RLS getting worse naturally or augmenting... how do you know?

[FluteE]

I feel more tingling and twitching throughout my body now and also earlier in the day. Up until now I’ve only taken one .125 mg Pramipexole 2-3 hours before bed. Can I augment on the lowest dose or is my RLS getting worse on it’s own? This has been a wonder drug for me.

[involuntarydancer]

It is possible to augment on a low dose of a d/a but it is more unusual. Is there anything going on at the moment that could be making the legs worse? Have you changed routine, increased stress etc? Could your iron levels have dropped?

If it doesn’t settle down, it might be worth taking a week or two off the pramipexole to see if you can re-sensitive yourself. Or you could add a different drug such as pregabalin or tramadol to deal with the breakthrough symptoms.

In your shoes I would resist the temptation to increase the pramipexole.

[Parminter]

You can augment on the low dose, I did.

The natural progression of RLS is very slow, so if the progression has speeded up relative to the period prior to medication, you are augmenting.

While you are still on that low dose, it might be wise to consider other options. If you increase your dose it will become increasingly difficult to stop what is, in effect, an addictive drug with huge problems down the road.

[Hidden]

Interesting! I’m wondering the same thing about my RLS. How do we know if it’s Augmentation or just a natural progression of the disease?? For me, knowing that it’s the latter would help me cope better (don’t ask me why that is).

[rls_optimist in reply to Hidden]

I totally get that. If it was just natural progression, then we could continue taking a DA, upping the dose as needed. But the question of whether it's natural progression or true augmentation is not always easy to answer. I believe the RLS Foundation web site has several text and video links dealing specifically with augmentation, so there's one resource you might try. Some of that content is for all, some is for members only. (Definitely worth shelling out some money to join that organization. They are truly a treasure.)

As for myself, the way that I became convinced I was experiencing augmentation and not just natural progression was when I went on a drug washout a few years back, tapering off (over several days) the 2.5 mg pramipexole I had been taking, and plowing through the withdrawal with the blessed help of oxycodone. After 10 days, I gingerly started adding pramipexole back in (didn't know better, nor did my doctor). After titrating back up to 1.5 mg, with no oxycodone, I found that to be enough. Gradually, it crept back up. But the fact that 1.5 was enough, even if only for a few months, told me it was augmentation, and not natural progression, that had ratcheted up my RLS symptoms to where they were breaking through 2.5 mg before the drug washout.

[hausbauer]

I was augmenting on a low dose of pramipexol. When I added Pregabalin, it stopped. I had no more sensations when taking a nap in the afternoon or evening when watching TV f.i. Though I did not like Pregabalin (gastrointestinal complaints, indifferent bad moods). But this may of course be different for you.

[rsears57]

I suspect its just not enough. I take .75 3x daily