Augmentation and Pramipexole

[Retro_bob]

Hello

im quite new to the site and was hoping i could get some information on augmentation with pramipexole and how long it lasts and when it can start. Looking at some of the posts here im probably at the lower end of the scale on severity. I was put on 0.088mg of pramipexole about 3 months ago, worked really well, proper full nights sleep in years (had self medicated upto then but it was working less well hence the medication) following warnings from doctor (on side effects but not i hasten to add anthing about augmentation........ ) i was only taking one every other evening as it seemed to help the next night as well. A few weeks back started getting buzzing feelings in arms and legs during the day but no issues at night. started investigating and found this site and all the horror stories on augmentation. 3 days ago i stopped taking the pramipexole to see if it made any difference as i figured i was on a low dose 3 times a week and only a few months it should be ok. but the buzzing i felt seems to now be continous in my legs. to those with alot more experience / knowledge should i have done this ? or should i go back on and start cutting up the tablets as i read others have done to reduce the dose over a few weeks ? just presumed as it was really low id just go back to restless nights again. Also do these presumed side effects fade overtime ...

Many thanks in advance

[Hidden]

This sounds like dopamine agonist withdrawal effects or rebound not augmentation.

Withdrawal effects can occur within 24 hours after taking a dose. Hence it's not a good idea to take it only every other day.

You could consider these.options.

1). Continue without taking the pramipexole for at least two weeks if you can bear it. Withdrawal effects may then fade. Then review the situation.

2). You can replace the pramipexole with an alternative medicine at any time, but not another dopamine agonist, i.e. ropinirole or rotigotine.

3). At the other extreme you could go back to taking 88ug pramipexole a day, but take it every day. Your symptoms may then subside. You could continue like that until anything changes.

Dopamine agonists are no longer supported as the first treatment for RLS because of the risk of augmentation. Unfortunately of the 3, pramipexole has the highest risk.

If you've not already had one, a blood test for serum ferritin is a good idea. If your ferritin is below 75 it's advisable to start an oral iron supplement.

If you're taking any other medication, it may be making your RLS worse.

[Retro_bob in reply to Hidden]

Thanks, that is really useful. Needless to say neither my doctor or neurologist who both were aware about me taking every other day said anything, which im pretty annoyed about now.

Its not even like it was a brief comment, the only side effect i seem to have had was to lower my blood pressure which wasnt atually a bad thing as im on medication for high blood pressure anyway (remipril ) but as it was going too low on days i took the pramipexole (getting light headed) it was agreed i could take a lower dose blood pressure medication on every other day.

Ive had bloods taken recently and everything including Ferritin was in the "normal" range which i thought was good, but , following comments here i now realise that dosnt mean anything so ive chased up the actually readings and we'll see.

going on your comments above im going to stay off the pramipexole for now and try some of the other suggestions mentioned on this site. Then if needs be go back to the docs better armed for a discussion on better treatments. From what ive read here pramipexole seems a road of short term relief for long term issues..

I wish id found this site 6 months ago, your an encyclopedia of knowledge to which im very grateful

[Hidden in reply to Retro_bob]

Some blood pressure medicines can make RLS worse, but yours, I believe is OK.

[involuntarydancer]

I would second the options Manerva suggests. People's response can be variable - there are some who successfully alternate with other drugs on that dose (ie take mirapexin intermittently) but even though those little 0.088mg tablets look small and innocuous, they are relatively powerful and it is possible that it is a withdrawal you are experiencing.

I just wanted to add that I would not be too panicky in your shoes. Three months is a comparatively short time and 0.088mg is not a high dose. Although it's not impossible (I can think of one or two members of this forum who augmented in a very short time), it is unlikely that you have augmented to date or that you will experience the really bad withdrawal symptoms of a more prolonged and higher dose.

If you decide to go back on the pramipexole, make sure to get a serum ferritin test and if you are below 100 (get the actual figure - not just that you are 'normal') start a supplement. There is evidence to show that augmentation is much less likely if your iron levels are high. Better yet, agitate for an iv iron infusion. Raising iron levels results in a complete alleviation of symptoms for an appreciable percentage of sufferers and improves symptoms for over 50%.

If you decide not to go back on pramipexole, you could use solpadeine to see if it helps with the tingling - it's the codeine that will do the work. You have clearly read round on the subject and will have an idea of what the alternative treatment options are.

Generally, if you stay on mirapexin for any length of time, it would be better to half the dose for a couple of weeks and possibly even go down to a quarter before stopping completely.

[Retro_bob in reply to involuntarydancer]

Thanks involuntarydancer, im feeling slightly more relived now knowing its likely to be short term withdrawal symptoms (hopefully) and having read various posts more determined to try and find whats causing it for me, rather than use a sticking plaster of dopamine agonists.

next step is get my ferritin level results and go from there.

Thanks again to you and Manerva, as a newbie to this, your insights, unfortunately gained not through choice are invaluable to others ..

[Ranjits in reply to involuntarydancer]

I took premipoxle for 8 years after that I start getting augmentation I was on two tablets of 0.88 every night after 8 years I start getting augmentation

[Felicity21]

Hi Retro_bob, I would agree with Involuntary dancer, however taking Prami every other day is unusual and may be ineffective. I would first try taking it every day and then if necessary, add the Solpadeine. I myself take Mirapex (which is similar to Prami) in combination with co-dydramol or co-codamol which does not contain caffeine (that would have an adverse effect on my sleeping). I take Clonazepam which helps me to go to sleep. Good luck!

[Bat3353]

In my opinion do what you think gives you the best relief I did the same I found this site and for the first time heard augmented so I tried to get off ropinorole and after a month of torture and seeing two doctors I said why am I putting myself through this the only possititthing out of it is I reduced my dose so do what works for you I first used the meds you take and yes after a short time I augmented on it and switched to ropinorole and have been on it for more than 15+ years

[HMGH]

I have been taking 0.008mg x 4 a night starting at 4pm, for 5 years. I havexaugmentation but find it helps if i take ginseng in the morning and 2 tablets of 5HTP in the early evening, from Holland and Barrett. I think the hydroxy triptophan helps the brain signals more balanced and therefore RLS a bit more bearable. Augmentation is still present but spacing out the pramipexole in 2 hour doses seems to help too.

[Retro_bob in reply to HMGH]

thanks for the comments, following Manerva initial suggestions ive decieded to stick going cold turkey, its been about 10 days now, still got the tingling feelings in arms and legs during the day, my sleeps gone back to pre pramipexole, so up 2/ 3 times a night but managing with non medical methods and made a list of a load of new ones from here.

Im also still battling to get my ferritin results from the neurology clinic, talk about blood from a stone.... or data from a consultant .... In the intrim ive decieded to take a multi vit supplement and up my iron rich food intake, on the off chance the results are below 100 but still classed as "normal".

im also starting a diary of food / exercise and RLS severity each night to try different things. Im aware in the past before using pramipexole i would have the odd rare night of no symptoms and a full nights sleep.

Has anyone else had this ?

Im now thinking on these very rare days i could have had a perfect combination of solutions that stopped it. But this was before i realised diet / exercise and a host of others things could be a cause or cure so was just pleased for the respite