Have been on 1mg for 4 years. Last year I applied it to my under arm and it worked mostly 70 percent of the time as I rotated arms every other day. Tried putting the patch on my abdomen and seems to get worse.
Have been on 1mg of Neupro and think I am augmenting. Have had severe RLS the last couple of nights. Take patch every day at 9am and end up taking .25 pramipexole late at night, which works well after 2 hours later.
Do I move up to the 2mg patch?
Any thoughts are welcome.
Jim
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JPB5
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Although you say your RLS is worse, it's not entirely certain you'suffering augmentation. There's more to augmentation than just symptoms getting worse at night.
Please can you confirm I've correctly interpreted what you write.
It's clear that you replace the patch every day and have been doing that for 4 years.
Since you write you "end up" taking pramipexole late at night, I'm assuming that you don't take it every night. If that's the case then it appears you're taking 0.25mg pramipexole one night, then either none the next night or taking it later.
It also appears that you may be taking the pramipexole after your RLS symptoms have started.
A reduction of pramipexole of 0.25mg to none is quite a large reduction and since dopamine agonist withdrawal effects can occur within 24 hours one explanation for you worsening symptoms is that this a withdrawal effect.
Alternatively, it does take pramipexole about 2 hours to work, so it's best to take it 2 hours before you want to sleep or 2 hours before your symptoms usually start. NOT after they start.
One option for you then is possibly to take the pramipexole the same time every night, but earlier.
Another option is that you could ask for an increase in the neupro dose.
However, both are dopamine agonists and it's clear that as regards the neupro, it is failing. This followed by increasing the dose does lead to augmentation. That would make things much worse than what you currently seem.to be experiencing.
So your third (and possibly best) option is to slowly reduce the doses of neupro and pramipexole and replace them with an alternative medication.
I'd suggest reducing the neupro first and when you've stopped that, start reducing the pramipexole. However, you would be best to discuss this with your doctor.
Thank you. I take the neupro patch every am at 9. I only take the prami. .25 once a week if my RLS is bad and it seems the patch is wearing off. Usually at night or early evening.
Hello, I was on 2mg Neupro but decided I needed to get off it and have been reducing very slowly by making a 2mg size mask and marking it out into 16 equal segments. I have been using the mask on the Neupro patch to cut out one segment a month. I have currently cut out 7 segments and had no RLS because my doctor has at my request prescribed 2 X 75mg Pregabalin for me to take as well. The Pregabalin is controlling the RLS as I reduce the DA. I will probably need to increase the Pregabalin as the Neupro dose becomes smaller and I expect to increase the time between cutting out segments to minimise the withdrawal effects. Take it slowly I am sure that will make your situation easier.
Thank you- given COVID I have had a tough time finding someone who knows what to do. Was scheduled to go to CA. and see Dr. B. In LA but had to cancel for COVID. My GP recommended go up to the 2mg Neupro which I am hesitant to do. I can suggest another drug regiment and she would be open to it? Thoughts?
My suggestion would be to slowly reduce the doses of neupro and pramipexole and replace them with an alternative medication.
I'd suggest reducing the neupro first and when you've stopped that, start reducing the pramipexole.
You don't need a doctor to stop gtaking the agonists, but you will need them to prescribe an alternative. You can start the alternative before reducing the agonists.
I imagine your doctor would be willing to prescribe an alpha 2 delta ligand, pregabalin (lyrica), gabapentin (neurontin) or gabapentin enacarbil (horizant).
Another alternative would be an opioid. Dr B does prescribe opioids but your primary doctor may not be willing. The favoured opioids are methadone, oxycodone or buprenorphine - in low doses.
Why do you apply the patch so early in the morning. RLS symptoms usually come on in the afternoon and evening and most people tend to be moving about the house, workplace or outside during the day, so I've always taken it a few hours before than i.e about 2 pm. I know it's supposed to provide 24 hour cover, but I was told by a neurologist the best time is early afternoon as there will be more of the medication in your system when you need it the most?
Ok- makes sense. I am moving it today to 2pm. Had a tough night anyway last night before bed and it seems it did not work, applying it at 9am that is. I am looking today to try and set up an appointment with Dr. B. in CA. For spring and will fly in to see what options he has. Thank you.
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finished Neupro taper and looking for guidance on increasing my Gabapentin dosage
Augmentation? I'm guessing yes.
More time lost to RLS - Has my kratom/neupro system stopped working?
