him that you have learned you will experience 2 weeks of withdrawal consisting of worsened symptoms, during which time your dose of hydrocodone should be increased. After that's over you should have LESS symptoms than you currently have, and who knows may even be able to reduce the HC lower than your current level. Or not, but you won't be suffering so crazily anymore.

I had augmentation that began in the morning and had me dancing at my computer (standing up) by 1 PM and a complete wreck of uselessness by late afternoon. It was the second-most unfun thing that ever happened to me. (The most unfun was intense 24/7 RLS from gabapentin withdrawal.) So you are in a bad way.

Take your doctor as much info as you can find on RLS augmentation.Don't assume your doc knows about this already!

[ViewsAskew]

When my augmentation was at its worst, it was 24/7 - I slept in 5-10 min snatches when I'd fall asleep in a yoga pose, only to awaken a few minutes later when the muscles relaxed.

It's clearly one of the worst experiences any of us go through. Just awful!

My only additions to badnight's advice is that some people take 3-4 weeks to get through that rough period of increased WED when they stop the dopamine agonist, and some people get through it in 5 or 6 days. It's variable. I can say that with low dose of methadone - 10 mg - I had no issues getting through this period.

I hope your doctor understands augmentation. The book, Clinical Management of Restless Legs Syndrome, has information on handling augmentation from a doctor's perspective. It can be handy to have this resource to help you when you visit the doctor.

[rlsidaho]

Thank you for the replies. I agree that te Requip is too high. It is Requip XL (extended release) but I understand your point. I would like to get away from the Requip completely and once it is out of my system, reintroduce a much lower dose of Mirapex which worked well years before. I was on .5 mg once each night.

[cornelia]

Many of uw have had augmentation issues on dopamine agonists. You are on an extended-release DA and I have always thought that the chance of augmentation is very low on them. Dr B says about 10%. I guess you belong to this small group?

Corrie

[rlsidaho]

Thanks, Corrie. My augmentation actually began during the last month of taking Mirapex (.5 mg every evening). I was on this dose for about 4.5 years with no other meds and as long as I took the Mirapex before 7pm each night I usually had no problems sleeping. When I started to augment my doctor at that time tried several (really several) different meds to try and combat the problem. I finally became fed up with feeling like a guinea pig, and feeling like this doctor had little belief that I was suffering as much as I was.

M current doctor agreed to allow the inclusion of an opiate (hydrocodone) which has been a blessing but I don't think I will know it's real benefit until I have the Requip out of my system and I can lower my opiate dosage. I am wondering though, what my next step will be in keeping the RLS-WED at bay once I am through cleansing body of the Requip.

[rthom]

Something to ponder, I was given clonidine to help witht he effects of the withdrawl (it's supposed to clear the receptors quickly, i think).
Also my requip level is prescribed up to 3 mg and i'm on 2.
just info--good luck

[rlsidaho]

Can anyone provide me with some feedback with what has worked for them after they have stopped taking a DA and it has completely left their system? At present, I am still going through discontinuation withdrawals from stopping Requip but assume it's only a matter of days or weeks before I have conquered this phase of my RLS/WED.

I have been happy with hydrocodone, so maybe I remain with it, but just wondering what others have done in this same situation. Thank you.

[ViewsAskew]

I used methadone to get me through that period and continued to use it after that. After a time I tried multiple combinations of things...none worked as well.

Now, several years later, I alternate methadone (tiredness, lethargy if I take it daily) one night with pramipexole (which caused the ruckus in the first place) on the next. For me, this is best combo I've come up with.

[rlsidaho]

Thanks, Ann. Did your augmentation eventually disappear? Just trying to anticipate what to expect.

[ViewsAskew]

I've been here since 2004, which is when I was doing what you're doing - trying to find help to resolve the augmentation. Between now and then, only 3 or 4 of us have had permanent augmentation. I'm one. Though, in all honesty, I'd say that it isn't quite as bad as initially.

The doctors say it can't happen, that it's a "normal" disease progression, not permanent augmentation. I don't see it. I only took the pramipexole for PLMs, not RLS/WED. I rarely had WED symptoms - a couple time a month? I've had the PLMs since I was a toddler.

The augmentation gave me nightly WED within a week. Then it started earlier, etc. until it was 24/7. When I stopped the drug, I was hoping for the original symptoms, but was expecting it to be nightly. I never thought it would stay within 80-90% of the worst level.

While I can have symptoms anytime, I only have to medicate at night - from 6 or 7 PM until 6 or 7 AM. I go to sleep at 3-5 AM and get up between 10 AM-1 PM most days. I do get symptoms during the day at times, but I can always walk them off and be fine.

This hasn't happened to many of us and hopefully you will not be in this group.

[rlsidaho]

Thanks for your insight. I hope I'm not one of the few, either

[badnights]

When I augmented on Requip, I switched to Mirapex. I rejected it because it made me sleepy and went back on Requip (!!) while my doctor figured out what to do. I tried a few other things but ended up on hydromorphone extended release plus a sleeping aid (zopiclone), which so far has been removing most of my symptoms. I only take meds at night but sometimes in the day it gets distressing now, so I think it is getting worse again. I don't know how much hydromorph stays in me during the day, presumably some, so I don't really know if I have daytime symptoms anymore or not, I mean baseline - what I would be like without the meds. But my sense of it is that once the augmentation and withdrawal issues I had were over, my baseline RLS retreated from 24hr to mainly nighttime.

[rlsidaho]

Thanks, Beth. I appreciate the response.

[cornelia]

Beth, you might consider taking 100 mg (lowest dose) Tramadol Retard for daytime symptoms. It works 24 hrs and it might even help you in taking less hydrom.
It's what I do. Tramadol is not that strong.

Corrie