I've just started on Neupro patches, 2mg. Having augmented on pramipexole I am aware of the high risk of doing so on rotigotine.
Assuming the patch continues to deliver some benefit to my RL control, so far ok with only mild breakthrough (though it seems to be increasing, with possible arm involvement as well. 
) how can I minimise the risk? Any ideas please?
I've just found several posts about this topic so having a good read. 
I managed several years of 90 % relief from the patch by sticking to the lowest dose of 1 mg and taking regular breaks. During the breaks I need to take strong painkillers to help get me through. I try to manage 2 weeks break but rarely achieve it although I think even a weekoff is better than nothing. Recently I haven't been getting such good results and I thoughtaugmentation had struck so decided to attempt a long break. However once I reduced my patch to 3 quarters I found relief again for a few weeks. I am now on half a patch and doing ok 90 % of the time again. .Hope it makes sense I am in a rush! X
Hi Pipps, good to hear you have fairly good coverage of your symptoms again. Long may it last!
Thanks Pippins2. I'm not sure what is happening really as I had legs bad enough to stand up for an hour last night. I am also withdrawing from Tramadol and gabapentin so things are quite complex I guess to see what is causing what.
I will keep your comment in mind and add it to my growing knowledge. Thank you.
Ive been on the patch now going on 4yrs started on 1mg then 2mg ive been on 3mg for at least 2yrs sometimes i do have to add a 1mg when i am really stressed but up to now i am well and i really dread if i get augmentation before i got the patches i was really at the end it was so bad i had to finish work because i was getting hardly any sleep i worked for a doctors surgery and found i couldnt concentrate on the patients needs but the patches have really worked for me ,i really hope that they carry on working for you
That's a positive post, thank you. It gives me hope. Do you ever take a 'holiday' from the patches? Stress is a bummer! It was only after many years suffering that it dawned on me that stress was a huge trigger and unfortunately, I have a lot to deal with due to a daughter with a mental health problem. It's all about me trying to not react with typical stress reactions, but keep my own mental health strong and resilient and focusing on the positives. I take time out in the garden... a way to step out of the stress, and meditation has helped with that. However, now, having a son with drug and alcohol issues that he won't admit/deal with, is another nasty that I'm currently dealing with. More garden time! And hobbies to take my mind off the 'real life' issues that are a constant in my life.
Did you get back to work after the patches? I know I was close to having to leave my job if I hadn't come across the patches, courtesy of my GP... and a suggestion from Dr B.
I would suggest sticking to the lowest possible dose. It might be worth trying 1mg rather than 2 to start with. You will greatly increase the risk of augmentation if you start to increase the dose when the existing one seems not to cover symptoms. Ideally when you notice symptoms starting to break through reduce or even discontinue the patches for a week or so (as Pippins suggests) Keep serum ferritin high (unless you are in the rare group who suffer haemochromatosis) and have a fall back treatment such as tramadol for when you need to take breaks.
I have come off from premipoxle nearly two months now and on my Rotingine patches starting with one Mg dose I some time take two Patches so that is 2 Mgit it is helping during Christmas I have wine with my dinner make the symptoms worse it was like both my legs was on fire so wine make it worse same thindg on new year day with wine it’s worse so no more wine but patches are working well
Do remember that the higher the dose the more risk of augmentation, I wrote this post a long time ago and I augmented on the patches after only two weeks so had to go off them. Now I'm on buprenorphine patches which controls the RL symtoms very well. Good luck with yours.
Yes Rotingine patches are not working that well may be I am on low doses got neroulogist appointment and will ask bprenorphine patches
That's great. Good luck.
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