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Restless Legs Syndrome
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Augmentation, opiates, benzodiazepines

I read a lot on here about the danger of augmentation with dopamine agonists and of switching to opiates. But from what I read, opiates are also dopamine agonists.

My doc is probably about as keen to let me have opiates or even benzodiazepines as offer an alcohol a drink.

I, myself, have thought occasionally, that if I were a Victorian, I would have been finishing myself off with laudanum, and am aware that benzodiazepines are harder on the kidneys and liver than the zopiclone I also take, and presumably ropinirole.

I will need to get a repeat for my ropinirole before the middle of this week. I'm currently averaging about 4.5 mg per afternoon/night.

Anyone any comments?

(Gabapentin does not work for me at all.)

21 Replies

Oopiates are not DAs and at a low dose are safer than anti depressants. Far less danger of addiction .

Make sure theyare longacting/ slow release.


Every so often when I have slept badly for several nights in a row, I will take a small dose of Opiates and get some really needed sleep. The problem with most of the prescribed opiates, in the U.S. is that they are each coupled with 500mg of acitiminifin (probably spelled wrong) but everyone knows them as Tylenol . If you take very much it isn't the codine that hurts you, it in the Tylenol that kills your liver.

A Pharmacist friend said Tylenol is the worst drug in his store and sometimes when it happens, there is no liver available and you simply die waiting for one that is compatible.

If the cowards, at the drug companies would make a pure codine pill we could use them, without hurting ourselves, not for recreation but to stop the fibromylgia pain, long enough to sleep some..

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When I had only had RLS for a year or two, I found I could get relief with paracetamol. In overdose, it does poison the liver – very nasty. I do have some paracetamol/codeine OTC caplets – can't remember the last time I took one. I also had some effervescent prescription strength paracetamol/codeine tablets at one time – used up on a tooth splitting in three. In fact, I can't take more than about two doses of codeine without losing proper bowel function.

I think one of the main opioid drugs prescribed for RLS is low dose oxycodone in combination with naloxone. Naloxone stops the oxycodone affecting the gut (so much). This combination is sold as Targinact, and is licensed in the UK for RLS.

If what an opioid does is increase the D2 dopamine receptor population, it would seem to be the most appropriate drug for the most common presentation of RLS – so long as one doesn't need so much that stopping taking it leaves one with too many D2 receptors and too great a demand on dopamine supply.

Of course, there's also the elimination side of things to consider, I guess.

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As Madlegs has said, dopamine meds are not opiates, so i dont know where you have read that. I notice you are taking 4.5mgs of Ropinerole , just to ask you is it working well, or are you having any symptoms coming earlier or not working as well at night. ? It is now recommended to take no higher than 1mgs, because of augmentation.


I was on 4.5 mg of ropinerole a day, I had been augmenting and the doctor kept prescribing more. I discovered I was addicted to them when I ceased taking them, 90 days of hell with zero doctor support before I felt better.

Nupro patches were useless to me and they cost a fortune in the U.S.

I am currently taking Gabapentin, 6- 300mg capules a day plus Tramadol at night for sleep.

This keeps the disease at bay most days, I don't sleep well, usually uncomfortable until 2 am, then I fall asleep.

The best thing I did was finding a Neurologist knowledgable with RLS and firing the family doctor.

The family doctor did not want to listen about augmentation, addiction to dopamine agonists, low iron and other topics discussed on this site.

A good sleep aid is Doctor Teals bath oils and epsom salts containing lavender.


Yes, I now wonder what I was reading!

The ropinirole still works well some/most of the time. The time I need to take it first can be anywhere between about 2:30 p.m. and mid-evening. I think I'm finding there's more of a problem with its effectiveness after I've taken some exercised (walked a few miles) or if I let the RLS symptoms start before taking it.

Of course, the UK recommended maximum dosage for ropinirole for RLS is 4 mg a day, so while I'm not far off that, my doc is maybe not going to be too keen to look at anything else.

Opiates work in fact by screening the D2 receptors forcing a population increase? Stopping the opiates results in too big a drain on the dopamine supply with a return of RLS symptoms?


As far as I am aware dopamine is involved in opioid consumption as it reduces GABA which reduces Dopamine its not a direct correlation. s

Personally speaking my choice of drugs would be opioid, dopamine agonist then benzo. I put benzo last because when I have RLS really bad and can't sleep I sometimes take a sleeping tablet which half the time leaves me sedated and still battling RLS which I find worse.

If it were Victorian times I'd go for opium with a cannabis chaser :) bye bye RLS!


I was about to post a question when I came across this thread. My question was to be, can I replace my Pram with a sleeping tablet such as Zopiclone, as I hate the side effects of Pram? I have taken Zopiclone and have had no side effects at all.

I know doctors are reluctant to prescribe this drug for more than a couple of weeks because of it becoming addictive, but as I will be taking Pram for my duration, does that matter.


Yes. The Pram is not addictive- partly because the chemical is in your system long term.

Benzos are short term and therefore up and down effect leads to addiction.

If you have intermittent rls- once every now and again ( sign it's being triggered by something)- then a benzo might be appropriate - assuming you don't abuse them and take as low a dose as absolutely necessary.


Zopiclone provides very little help, if any, with RLS.

It has been said to have slight muscle relaxant properties (as opposed to zolpidem, which doesn't), but If you have night cramps, I shouldn't put too much hope in it!

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I've found this too, you just have RLS and are too drowsy to walk it off.


Thanks for the posts, I suspected as much. The pram works well, but leaves me fighting my way into the world in the morning. I have tried taking just the one tab, but it doesn't work.


I booked a telephone consultation with my doc over the Internet. I didn't hear from them, so I don't know if there was a computer failure, they're sure they don't want to consider opiates/opioids for RLS treatment (yet, in my case) or they are still thinking about it. My repeat request for ropinirole has been accepted.

So, is there a way back from opiates to dopamine agonist? Would it involve taking l-dopa for a while? Is RLS always found in opiate/opioid withdrawal?


Try gabapentin


John- Gabapentin is not the answer to all rls problems.

It well may work well for you personally- but a lot of people can not tolerate it or its side effects.


Madlegs, gabapentin has far less side effects than any other med .its also the first choice when first diagnosed. Trials also show its extremely favorable.i treat at the Stanford sleep center,specialists in RLS. Hope ''tis educates you. Thanks

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maybe so but if you are trying to change from opiates to another treatment for RLS, the Gabapentin helps with opiate withdrawal induced RLS....


Bossy- you are right. Gaba definitely has a role to play in opiate withdrawal.

It both potentiates and inhibits opiates - depending on the timing. If it's taken before opiate it gets potentiated by up to 40%. If taken 2 hrs after it helps potentiate the opiate.

I'm unable to refind the reference where I first got it but it has been confirmed in various fora.

Hope that helps.

There seems to be a lot of different expereriences concerning Gabapentin. But then different people have different metabolisms.

Good luck.


I did ... for months. Had me walk into a door jamb, miss my coffee mug with boiling water, fall asleep standing up ... . Waste of NHS money as far as my RLS was concerned. I think it's thought more useful when there's nerve pain with your RLS.


I take Tramadol, a light opiate, for the past seven years and hardly feel addicted, all with my doctors medical approval. I take such a small dose and only increased it once about 3/4 years ago. Have you tried Trama? It's the least to cause augmentation, and for me, feel like any other normal person walking around. Some people complain out sleeplessness, it does happen, but for me it's a small price for not having RLS. Eventually your body adjusts and can give you at least 4 hrs of solid sleep, it did for me but everyone is different. I take short naps if I need to during the day, my worst time is around 3-5 pm. I take one 50 mg pill at 5:30, another at 11:30 before bed. Truck is to NOT let the RLS start, then it takes long time to feel the effects of the medication. Good luck.


Well, either the admin staff thought my request for an appointment – my reason given as "RLS, ropinirole >4mg, opiates?" to fit within the 32 character limit – was spam or there was a computer error, or my docs don't want to discuss opiates with me.

In the UK, the lighter opiates are not licensed for RLS, and I'd worry about bowel problems with them and any other opiates. These opiates are licensed for pain, of course, so if there is pain with your RLS, one might possibly be prescribed then that way, or, I guess, completely off-licence.

Targinact is licensed "as a 2nd line treatment for the symptomatic treatment of patients with severe to very severe idiopathic RLS after failure of dopamine agonists". See for example:


I can't find anything for Salford/Manchester (where I live), but if you go to the East Lancashire Medicines Board (just north of where I live) you find, however:

4.5.3. Use of weak opioids is NOT recommended

Although weak opioids such as tramadol and codeine are recommended as a second-line treatment option by the EURLSSG taskforce (consensus opinion group), evidence-based European guidelines from 2012 state there is insufficient evidence to make a recommendation regarding these medicines. For this reason and in view of the potential risks of tolerance and abuse associated with opioids, they are not recommended for use in the treatment of restless legs syndrome within the Lancashire health economy.

4.5.4 Targinact (Oxycodone hydrochloride/naloxone hydrochloride) is not recommended for treatment of restless legs syndrome.

Please see LMMG new medicines review for more details. Efficacy and safety data in support of Targinact® was not sufficient to allay concerns regarding:

– Safety issues and side effects associated with long term use of opioids

– The controlled drug status and potential for opioid abuse

– A lack of evidence for use beyond 1 year and uncertainty around the mechanism of action and potential for tolerance to develop when used to treat restless legs syndrome.

(This for Jan 16.)


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