Neupro to pramipexole switch and yikes

[JPB5]

1 week ago went to neurologist. Have had RLS for years. Been on 1mg neupro patch. Very limited problems, except rash from patch. He switched me to 6pm .25 and 9pm .12 pramipexole. Worst week I have ever had with RLS! If I take the .25 it takes a couple of hours to kick in. But, rough couple of hours until than.

Questions? Should I switch back? Was this all because of the patch it has gotten this bad? What next?

Going to a natural another NEURO doctor in a week to see other options?

[pvw2]

What does you current neurologist say about your reaction to the new meds?

[park_bear]

A friend of mine with restless legs has found relief with over-the-counter Mucuna, a form of levodopa. Avoids the potential serious adverse effects of dopamine agonists.

[johntPM]

I am not a doctor, and I have no personal experience of RLS, so make of this what you wish.

There is a concept in PD called "levodopa equivalent dose", which tries to equate the doses of different drugs. This uses the pharmacokinetic (what the body does to the drug) properties such as CMAX and THALF.

In your case, the relevant equivalence is 3.3 mg Neupro patch, 1mg pramipexole. On that basis your doctor has given a small increase.

But that doesn't go far enough. Time is important. Some drugs are slow acting and some are fast acting. As you note, pramipexole takes about 2 hours to kick in fully. What time is your RLS worst? You might wish to change the time that you take the doses.

I've written an app to draws a graph to show what's happening during the course of a day:

parkinsonsmeasurement.org/t...

John

[JPB5 in reply to johntPM]

Thank you - great information! Might be better to go back on Neupro patch 1mg -not sure what drug is better for me overall? Had very few issues with Neupro last three years.