Can opioids replace pramaprixole?

[PerniciousRLS]

I have finally gotten some sleep using dilaudid and taking them has also helped me reduce the amount of pramaprixole from .75 to .50 and now to .37.5. I started with a dose of 2mg of dilaudid which worked well for about a month and then was not effective. I increased the dose to 4mg and so far it has helped but I am concerned about needing increasing doses of this opioid and at what point does it become dangerous? Anyone have experiences with this? Please don't recommend remedies other than opioids as I have tried them all including cannabis. Thanks for sharing any experiences with opioids.

[Hidden]

The simple answer is yes, an opioid can replace pramipexole.

However, what you appear to be saying sounds dangerous to me. It appears that you are taking this drug without a prescription. The legality of that is no concern to me, but what is concerning is that you may be taking an opioid without medical supervision.

Of particular concern is that you took a lower dose and you then increased it. This appears to be "tolerance" i.e. after taking an opioid for a while you get used to it and need a higher dose to get the same effect. This can have a runaway effect.

This leads to addiction.

Dilaudid isn't recognised as an opioid used for RLS. The typical drugs used are oxycodone, methadone or more recently buprenorphine.

I suggest you seek a legal prescription for one of these and the medical supervision that goes along with it.

[PerniciousRLS in reply to Hidden]

Thank you. I have medical supervision and this is what the doctor prescribed. I have had very bad reactions to opioids in the past, with an unbearable reaction -- itching throughout my body. The doctor first prescribed buprenorphine and I had this reaction. I had previously used oxycodone, ultram, methadone, all with the same reaction. He then prescribed dilaudid and although I had the same itching, he prescribed Allegra which, while not eliminating it, did mitigate it. His prescription was for 2 -4 mg of dilaudid. This increase was in a 2 month period which was what concerned me. Frankly, I do not care whether I will be addicted or not, what I care about is whether using an opioid will eliminate the need for pramiprixole and eliminate the RLS from my life. My concern is how much I can take without harming my body.

[Hidden in reply to PerniciousRLS]

OK, that' reassured me that you are safe.

The answer to your question is still yes, although there's no 100% guarantee.

I'm not familiar with dilaudid but it is known that opiates can be effective for RLS when dopamine agonists, e.g. have failed.

Whilst you're reducing.the pramipexole you may experience some withdrawal effects. The opiate should counteract these, but if not then I suggest reducing the dose in smaller steps. You appear to be reducing in steps of 0.125mg. You could reduce in steps of half that.

I hope all goes well for you.

[PerniciousRLS in reply to Hidden]

Thank you I appreciate your concern and to be honest, I don't care what it takes -- I'll do anything to ----- GET RID OF RLS!

[Hidden]

I tried every drug for RLS out there with severe augmentation and some weird side effects (Neurpo patches triggered a porn addiction and I had a rage reaction to Klonopin because it put that portion of my brain to sleep that keeps me calm). I was despondent, not sleeping and had some suicidal thoughts because of it

Opiates are indeed very helpful in terms of controlling (not curing) RLS symptoms. While the rate of opiate addiction in the general population approaches can 25%; in people with RLS it is estimated at 1% in some studies. I could not find the studies in the limited amount of time I had this morning. If someone had better references, please feel free to correct me.

I have taken oxycodone for the past 15 or so years with no addictive issues at all. I could go a few nights without the RLS and did not feel the need to take any medications. However, my RLS has increased in the past 5 years to an almost 24/7 issue. I had to retire as I could no longer drive because of it. I found the oxycodone was no longer managing it at the dose prescribed and I did not want to exceed the dosage.

I still have oxycodone (5 mg tabs up to 4 a day) that I take for breakthrough RLS, but I was started on Methadone 10 mg twice a day which was absolutely life-altering. I went an entire month with no RLS at all. I did begin to have an occasional bit of it in the evening, but even that I could ignore. Again, though as I have aged, I began to experience it a bit more. Still manageable with low amounts of oxycodone. I did begin to experience it about 2 hours before my next dose of Methadone. My neurologist increased it to 15 mg but I still had problems. I finally spread out the doses . I started taking 10 mg first thing when I get up, another a couple hours after lunch and my final daily dose an hour after supper. This has knocked it back down to a minor annoyance most days. My neurologist thought that was a great idea. Occasionally, I do need some oxycodone for breakthrough RLS, but it is at most 2-3 days in a week. I feel absolutely nothing from either of these two drugs, except the damnable RLS is gone. However, they are a huge problem for my sponsor in a 12 step group I belong to. He says "one pill and all his problems go away". I have to recognize these are not the best drug for everyone and we are all different in our reactions to them.

For what it is worth . . .

Jerold in Citrus Park, Florida USA

[PerniciousRLS in reply to Hidden]

Thanks Jerold -- I really appreciate your taking the time to relate what sounds like a true horror story that only someone with the same situation could understand. I don't think anyone can really know the agony of suffering unless they have lived with it. Just the name Restless Leg Syndrome sounds so insignificant and easily dismissed as just a silly affectation. I'm not sure there is any way to describe how having only 1-2 hours of deep sleep can affect someone. I have suffered so long and nothing has helped. The opiates are not really an answer for me because, although I do have some sleep, it is a troubled one and I feel the same exhaustion as I did previously, primarily because I have such extreme itching all night I don't really receive any relief. My doctor prescribed Allegra to accompany the opiates but while it lessens it, I can only take it every 24 hours. I don't know whether switching opiates is an answer -- so far it has not been. Again, thanks for sharing.

[Hidden in reply to PerniciousRLS]

There are different types of opiates out that may not cause the itching. I get itching from oxycodone from time to time, but I do not get it from the methadone. If you physician is willing to prescribe opiates to, explain the situation to him and see if he will rotate limited quantities of different ones so you can see, Again - we are good people with a horrid disease and every one of us deserves to be treated with respect and dignity and to have their disease treated, not trivialized. Sometimes you may have to travel long distances and pay out of pocket but you are worth it!

[involuntarydancer]

Hi Pernicious,

unhelpfully, I will start by admitting that I don’t know what is considered a safe upper limit for dilaudid. I am sure you’ve already tried googling it

I’m posting to mention (forgive me if you already know this) that you may find that once you finally eliminate the pramipexole - ie once the drug is completely washed out of your system, you may not need quite such a high dose of opioid to control your rls as you do during the withdrawal process. I needed the maximum dose of oxycodone (30mg) when I first took it but the amount required now to control my symptoms (4 years post withdrawal from d/a) is more like 20mg.

In breach of your embargo on non-opioid options, could I give an honourable mention to Kratom which is legally available in many USstates? Forgive me if you’ve already tried it but I find it more effective in controlling my rls, with fewer side effects and MUCH easier to withdraw from (should that be required) than the opioids I have tried to date (oxycodone and codeine). While not an opioid (it’s related to the coffee plant), it does work on the opioid receptors however so care must be taken if adding it in to an opioid treatment regime.

One way or another I hope you find a good treatment regime. It sounds like you’ve been through the mill.