From ropinirol to Rotigadine patch

[Lyndabutt]

Commenced 1 mg patch last week and my RLS has gone much worse.i was taking

Ropinirol 2 mg dailyAnyone else had this.

[Joolsg]

It’s quite common to augment quickly on the patch if you were augmenting on Ropinirole. How long were you on Ropinirole and why did you switch?

[Lyndabutt in reply to Joolsg]

Thank you for replying.i was on Ropinirol for 12 months but I thought it would be easier to wear a patch.

[Joolsg in reply to Lyndabutt]

Thanks for that further info. Manerva's and Lotte's answers explain why your RLS has worsened. If you don't take an equivalent dose you will get withdrawal symptoms.

Can I just check whether you were taking any other drugs before Ropinirole? You mention that you have had RLS for 40 years. Were you on Pramipexole ( mirapex) or any other dopamine agonists before Ropinirole?

I hope your GP sorts it out soon. All the best.

[Lyndabutt in reply to Joolsg]

Thank you for your reply.i wasn’t taking any medication.i had accupunture for years then it stopped working for me.

[Joolsg in reply to Lyndabutt]

Thanks again. You should be able to resolve the matter by asking your GP to put you on an equivalent dose but please do consider putting everything in writing as your GP clearly has no knowledge of RLS. Have a look at all Manerva's recent posts. Did your GP warn you about Impulse Control Disorder and Augmentation? They are both serious, common side effects of Ropinirole ( and the patch) and GPs must discuss with you before prescribing Dopamine Agonists. You should also report the worsened RLS on the Yellow Card scheme and ask them to notify your GP. The more people who report this side effect of "withdrawal from Ropinirole" the more information/education GPs will get.

yellowcard.mhra.gov.uk/

[Hidden]

In order to switch straight from one dopamine agonist to another you need to take an equivalent dose.

I believe 2mg of rotigotine is equivalent to 2mg ropinirole. Also since rotigotine is slow release and ropinirole immediate release the amount of rotigotine reaching your blood stream will be less than an equivalent dose of ropinirole.

In effect then, by switching as you have done then you have possibly more than halved the amount of dopamine agonist you're taking.

What you may be experiencing then is dopamine agonist withdrawal effects.

If your doctor advised this sudden reduction, I think it irresponsible.

[LotteM in reply to Hidden]

Lynda, I agree with Manerva about the dosing and the possible effectively reduced dose. And if you were changing because of loss of effectiveness or symptoms occurring sooner and earlier in the day, than it may be even worse, as these are some of the signs of augmentation. Read about augmentation on this forum (you can use the search function and there ia a pinned post about it) and see whether that applies. I am afraid you'll have to go back to your gp, but it is better to go armed with lots of knowledge and information. I suspect you may be better of switching to an alpha2delta ligand (gabapentin or pregabalin) and slowly reduce the ropinirole. If so, be aware that it often takes several weeks for the gabapentin to become effective. Etc etc. We'll get you more appropriate info when you let us know what is going on. We're here to listen and help if we can.

[Lyndabutt in reply to LotteM]

Thank you so much for your advice and support.

My RLS is definitely worse when I have sugar so I am going to think about what I eat more.

[Lyndabutt in reply to Hidden]

Thank you for replying.i think you are right.its. I will go back to my GP.

It’s been horrible.i have had RLS for 40 years but never as bad as this now with patch.

[LotteM in reply to Lyndabutt]

Lynda, I -again- have no time for a more complete reply. If you go to see your go, several things are important. If you hunt around here, you can find the info (or others may post links).

- make sure you know the 4-5 signs of augmentation

-don't let tour go prescribe you another dopamine agonist (pramipexole or levodopa)

- gabapentin or pregabalin are the next options, but they take time

- reduce your current meds very slowly. Very. It will likely worsen your symptoms, ask your gp if she would temporarily prescribe tramadol (or weaker codeine or stronger oxycodon) to help with these increased symptoms until things are well over. To take when needed, usually the last bits of the ropinirole or rotigotine

- it may be easier to reduce the ropinirole slowly as they come in smaller amounts) 0.5mg or even 0.25mg. Maybe it is worth switching back to ropinirole before reducing.

-get te relevant NICE guidelines (look in posts or replies by Manerva; I can't post them as I am not in the UK).

Good luck. You will get better than now.

[Hidden]

Presuming you live in the UK, here's a link to the National Institute for Health and Care Excellence's (NICE) guidance for GPs on the managment of RLS.

cks.nice.org.uk/topics/rest...

This is a very comprehensive web site in which you can find a lot of informatkion about RLS. You can refer your GP to the site, they will recognise NICE.

PLease also note that the NICE guidance does suggest that if your GP prescribed you ropinirole or rotigotine then they should have warned you of the risks of taking a dopamine agonist i.e. augmentation and Impulse Control Disorder.

The guidance is not mandatory, however, according to guidance issued by the General Medical Council by failing to do this and by not discussing alternatives, your GP's conduct is unethical.

Please see this post.

healthunlocked.com/rlsuk/po...