Restless Legs Syndrome (RLS) Discussion Board

After six months I finally got in to see a neurologist. My previous meds were 1200mg Gabapentin and 30mg of Hydrocodone nightly. She thought the Hydrocodone was too short acting for me to make it through the night. She was right, I was up two to three times a night. I now have Methadone as a replacement for the Hydrocodone as it is supposed to have a longer half-life and perhaps resolve the insomnia and RLS by just being able to sleep all night. The dosage at this time is 7.5mg for starter. It is not working, and I am going to call her to see if 10mg is ok to try. The literature suggests up to 15mg without habit forming problems. Just curious what dosage others are using to get a good night's sleep. Still at 1200mg of the Gabapentin too and concerned for the respiratory depression with this combination. The combination seems to be a bit of an unknown when reviewing the literature.

I take 7.5mg of methadone and 900 mg of gabapentin that is supplemented by 0.125mg of pramipexole. This has been my RLS treatment regime for about 10 years now.

I have experienced two different issues with methadone. Early on, it was causing me severe depression but I discovered on my own that opioids cause testosterone depression in men (but not women) and I was able to resolve my methadone induced depression with hormone supplementation.

I also was having issues with insomnia when I first started on methadone. If I took it at bedtime, I felt like I was wide awake for the next eight hours even though my body was telling me that I really needed the rest. This side effect only hits some of us and is something that many of us refer to as "alerting". Since methadone has such a long half life, I was able to address the alerting by taking it at lunchtime rather than at night.

When I first started on methadone, I was also told to titrate up to 10mg/day. Everyone reacts differently and I found that 10 mg made me feel mentally fuzzy and sort of drugged. At the time, I was still titrating off of pramipexole and was down to 0.125mg. I asked my doctor to allow me to stay at 7.5 mg of methadone supplemented by the 0.125mg of pramipexole since that controlled my RLS and didn't cause me to feel drugged. She agreed to that approach.

As for respiratory depression, that is always a concern anytime you are taking drugs with this side effect and especially when taking more than one. I also have the added issue of living at 6000ft elevation where any respiratory effects are compounded. As a result, my neurologist is adamant about my use of a CPAP machine and she asks about my CPAP scores during every appointment.

Thank goodness your neurologist knew what to do!

As for the methadone dosage, what's right for someone else might not be what's right for you. 10 is towards the lower end of what people take, so your neuro should be ok with you going up.

That said, it may not be wise to aim for 100% relief. It seems as soon as things get that good, the WED/RLS gets worse and we end up needing more medication.

As Steve said, the time of day that you take the methadone can be important. Opioids have that alerting effect in many of us so they should be taken early enough in the day that the alerting wears off before bedtime, but not so early that the symptom relief wears off before morning. That timing is probably individual and also dependent on the type of opioid. I take hydromorphone, and I take my first dose at 6 PM, to get to sleep at 12 or 1. I don't know how to get to sleep any earlier without actually taking a higher dose, which I don't want to do.

I use 5 mg Hydrocodone as my Silver Bullet about once a week. I totally agree it is short acting. I try hard not to take it before 1 or 2 am. By 4 am my RLS starts to naturally disappear so I might make it through the night. I've learned to take it, lie down and relax, trying to break that wake/sleep barrier. If I sit around and wait to be tired it will fail. I would like to take it on a more regular basis but it really binds me up.

tried taking all 7.5mg at 9pm but did not get an effect until midnight or 1am. Miserable up until then. Will try tonight to take it at 6pm and see how that works out.

pexj wrote: Thu Apr 24, 2025 3:58 pm tried taking all 7.5mg at 9pm but did not get an effect until midnight or 1am. Miserable up until then. Will try tonight to take it at 6pm and see how that works out.

It takes at least 2 hours to kick in. Also, consider that Steve takes it at noon, and Ann used to take it at 4 (I think). If you were miserable for 3-4 hours after taking it, make sure you take it 3-4 hours before you want to go to bed.

(It won't necessarily work that way, though; my symptoms are worst around when I want to go to bed; if I just wait, I can get by with less meds. )

pexj wrote: Thu Apr 24, 2025 3:58 pm tried taking all 7.5mg at 9pm but did not get an effect until midnight or 1am. Miserable up until then. Will try tonight to take it at 6pm and see how that works out.

I could have sworn I replied! Huhn. Likely did it while medicated and using a different device and never hit enter.

I take methadone at 4 to 4:30 to get a 10-11 PM sleep time. Even then, it's dicey, but mostly because of the arousal characteristics, not symptoms. If I waited until 9 PM, I'd be up until at least 2-3 AM with symptoms. SO important to stay ahead - and with some medications, ahead by several hours.