Does anyone here have any experience with rotigotine patches? In particular the difference between these and ropinerole. I am currently on Requip 2mg, and while these do appear to be working, they make me so tired in the evening and hard to wake in the mornings. This doesn’t help much when it comes to my job, which requires me to sleep at work, be available to wake in the night if required and get up at 6:30 every morning.
The next treatment I’ve been offered is a trial of the patches, but if they pretty much have the same ingredients surely the symptoms will be the same?
Any advice would be greatly appreciated.
Sam.
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Alfsdad86
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Just to clarify, Requip is the extended release version of Ropinirole, I believe. The Rotiigotine patches (Neupro) are also extended release.
They are both Dopamine Agonists, therefore both substances have similar or identical actions and similar or identical side effects.
Any difference in their overall effect will be due to any differences in the rate at which they're released and the rate at which they dissipate.
The rate at which substance is released is measured in terms of how long it takes from commencing the medication until a maximum level is achieved in the blood.
For an immediate release tablet it will often take between 1 and 2 hours for the maximum level tlo be reached in the blood, after which the level of it falls.
For an extended release tablet, it will take longer for it to reach a maximum level. For a patch it might even be longer. I have been unable to find any figures for Requip or Rotigotine.
If Neupro is released slower than Requip then it's possible that you will get less drowsy in the evening.
The rate at which a medication is dissipated is measure in terms of its "half life", i.e. how long it takes for half the medication to disappear from the blood.
The half life of immediate release ropinirole is 6 hours. For requip it will be longer and for Neupro it may even be longer, as the idea of a patch is that it sustains levels until the next patch is applied.
Again, I have been unable to find any figures.
I am only therefore guessing, but in comparison to an immediate release medication, which will take effect quite quickly and wear off quite quickly, extended release medications take longer to achieve full effect and longer to wear off.
With a 24 hour patch particularly, after using it for the first day, the balance of levels in the blood may be similar at the end of the second day and subsequent days as the beginning of the previous days.
Logically then, I imagine that with an immediate realease medication it will make you quickly drowsy in the evening, but will have worn off in the morning. Requip may make you less drowsy in the evening, but more drowsy in the morning. If Neupro does make you drowsy, it might make you consistently less drowsy but more of the the day.
I found that taking Pramipexole made me drowsy at first in the evening, some days I had to literally crawl to bed, barely able to get up the stairs. That wore off to a large extent.
After taking it for some years, although often feeling drowsy it greatly disturbed my sleep and there were times when I was unable to get more than 3 hours sleep. Suddently falling asleep during the day often happened.
Sorry if this isn't much help, it's a complicated issue.
That’s a very in-depth and very appreciated answer. My current side effects of requip are the same as yours was for Pramipexole, which I have tried but had no effect on me what so ever. My dosage of pramipexole was only 88mcg though, which as my doctor informed me a number of times is a “tiny dose”. However following the recommendation letter from the sleep clinic it wasn’t to be increased and I was to be switched to the requip if not successful, then to the patch if still unsuccessful.
A wise sleep clinic! I took 540 mcg of Pramipexole, the "maximum" in the UK and consequently suffered augmentation, including chronic sleep deprivation.
Some would agree that if 188 mcg isn't working then not a good idea to increase it because of the risk of augmentation. They're all dopamine agonists so they all run the risk of augmentation and loss of efficacy.
Immediate release versions have a higher risk than extended release versions and Neupro possibly has the least risk.
Unfortunately possibly all the medications used for RLS are gling to make your drowsy to some extent, whether dopamine agonists or alternatives.
I have been on both - now on the patch. I get slightly sleepy on the patch but Ropinirole caused me to fall asleep at all sorts of times - even sitting, in company.
Eventually your body gets used to it. I have found that a half tab works if you rub magnesium oil on your legs at bedtime. I ordered it from Amazon. Wake up fresh
I don’t know about the patches but I take ropinerole. I found if I take 1/2 pill mornings and 1/2 pill around 6pm and a whole one at bedtime I sleep good and wake up easily. I’ve tried different doses and this works for me. You just have to experiment. Everyone is different
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