Is a combination of drugs the answer?

[Felicity21]

Having been on Prami for years, I tried Ropinerole which did not work for me so the Rotigotine (3mg) Neupropatch was great for a while until this summer when clearly augmentation set in again. I had a lot of sleepless nights until I discovered it worked well with 2 co-dydramol (plus one Senekot to help with the constipation). However, I did not think I could carry on with the co-dydramol, so I went to see my Neurologist who prescribed Gababentin and told me to go up slowly and come off Neupropatch slowly. More misery and endless sleepless nights. I tried for weeks because I know it takes time for Gababentin to work (even went up to 1200 mg of Gababentin and reduced Neupropatch to 1 mg but it was awful and I did not seem able to come off the Neupropatch until I had enough and discovered what works for me is 900 mg of Gababentin PLUS 2 mg Neupropatch plus 1 0.5 Clonazepam. All seems too much hence my question. Can I carry on taking this combination of drugs? Many thanks.

[Joolsg]

At least your neurologist knows what he’s talking about. He was correct in advising you to slowly get off the patch as you have clearly augmented.

Withdrawal is very, very hard for the majority, but it seems that the slower you reduce the patch, the more likely you are to succeed.

Try cutting the patches- a lot of people have done this.

However, if you are currently experiencing no RLS and no worsening of RLS on Gabapentin, the patch and clonazepam- you could stay on that regime for now. A combination of meds at low dose is often better than one med at high dose.

However, if you get signs of augmentation again, you would have to try to get off the patch.

[Felicity21 in reply to Joolsg]

Many thanks indeed for that.

[Hidden]

Hi Felicity, if I were you I'd get some professional advice. I know from experience (I have a condition called Diverticulitis ) that messing around with different strengths of a table can be risky.

[Hidden]

Dr Buchfuhrer has often said a combination of different class of meds at low doses can work alot better than just taking one med at a higher dose. I also agree with the rest of what Jools has said, and cutting a patch is ok to do, i believe even Dr B has said its ok. I have done it myself when i was using the patch,. Good luck with your now regime that it keeps working for you.

[Felicity21 in reply to Hidden]

Thank you Elisse.

[Hidden]

Just to say that I believe it's OK to take both Gabapentin and Rotigotine. The only drawback I've read is that the side effects add up. So I guess if the side effects aren't a problem, then it's OK.

Dr B also advised me it's OK to combine.

Augmentation is still a risk, but not as much as if you were taking a higher dose of Rotigotine or taking immediate release Pramipexole or Ropinirole.

.I have read contradictory things about Clonazepam however. I have only ever been allowed 4 weeks worth on the basis that dependency sets in. after that. Not necessarily a bad thing in itself, but Benzodiazepines are known to stop working once you've become dependent.

It's possibly better to take it intermittently rather than every day. If it's not working, the only reason you're taking it is to prevent withdrawal effects.

[Felicity21]

Thank you Manerva and the others who have replied. I really appreciate your views.