I have RLS which is under control with Ropinorole, however I think it's also causing me insomnia which I've been prescribed Gabapentin, which seems to help. I wanted to know though if Pramipexole (which I was using years ago) also causes insomnia? I know they are both dopamine antagonists but maybe one is better than the other in that respect and it was over 10 years ago I last took it.
Has anyone swapped between them and found any difference? My RLS is under control so this seems to be a side-effect from what I've read on here. I really don't want to be on Gabapentin I've read loads about negative side-effects and don't want to loose my hair etc.
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silkusmaximus
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It's an easy mistake to make but both ropinirole and pramipexole are dopamine "agonists" NOT "antagonists" these two terms are the exact opposite.
All dopamine agonists share more or less the same unfortunate consequences, although not equally.
In this respect pramipexole is worse than ropinirole.
If ropinirole is causing you insomnia,then pramipexole may make it worse.
Gabapentin also has some potential side effects which affect different people to different degrees. It suits some people but not others.
The usual side effects of gabapentin are drowsiness, dizziness and a stumbling gait. It can also cause blurred or double vision. Some people put on weight. For some people, these side effects outweigh the benefits of gabapentin. A lot of people, benefit from taking gabapentin and find the side effects tolerable.
I haven't heard that hair loss is one of them.
The biggest difference between dopamine agonists and gabapentin is that the former commonly cause augentation and can cause an Impulse Control Disorder, (ICD). Again pramipexole is the worst for causing augmentation. Gabapentin does not cause augmentation or ICD.
For this reason, it is now increasingly accepted that RLS sufferers should not be prescribed a dopamine agonist when first diagnosed with RLS. Dopamine agonists are not a long term solution for RLS and can end up causing RLS to become significanlty worse i.e. augmentation for most people.
Gabapentin can be effective for RLS, without taking a dopamine agonist as well. An advantage is that it also helps sleep not causing insomnia.
I usually suggest that if anyone is taking any dopamine agonist and having any problems with it i.e. it stops working, causes augmentation, causes an ICD or insomnia then they stop taking it.
To clarify, gabapentin doen't necessarily cause the horrendous side effects you may have read about, it can relieve RLS and promote sleep depending on taking an effective dose. Dopamine agonists on the other hand can cease working and cause augmentation.
Furthermore, a dopamine agonist should not be stopped suddenly as this is dangerous and/or can casues significant withdrawal effects.
If you're wondering if you should switch back to pramipexole from ropinirole, I think it would be better to stop taking any dopamine agonist and possibly increase the gabapentin.
I confess to being biased, after suffering augmentation and sleep deprivation for several years due to pramipexole, I now feel some days, like I've never had RLS at all, it was a bad dream. I only take gabapentin, only have mild side effects and currently have more hair than I've had for years, due to the lockdown!
Yeah I think when I was first diagnosed around 10 years ago now, Gabapentin wasn't even on the cards so it was only when I went back to the Dr's a couple of months ago he suggested trying it with the Ropinorole. At this point I'd already reduced my dose of Ropinorole from 2mg down to 1mg which stopped some of the side effects but still kept the RLS under control, which was good...but then I'd read a lot of people who'd lost a lot of hair using the Gabapentin so I'm keeping a close eye on it.
I think coming off the Ropinorole would be great, I hate taking two different kinds of drugs (or even one) but as it stands the Gabapentin doesn't stop the sensation...I hope I can ween myself off of it in the future.
I haven't had any side effects from the Gabapentin in 3 months now. If you think the Pramipexole would be worse then it's not worth trying. It was the insomnia rather than the augmentation I was wondering about though. Luckily I'm not showing signs of the latter...
I'm only taking 300mg Gabapentin, which I'm told is a low dose, so next step would be to see if I can reduce Ropinorole down to 0.5mg and try increasing the Gaba...
Did you personally have problems with insomnia with the dopamine agents? I fall asleep ok but I wake up and I just can't get back to sleep....or I wake up 6-7 times a night and feel shattered all next day. I'm sleeping so lightly....but not because of any RLS sensations, just my mind racing....likely a gaba/glutamate imbalance I suppose, at least that's what it feels like.
Tried a natural Gaba supplement too but that doesn't seem to work.
When I was taking pramipexole I was sleeping on average no more than 3 hours a night. Every night!
Now, although I don't always go to sleep early, once I'm asleep and I rarely sleep less than six hours, sometimes 8 hours.
300mg gabapentin is not enough. A minimum effective dose would be 900mg.
Reducing from 2mg ropinirole to 1 mg is easier than reducing from 1 mg to nothing. The smaller the reductions you make and the longer you take, then the less the withdrawal symptoms will be. Despite the gabapentin you will still probably have withdrawals. This may be at its worst 24 to 48 hours after stopping altogether.
I suggest reducing 0.25 mg at each step, say every two weeks. However if at any time you reduce you do not get withdrawals after 48 - 72 hours, then you could try the next reduction.
The mind racing may be a gaba/glutamate imbalance, but it could also be the ropinirole or stress.
Although some RLS sufferers scoff at this, I find "sleep hygiene" measures beneficial for sleeping, especially light management. I believe I have invented a new condition Seasonal Insomnia Disorder (SID). My sleep is much worse in the winter months - lack of daylight.
Yeah that gabapentin actually worked and definitely helped me sleep with 300mg but after about 2-3 weeks I started getting very short of breath (I'm fit, cyclist etc) and stopped immediately after I realised what it was....my breathing returned to normal within 24 hours....so that's definitely something I wont' be going back to. I'm trying Pramipexole again but that's just out of desperation ....I know they all work the same so I'm not holding out.
The fact that the Gabapentin helped so much was promising though.
Oh dear, I'm sorry to hear this. Respiratory depression is a risk with either gabapentin or pregabalin.
However, the risk is relatively small and is usually confined to people who have pre-existing respiratory "compromise" e.g. have some condition which causes "central" respiratory depression or are taking medicines which cause it e,g, opiates.
It may not be of any concern at all, but I am always wary about "fitness". This is because fitness doesn't necssarily equate with health,.
I would suggest therefore that you have a health check to see if your heart and lungs are OK. Additionally, is there any suspicion you suffer sleep apnoea?
I recall that your main problem with the DA is insomnia rather than augmentation and so you probably realise that you need to keep the dose of pramipexole as low as possible. 0.25mg is probably the maximum you can take safely.
A benzodiazepine (e,g, clonazepam) or a "Z" drug (e.g. zopiclone) can be used for short term relief of insomnia. Otherwise sleep hygiene measures and relaxation techniques may help along with remedies such as valerian or lavender.
Anxiety may be contributing to your sleep problem.
Hiopefully you have explored the variety if non pharmacolgical remedies for RLS, not everyone needs medications.
Ropinrole caused me loads of side effects i switched to pramipraxil now have ño noticable effects except they do the job . The ropinrole has got far more extreme ingredients alliminum salts alsorts , she gave me tiny does of pramiprx to start with icreased each week , i did not tell doctor but got a good stash built up while used last of ropinrole then started straight on 3 tabs it worked well , gabs dont work for me at all i get super tied but legs wont allow sleep
Aluminium??? Arrghh, I hope not, I don't wanna be taking that.
What side-effects were you getting on the Ropinorole? I'm just having very bad insomnia at the moment....difficult to say if it's just the Ropinrole as I can't not take it....
All oral medicines contain the active ingredient and some other substances which contain the active ingredient. The actual volume of the drug is tiny. You probably would need a magnifying glass to see it.
These other substances are called excipients.
Different manufacturers of the same drug may use slightly different excipients but there are many commonly used ones.
The most commonly used excipient is Lactose, a sugar. This is OK for most people unless you are Lactose intolerant.
Checking the list of excipients in ropinirole, I can see that aluminium is not used.
As aluminium is fairly toxic, I doubt if aluminium is ever used as an excipient
Lactose is the main excipient in ropinirole. Magnesium is also, in a small amount and magnesium may actually be helpful for RLS
I hope ypur doctor made you aware of the longer term consequences of taking a dopamine agonist. It seems they often neglect to do this. I suspect it's probably because they don't even know what they are.
In the UK the national guidelines for the management of RLS do state that you should be aware of these risks.
They are loss of efficacy, augmentation and Impulse Control Disorder. The first two are common and significant.
Of all the dopamine agonists pramipexole presents the highest risk and the higher the dose, the higher the risk. 3 tablets, presuming these are 0.125 mg each, is perhaps too much if you wish to avoid augmentation. Certainly if your symptoms start occurring despite this dose, do NOT increase it.
Something else you may not be aware of, it's OK to switch straight from taking a full dose of one dopamine agonist, i.e. ropinirole to taking a full dose of another i.e. pramipexole. However if you had been been switching from a dopamine agonist to another NON dopamine agonist, you would have probably suffered significant problems OK in this case, but something to be considered in future.
There is no aluminium in ropinirole, the main excipients are lactose and magnesium.
It’s so sad to read of so many people who are taking pramipexole and having such faith in it. I can understand this as it is seductively effective.
However it seems that whoever prescribes it fails to warn people of the consequences of taking too much of this drug for too long or even seem to know of them.
Like the latest recommendations for the treatment of RLS, I would never advise using pramipexole as the first drug of choice for RLS.
It’s so sad to read of so many people who are taking pramipexole and having such faith in it. I can understand this as it is seductively effective.
However it seems that whoever prescribes it fails to warn people of the consequences of taking too much of this drug for too long or even seem to know of them.
Like the latest recommendations for the treatment of RLS, I would never advise anybody to use pramipexole as the first drug of choice for RLS.
III have been on pramipexole for years. Sometimes I think I should try something else.
What else is there? it's all hit and miss with RLS.
I have just had a hip replacement and while I was in in hospital my RLS was off the scale and the jumping caused me such pain that I was given shoretec. it's a pain killer but it stopped my legs Fantastic. apparently it's a controlled drug so whether your GP would prescribe it is another question. good luck
You will have been given an opiate for your pain and it will have been this that relieved your RLS.
Opiates are known to be effective for RLS.
However, it's difficult to get a prescription of an opiate for RLS as they are particularly out of favour at the moment.
This is nothing to do with them being controlled drugs.
The alternative first line medication for RLS is either gabapentin or pregabalin. Doctors quite commonly prescribe these, so there should be no problem obtaining them.
They are both controlled drugs.
Pramipexole is no longer recommended as a first line treatment for RLS because of augmentation.
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