Pramipexole/gabapentin/codeine???

[Bks429]

Hi there- back again with a question....I have been taking pramipexole (250) and gabapentin (300) for a couple of years now. I was experiencing breakthroughs during the day. My prior neuro’s solution was increase prami. Frustrated with him, I went to see a new neurologist who wanted to wean me off the P&G, and added Tylenol 3 with codeine. I started taking the codeine and slept better than I had in years. I tried weaning off the P&G, But I had symptoms at night, so the doctor said I could take everything which I was. Well now it seems I’m developing an allergy to the codeine: itchy and phlemy cough developing at night. The symptoms began to worsen as time went on. I have discontinued the codeine. Any thoughts on the above?

[Lapsedrunner]

I think the pramipexole is the problem. Over time the vast majority of us experience “augmentation” with it (it seems to stop working, spreads to other body parts, seems to start earlier) there’s a pinned post to explain this.

You’re right to not want to increase the pramipexole..that’s the worst thing to do. You’ll actually need to GRADUALLY decrease and stop it. Ironically codeine would help with this process. Don’t stop your gabapentin.

Have you had your ferritin level checked...we need 100+ (don’t just accept that it’s “normal” because anything over 15 is considered that!

Are you taking any other medication? There are some that can make RLS worse.

You’ll get lots more good advice soon I’m sure!

Good luck

[Hidden]

Hi I agree with Lapsedrunner. The pramipexole is most likely the cause of your "breakthroughs". It's stopped working and as you have breakthroughs in the day then it's likely you have augmentation.

The answer to that is, I agree, to reduce the prami and if you can, stop it.

However, I suggest you try increasing the gabapentin first. 900mg is usually quoted as the minimum effective dose for RLS, i.e. on its own.

You can increase it by 100mg a day (or 300mg every 3 days). THEN try reducing the prami. As you seem to be taking 0.25 mg (= 250ug), then I suggest reducing it in steps of 44ug . This is equivalent to half of the smallest dose tablets which are 0.125mg pramipexole hydrochloride which gives 88ug pramipexole.

You could cut the 0.25 tabs in quarters, but it's not so easy.

I'd suggest reducing it about once every 2 weeks. Your symptoms may get worse at first due to withdrawals, but should settle. If they settle in less than 2 weeks then you can reduce again.

Take it as slowly as you can.

Tylenol + codeine can help with withdrawals, but it's a bit limited.. The dose of codeine isn't brilliant, AND you can't increase it by taking more because of the tylenol.

As you also say, it may be causing itchiness.

Codeine, an opiate, can stop coughing. Some cough suppressants have an opiate in them. This may sound contradictory but if your coughing reflex is depressed, then you will get a build of phlegm.

Codeine is also a respiratory depressant. I'd suggest you consult your doctor, if you're worried. They might agree to an alternative opiate.

An expectorant medicine may help your coughing, these help liquefy the phlegm.

[Bks429 in reply to Hidden]

I spoke with the doctor and he suggested cutting the coding in half, which has alleviated that problem, however now I’m waking up 2,3,4 times with rls! I’m terrified to try stopping prami? Thoughts?

[Hidden in reply to Bks429]

Your main problem remains the pramipexole and I don't think you'll get any real improvement until you've stopped the pramipexole.

My previous reply then, still stands.

You should get some improvement if you increase the gabapentin.

Then you can start reducing the pramipexole.

It's unfortunate that you've had to reduce the tylenol and codeine. The amount of codeine isn't a great amount anyway. It was helping you a bit and it would have helped with withdrawing from the pramipexole.

I can understand your anxiety about decreasing the pramipexole, this does show how dependent you are on it.

I appreciate it's difficult to see at the moment but the most fearful thing is to keep taking the pramipexole and stay in your current situation, or worse, indefinitely.

Whilst reducing the pramipexole things may get temporarily worse, but after withdrawing, things should improve.

I'm afraid it doesn't sound as if your doctor is being particularly helpful. Did he/she check your chest?

I'm afraid the best thing yo do may be to take your courage in your hands and go for it. You can expect some sleepless nights, but it's well worth going through it.