New Symptoms

[Woody4]

I take .5 mg of pramipexole nightly. I have at times fallen asleep only to wake up in an hour or so with the urges to move. This was seldom til this past week when it was 2 out of 3 nights. The 2nd night was horrible. I woke up with 1 arm going nuts but it soon spread to both arms and 1leg. I must have really looked hilarious trying to move both arms and just 1 leg. Is this a sign the pramipexole is starting to lose its effect?? Also several times lately I have had afternoon leg problems. Never in the past have I had trouble other than at bedtime.

[LotteM]

It is a sign of augmentation! Please search this forum for 'augmentation'; there are pinned posts. Also look at rls-uk.org for relevant info. No time now to give you more details.

[Hidden]

Hi Woody, Lotte is right.

If you have the following signs, then you are suffering from augmentation.

Symptoms getting more intense

Symptoms happening earlier in the day

Symptoms spreading from the legs to other parts of the body

The time between relaxing or lying down and the onset of symptoms gets shorter.

Augmentation is a common occurrence with dopamine agonists like Pramipexole and is when, not only does it stop working, it actually makes things worse. You are taking a relatively high dose and that will have contributed to the augmentation.

Here's a link to a good article on augmentation

sleepreviewmag.com/2015/02/...

Dealing with augmentation, I'm afraid is quite difficult, Since the Pramipexole is causing it, you have to reduce the dose and possibly stop taking the Pramipexole.

You will need to discuss this with your doctor.

He/she may want you to switch to Rotigotine patches (Neupro). This can sometimes relieve augmentation. However it is another Dopamine Agonist so after some time will also cause augmentation.

The advantage of switching to Neupro is that you can simply stop taking the Pramipexole and start using the patches.

It's possibly better to switch to an alternative first line RLS medication, i.e. either Gabapentin or Pregabalin.

However, you must have a plan for doing this, you must reduce the dose.of Pramipexole very slowly because there can be serious withdrawal symptoms. I reduced it in steps of 0.0625mg or thereabouts by cutting 0.125 tabs in half.. I only reduced every four weeks, but you could try faster than that.

I was taking Gabapentin BEFORE I started reducing Pramioexole, it takes about 3 -- 4 weeks to start working.

I found that as I reduced the Pramipexole, my symptoms improved, but at each reduction they may get worse before getting better.

If you withdraw from Pramipexole too fast or don't start on an alternative, withdrawal effects will be significantly worse..

[Woody4 in reply to Hidden]

What can a person take beside a dopamine?? I am taking the pramipexole because I have already done the augmentation thing on roprinole (sp).

[Hidden in reply to Woody4]

Unfortunately, Pramipexole is just as bad as Ropinirole for augmentationp. If not worse. If you really want to avoid augmentation, it's best to avoid dopamine agonists altogether.

The alternatives are an alpha 2 delta ligand, Gabapentin or Pregabalin.

[Henshaw241241]

Hi I was on pramipexole for a long time worked for a while then people told me to get off them slowly all I will get almentation and I got it very bad at the end I went to see a neurologist the best thing I done she put me on pregabalin 1 tablet at 6 PM 75 m and 1 tablet at 9 pm 75 m very good the best nights sleep I have had in for a long time hope you get on all right Xx Henshaw 241241 let me know how you get on

[Woody4 in reply to Henshaw241241]

A neurologist is who prescribed the pramipexole. When I first started on it I showed signs of augmenting after just a couple weeks. Called his office and he told me to up it to 1 mg a night. Luckily I didn’t and the .5 for, whatever reason, started working.

[Joolsg in reply to Woody4]

Sounds like the neurologist you saw is not knowledgeable about RLS. As you augmented on Ropinirole, taking another dopamine agonist will also lead to augmentation quickly. He should never have prescribed pramipexole and suggesting a dose of 1mg is negligent- most RLS experts know the dangers of DAs and that high doses lead to augmentation very quickly. As others have advised, pregabalin is a better alternative. I suggest you read everything you can on here and find another neurologist.

[Henshaw241241]

Hi you don get any augmentation with pregabalin I find them very good and the nights sleep is very good when I was on pramipexole every one told me to get off them soon as possible it took me a long time to come off them slowly I really had a bad time with them Henshaw 241241 hope you get on ok

[Henshaw241241 in reply to Henshaw241241]

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