Medication choice

Hello. I'm new here. I can't remember when my RLS started, at least 30 years. I didn't seek medical help until about 10 years ago. I saw a neurologist who prescribed Pramipexole and I've been taking it ever since. It worked in that I am able to sleep at night. I rarely have that horrible crawling sensation. The main symptom I get, when I get any is twitching and again, rarely, painful muscle spasms. I can't remember exactly when it started, but the twitching spread to my legs and shoulders. When the twitching starts, it usually starts in my shoulders. I didn't do anything about this, I find it an annoyance rather than a problem. A short while ago I started on Gabapentin for neuropathic pain by my GP. My GP isn't particularly knowledgeable it seems, about RLS. I've found that I have had practically no twitching at all since then.

It seems that Pramipexole works for me but leads to the augmentation I've experienced. I've read there's less chance of this with Gabapentin but I've read of it's side effects, some of which I've already experienced. Some of which, possibly yet to come, I already have to be careful of my Blood Pressure and i'm already overweight.

I've also read that Tramadol is another drug that could be used, but a) The pain I have is neuropathic not due to RLS and b) Tramadol has its own side effects.

My question is what's best, take one of these, or take a combination of any 2 or all 3 to minimise side effects OR are there other newer alternatives I've not yet heard about. Are they any nearer finding out what causes RLS?

[involuntarydancer]

Hi and welcome,

I have found a combination of drugs at a low dose much more effective for rls than a single drug at a higher (and usually increasing) dose.

What dose of mirapexin are you on? If you keep the dose low (the worst thing is to ‘chase’ the symptoms with the drug) and keep your serum ferritin levels high you might avoid augmentation. Unfortunately, once you have augmented there really is no option but to withdraw from the drug (an agonizing process) and use a different option for a while. For you possibly a lower dose of gabapentin - to keep side effects to the minimum - taken together with an opioid such as tramadol - again at a low dose - might be the best option.

You have clearly find your homework which is recommended as most sufferers have the same problem as you of an inexperienced GP.