Need Advice

This is my first visit to the forum. I have had RLS for about 4 yrs. It got worse about

a year ago and my GP put me on 0.5mg of Ropinerole this worked well for about nine months. Now it has little effect. So I saw my GP last week and he increased the dose to 1mg immediately and this has been beneficial. He wants me to further increase the dose to 1.5mg in two weeks and then to 2mg.

I had never heard the word "Augmentation" until I started to read the forum very recently. I am not sure exactly what the implications are for RLS. Is it wise to keep increasing the dosage?

Comments and advice from people who have experienced "Augmentation" would be appreciated.

7 Replies

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  • If the drug is working at a lower dose DO NOT increase it, that way when your body develops tolerance you will be able to increase it with less risk of augmentation. I find it strange your Dr wants to increase it if it is already working.

  • Why your doctor wants to increase you tabs when low dose is working is nonsense ,don't increase unless you have to then not more than 2mg, I had augmentation with Requip it was so very painfull ,I am on Tramodol and you don't get augmentation with those ,hope you get sorted

  • Be careful. I had an immediate positive effect when I first took Ropinerole, but my doctor allowed me to increase the dose until I was on 4 mgs per evening. I was like a zombie and hardly managed my life. Luckily I found information online, including this site, and changed to the neuro patch. Only then did I realise how small my life had become. Since, because of skin reactions, I am taking pramipexole (x2) and Targinact, but the dosage is low and I find with other routines I am able to manage on the lower dose and live a fuller life. (With limitations!)

    Good luck.

  • Hi eyeswideopen, absolutely no it is not wise to increase the dose. The higher the dose the greater the risk of augmentation. When these dopamine agonists pills were first used for RLS the daily recommended doses were much higher then once augmentation was discovered the experts realised that they needed to change the dosing and set it much lower,Unfortunately most GPs and even some Neurologists are not aware of this but believe me when I tell you that the top RLS Specialists in the world do not recommend Ropinerole over 1mg per day 2mg absolute tops and only under close supervision. Your doctor by wanting to move you up to 2mg when 1mg is working well is showing that he/she is sadly not aware of these risks.So you know the signs of augmentation are having to increase your dose, symptoms starting earlier in the day, symptoms starting upon shorter periods of relaxation, symptoms spreading into other body parts usually the arms and medication not working so well at night. Personally I would not take a short acting dopamine agonist and would insist on a slow release one such as Neupro patch. Alternatively you could change to a painkiller such as Tramadol, good luck. .Pippins2 x

  • Sounds a bit like me. Because of augmentation I've been determined to keep the meds to a minimum. I've recently started taking supplementary magnesium which has allowed me to reduce the ropinirole back to 0.5mg. Worth a try...

  • Augmentation is a fact. I started out with 0.5 mg of Requip just at bedtime and over the course of 8 years I had to increase the dosage to 1.0 mg 4 times a day. Instead of increasing the dosage beyond this, I changed to Merapex and went back to 0.5 mg 4 times a day. The relief was immediate and am still taking the 0.5 mg 4x a day a year later. I expect I'll have to increase the dosage at some time but hopefully if the Merapex stops working I can go back to Requip. You didn't say if you were only taking 1.0 mg of Ropinerole once a day or more often. If it's just once a day, that doesn't seem unreasonable. I've found it's constantly trial and error and what works for one person doesn't necessarily work for another. Luckily I have a doctor that trusts my judgment after all these years and is willing to let me decide works best for me. Hope this helps some.

  • Ropinirole is medicated as either slow release or norm tablet. For some the slow (modified) release works okay over 24hrs, keeping RLS at bay. Up to max 2 mg a day slow release is sufficient to control RLS. For other RLS sufferers that tablet/ relief strategy doesn't work. The normal tablet provides relief for when the RLS is likely to strike - I take 2mg a day (1.5mg at night) and from time to time have to take a further 0.5mg/1mg when the symptoms are unbearable. The following day I reduce the daily intake to try and even out over 72hrs to max 12 X 0.5mg tabs. It's not fall proof and sometimes get augmentation.

    I also take 3 x 300mg od Gabapentin each day to supplement the Ropinirole.

    I've got RLS bad but I try not to let it stop me living life to the full.

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