Controlling augmentation and impulse control issues

[involuntarydancer]

Ok I have no personal experience of this but as there are many on here going through the horrors of augmentation I thought I would pass on the experience of a poster on another rls forum.

He was prescribed naltrexone for a separate issue but found that after he started naltrexone he was able to half his dose of mirapexin from 1mg to 0.5mg (he states himself that he was severely augmented at that stage). He also found that impulse control issues he was experiencing, caused by the high dose of mirapexin, disappeared.

As I say, I can't vouch for this myself but naltrexone in high doses is used to help addicts stay on the wagon. Apparently it works on opioid receptors and his theory is that the naltrexone negates the excessive effect of the augmented mirapexin in some way. Importantly, he does not take a low dose of naltrexone. He started on 25mg (ldn uses something like 3mg) and has reduced to 12.5mg which is still effective for him (these are American doses - I'm not sure if they are the same in the UK).

Given the difficulties associated with achieving a workable regime after augmentation and the calibre of drugs required to afford relief to those with pronounced symptoms, it would seem to be worth trying this in appropriate cases (ie where a substantial dose of naltrexone is not counter-indicated) for people who are experiencing augmentation on dopamine agonist drugs.

[involuntarydancer]

Should have said, the original poster found that he experienced relief almost immediately he started the naltrexone so it wouldn't be necessary to take the drug for very long to find out if it was helpful.

For me mirapexin enabled the closest thing to a normal life and I am very tempted to see if my GP would prescribe naltrexone and give mirapexin another go. It would be such a relief to give up my regime of illegal drugs, hateful patches and central sleep apnea inducing opioids!

[Hidden in reply to involuntarydancer]

Been reading up on LDN and am considering it although I have more research to do. Flowergirl has a good post here:

healthunlocked.com/rlsuk/po....

[involuntarydancer in reply to Hidden]

Thanks, Raffs, for that link - I recall reading it at the time and thinking I should pursue it but I also came across quite a few reports of people for whom LDN is not effective for RLS/WED.

It refers to a low dose of naltrexone and I would just point out that in the case I refer to above the dose of naltrexone was relatively much higher.

In general, I found it so difficult to achieve a regime that controls my rls that I'm reluctant to tamper with it even though what I take now really does not allow for a normal life. I can never rely on symptoms being controlled and even if they are, often I don't sleep due to hyper alertness. I also find I need a lot more sleep - I think to allow my body to process the drugs.

I don't think I will try LDN. I would be anxious about adding it to my current regime because I'm not sure how it would interact with the Kratom and as I take this illegally I can't run it past my GP.

I might, however, consider moving back to mirapexin entirely and trying a high dose of naltrexone once augmentation set in (which I would expect to happen quickly given my history).

[Hidden in reply to involuntarydancer]

My regime although not great is better than it has been so I too would be reluctant to change but I know it wont last so will have this as a back up.

[Joolsg]

That's very interesting involuntary dancer. It will be very useful for those new members experiencing augmentation. Maybe someone can ask their GP/neurologist to consider prescribing it to help reduce the DA dose.

I remember a recent post on the benefits of low dose naltrexone for RLS and kept meaning to follow it up. It's something I think would help either on its own or in addition to existing therapies for RLS.

[lee1983]

if you dont get off the opium train you really be in for a ride that you want like where it takes you and want bring you back

[nightdancer in reply to lee1983]

Sometimes, a lot of the time, none of the 'regular' RLS meds work. I have been on EVERY med known to be used for RLS, on and off label. The ONLY thing that stops my refractory RLS is opiates and many, many people on here and in my groups have to take opiates, at the lowest dose possible to get ANY quality of life. I know from your other post that you are 8 mgs of Requip, Lee1983, and that is way to high of a dose for RLS, so the "dopamine train of augmentation" is also a ride you do not want to be on".

[Kayakcarole]

After beginning augmentation on Pramipexole after 10 years, I just began taking low dose naltrexone with 2 capsules of 2.5 mg each along with a quarter tab of .25 Pramipexole. Total relief! I am so excited!!

[involuntarydancer in reply to Kayakcarole]

Wow! That is exciting. I have wondered and wondered was there anything in this proposition (that naltrexone could have a positive impact on augmentation). I really hope it continues to work for you, kc. I hope you will keep posting.

I have just resumed pramipexole after a long break. I am on a very low dose at the moment (.044mg) and am planning to take a break from it for two nights a week to minimize the risk of augmentation but I have naltrexone in the house now and will try it if I find I am augmenting.