TRAMADOL

[TEAH35]

The common thread for dealing with augmentation (on the forum) seems to be the use of Tramadol. One question .... what happens when we augment on Tramadol?

[Pam34]

Hello

I take 50mg of Tramadol (sometimes 100mg) and wondered if I was augmenting as their efficiency was nowhere near what it was to start with. I emailed Dr B for some suggestions and this was his reply. It may give you some ideas.

"It is much less likely that you are becoming tolerant to tramadol as you are on a very low dose. It is possible that you could be developing augmentation from tramadol (the only non-dopamine drug that may cause augmentation) and although that is also dose related, it sometimes occurs at low doses. It is also possible that your RLS is worsening for other reasons (lower iron levels in your brain despite reasonable blood ferritin levels, other drugs that worsen RLS, increased stress, change in lifestyle or natural worsening of your RLS).

There are several reasonable choices for therapy:

1. You could increase the tramadol and see if this helps the RLS without making it worse after a few months or so.

2. You could add pregabalin (or Horizant if that is available) and that might help considerably. You can even try transitioning from tramadol to pregabalin alone (at higher doses) if that does not cause any side effects (typically sedation, dizziness).

3. You could change the tramadol to a very small dose of a potent opioid like oxycodone or methadone (which may be hard to get from your GP) and is very effective and safe over the long term."

[LotteM]

Hi. I used tramadol (combined with gabapentin) after I augmented on ropinirole. It worked well for a short while using only 50mg. But in hindsight I became tolerant to its positive effects after some 2 months. And increasing the tramadol dose gave me awful side effects that didn’t subside. Gabapentin at low or higher doses didn’t help and gave me bad side effects too. In sum, I quickly became tolerant to tramadol while on the lowest dose. Thus, however unilkely, it CAN happen.

Almost two months ago I switched to oxycodon/naxolon (Targinact), also a low dose of 5/2,5mg only. That works well; I do alternate 4days of Targinact with 3d of ropinirole (0,25mg). Others have reported tolerance of oxycodon, so don’t think it will not happen just because DR. B. says so. He knows very, very much about RLS, but may not be aware, or simply discards, odd chances. I think on this forum there is a relatively high fraction of people experiencing these ‘odd chances’ - that is why they post, otherwise they would be happy with a succesful treatment.

[LotteM in reply to LotteM]

An afterburner: I don’t think I augmented on tramadol. But I know it can happen; there have been reports in the scientific literature and also several people here in the forum reported it. I remeber raffs as one of them.

[TEAH35 in reply to LotteM]

Oh crap ... but thanks for your insight

[TEAH35 in reply to LotteM]

With using Sifrol/Mirapex we seem to experience similar, (in most cases the same) side effects, however I have learnt that different drugs often affect us differently. Keeping this in mind .... would you mind if I ask you what kind of side effects you experience from Tramadol.

I have taken Tramadol before but I don't recollect any side effects that I was aware of. I know I can't take Endone, as I get very delusional for the first 3 or 4 days, eg I was on Endone during my recovery from the golden staph infection; I couldn't understand why I was strapped up so tightly and I tried to take all the bandages off; including all the heart monitors. I thought I was staying in a motel and couldn't understand why I couldn't get out of bed when I knew I should've been at work.

[LotteM in reply to TEAH35]

Hi Grany, I got heart palpitations from tramadol doses above 50mg. Even if I took each 50mg tablet/capsule several hours apart. They didn’t subside - and I tried for almost a month. So I stuck with 50mg (or lower) and the experienced tolerance after another 3 months or so.

[Pam34 in reply to TEAH35]

I’m certainly becoming tolerant of Tramadol hence my previous post to you with advice from Dr B.

Tramadol leaves me very tired the following day (probably because it gives me insomnia) and sometimes I have quite a bad headache, but no other side effects.

[TEAH35 in reply to Pam34]

So if insomnia is a possible side effect of Tramadol .... I'm basically up the creek! I'm pretty sure I read somebody mention OxyContin, I will have to be trying something very soon, woke up at 3am with RLS symptoms, threw 2 Sifrol down .... symptoms gone, but returned again this arvo. My psychiatrist appt to discuss augmentation and our plan-of-attack, is next Thursday so I will let you know.

If I get the side effect of a headache from Tramadol .... you'll hear me scream from Oz. (Headaches are something I have never experienced).

[Pam34 in reply to TEAH35]

To be honest I’d take the insomnia over the restless legs any time and I would NEVER take a dopamine drug again.

I tried to take the Tramadol every other day to try and delay my body getting used to it (I suffered on the other day) but now I have to take it most days the headaches have gone. Like any drug many of the side effects disappear once your body is accustomed.

I’ve found Tramadol to be great, I’m just sorry I think my time is coming to an end with it.

[Gmc54]

I am augmenting on Tramadol, I have an appointment with my GP next week, but don’t hold out much hope of getting help.

[Pam34 in reply to Gmc54]

See my reply from Dr B at the top of this post with his suggestions

[Jumpey]

It's a bugger this syndrome -it's so complex and intractable. I have experienced tolerance on tramadol even whilst rotating it with codeine. Although it still retains some efficacy when used ths way. I don't think that i have expeiencev augmentation with it but it's worth bearing in mind.x