Mirapex and Augmentation

zombie76 · Post by **zombie76** » Sun May 25, 2008 5:06 am

Just diagnosed with RLS last week but have had the symptoms for over 3 years. The pains are generally in the back of my left thigh and the front of both legs from the knees down and are light during the day and worse at night.
I started on Mirapex 0.125 mg four nights ago and now the pains are 24/7 and are much stronger. I'm having pains in the back of my right leg now which rarely happens. Based on my reading it sounds like augmentation. Since I am on the 'starter' dose, I am going to stop until I can see my doctor on Tuesday. Am I on the right track?
If this is augmentation, is there anyone out there who had this problem with Mirapex but did better on other meds?

thanks!

SquirmingSusan · Post by **SquirmingSusan** » Sun May 25, 2008 5:44 am

Hi Zombie, and welcome to the forum. You could very well be having augmentation already, and it sounds like it to me. That sounds a lot like what happened to me when I was taking Requip. But then I'm not a doctor, not that most doctors know much about augmentation.

There actually are a lot of alternatives to Mirapex for treating RLS. In the "New to RLS" section of the message board there is a sticky post at the top which gives all kinds of information about treatment options. One good document to look up is the Mayo Clinic Algorithm for the treatment of RLS. It's especially helpful if your doctor doesn't know much about RLS or isn't willing to prescribe the medications that might work for you.

There are other things that can be helpful besides medication. First of all, you'll want to get your ferritin level checked. That's a measure of iron that's stored in the body, which is different from hemoglobin levels. Low ferritin levels are linked to worsened RLS, and raising the levels through supplements or eating iron-fortified foods can help many people.

Also there are a lot of medications, and even foods, that can aggravate RLS - Most antidepressants, antinauseants, antihistamines, caffeine, even ice cream. It's worth taking a look at what you might be able to change in that regard.

Best wishes with it all. I hope you find a treatment plan that helps instead of making things worse!

zombie76 · Post by **zombie76** » Sun May 25, 2008 6:11 am

I read the Mayo document and plan on taking it to my doctor. I recently had my annual checkup but I am not sure if they checked the ferritin levels. I'll definitely find out.
The only other medication that I take is Synthroid for Hypothyroidism. I'm one that is hesitant to take medication at all but I'm always exhausted and it has become such a struggle just to get out of bed that I had to do something.
Thanks for the response.

ctravel12 · Post by **ctravel12** » Sun May 25, 2008 6:28 pm

Hi Zombie and welcome to this group. So sorry for what you are going through. You are smart to stop the mirapex as it does sound like you are augmenting on it. I also take Mirapex .125mg and clonazapem 1mg. The last couple of nights I have had symptons in my left leg only (I have the painful rls) and it would last from 1-3 hrs and then would settle down. Last night was fine so who knows.

I did take requip two years and augmented real bad with it.

When you do go in for bloodwork you have to ask for the b/w for the ferritin as it is not included in the normal bloodwork.

Please keep us posted on how you are doing. Also let us know what your dr says and what the ferrtin level is. Another good site to read is www.rlshelp.org

I am going to have another b/w for my ferritin level as it is 50 and my neruologist said it should be between 100-150

Again welcome and sorry that you have rls but glad that you have found us. It is a great support group.

Post by **ViewsAskew** » Mon May 26, 2008 6:17 am

Zombie - the following is only my experience...so take that for what it's worth (if anything).

I augmented on Mirapex. Actually, I augmented within a week, but the doctor just told me to take more, earlier. Every few months, it started earlier, and I'd add another dose. In about a year, I had RLS most of the time. By 16 months, I had it 24/7 and had so many side effects that my life was pretty pointless in terms of working or getting anything accomplished. I started researching and found the Southern Cal Support Group and this site. I immediately went into full-time research mode and learned of augmentation. I tried to talk to my doctor and he did dumb things like put me on Sinemet. That causes augmentation in a huge percentage of people.

The story gets very involved at that point, but suffice it to say that finding a doctor to help and getting off Mirapex was all that I cared about. That took about 6 or 7 months. I went through 7 or 8 doctors and I think about ten meds.

Here's what I learned through this process. For me, because I had augmented so long (I am guessing, no one knows), none of the other DAs worked. But, some people can take a different DA when the augment on one. But, since Sinemet shouldn't be taken daily, at this time that only leaves you with Requip as the other DAs are not recommended at this time for other reasons.

The sooner you stop the drug when you augment, the better. I have no idea if my story would have had a different outcome, but it seems that there may be a connection between how long you augment and the chance that your increased symptoms become permanent. Mine did.

Another reason to stop quickly is that there is often a very difficult period when you stop the Mirapex, Requip or Sinemet. It lasts from a few days to several weeks. During this time, the RLS acts as if on steriods :shock:

. It makes the other RLS seem like child's play. For many of us, opioids are the only way to get through this period with any sleep at all and with our sanity intact. I know of a few people who did this without opioids and it just was darn hard. I tried stopping without help twice....I just couldn't do it. The third time, I had opioids and it made a huge difference.

While the opioids may be the only thing that really helps this transition, in a few days to a few weeks, you and your doctor can reassess how bad the RLS is (it might be much less than you think because you won't be augmenting) and find the right drug. That may take some work and many of us here have stayed on opioids. We have speculated that once you agument that opioids seems to work well and little else does...but that's just us and we don't know if this is real. But, after the Mirapex is out of the system and things have calmed down, this is a great time to see what works for you. The algorithm is a great help at this time.

Hope this helps.

zombie76 · Post by **zombie76** » Thu May 29, 2008 4:21 am

Went to the doctor on Monday and he switched me to Requip. I started on 0.25 mg and so far no worse and no better. Tomorrow night begins the 0.5 mg so I'll see how that works.
He also did some bloodwork including ferretin but I won't get those results until tomorrow.

ctravel12 · Post by **ctravel12** » Thu May 29, 2008 4:36 pm

Oh Zombie I sure hope that your rls gets better. Please let us know the results of your ferritin level.

You have a good day and please take care of yourself.

Hos · Post by **Hos** » Fri May 30, 2008 1:56 am

That's a good sign that the dr is willing to be proactive. It's such a guessing game but we can only try. Maybe after a few weeks the body will get used to the medicine and will adjust and start to work.

zombie76 · Post by **zombie76** » Fri May 30, 2008 4:31 pm

I still haven't gotten the ferritin results but I'm now on the .5 mg or Requip. I had trouble sleeping last night and the pains started first thing this morning. Seems like the Requip is acting the same as the Mirapex (augmentation). I'll give it another dose tonight to see what happens tomorrow.

ctravel12 · Post by **ctravel12** » Fri May 30, 2008 4:39 pm

Zombie please be careful as if it is starting in the daytime too it can be augmenting too. I did on Requip one week after my previous dr put me on 2mg of Requip and had rls 24/7 for 10 months. Please do not let that happen to you.

Do not know if I had mention going to the forum New to RLS (there is a sticky post Managing RLS) there is an excellent article from the Mayo Clinic Algorithm. Please read it and then print it out and bring it to your dr.

Alot of times you may have to take a cocktail of meds to see what works for you. I know that does not sound too encouraging but once you fine what works for you, you will get the relief that you so much deserve.l

Please do not hesitate to vent, talk, cry or even scream. We are here for you and always will be.

Please keep us posted on how you are doing. We really do care. I have walked in your shoes and know what you are going through.

zombie76 · Post by **zombie76** » Thu Jun 05, 2008 3:55 pm

I've been on Requip for 10 days now and although it isn't as bad, the augmentation is still happening. Guess I am headed to a neurologist to find out what is next.

Post by **ViewsAskew** » Thu Jun 05, 2008 7:32 pm

That's too bad. Hope the neuro is receptive.

ctravel12 · Post by **ctravel12** » Fri Jun 06, 2008 2:39 am

Zombie, please keep us posted and that your dr can give you something that will give you relief that you so desperately need.

SquirmingSusan · Post by **SquirmingSusan** » Fri Jun 06, 2008 3:32 am

Hang in there, Zombie, and keep us posted.

Post by **Polar Bear** » Sat Jun 07, 2008 11:03 pm

Good luck with the neuro. My neuro admitted he was not experienced in rls and he talked with me using the Mayo Algorithm which I had printed off and gave him. He discharged me to my GP, and told my GP to work with me as I had researched it well and knew more than him (about rls), all learned from this site!!