Pramipexole

[Hoochybaby]

I have been taking pregabalin for some time now 200 mg at night and also codeine 25 mg at night I’ve suffered severe insomnia

I told my neurologist that the pregabalin wasn’t working any longer the rls was stopping me sleeping she suggested that I return to a low dosage of of Pramipexole.088mg at night

I’m reluctant to go back on to Pramipexole because I suffered severe augmentation last time I took this da

I didn’t ask if I should take the Pramipexole in conjunction with the pregabalin I forgot to ask because I can’t think straight with lack of sleep

Any advice?

[Hidden]

Hi Hoochbaby.

Sorry to hear you're continuing to struggle.

I gather from what you write that you are experiencing RLS symptoms that are preventing you getting to sleep or waking you up.

I can't offer any advice but I can offer some thoughts.

I'm not anti-opioid. If somebody needs one, it suits their circumstances and its their preference then that's fine with me. However, from what I know about codeine, it's doesn't seem the best opioid for RLS.

It doesn't seem to be potent enough for RLS. Which may mean that to get enough of it to be effective you have to suffer the increased side effects.

Out of curiousity, I wonder how you get 25mg. I thought tablets were 30mg or 60mg.

One thing you could consider with your doctor is switching to a lower dose of a more potent opioid.

Some say opioids can cause insomnia.

Pregabalin can be effective for RLS, but on balance it's better at helping sleep than dopamine agonists, but not quite as good at controlling symptoms. The maximum dose for RLS is 350mg.

Dopamine agonists are slightly better at controlling symptoms but poor at promoting sleep.

You can combine any two of these, I wouldn't think it advisable to combine all 3.

As you know, you are risk of augmentation as you've had it before. If you do consider taking a low dose of a dopamine agonist, you may be better with ropinirole or rotigotine, rather than pramipexole. Rotigotine has the least risk, pramipexole the highest.

I hope this gives you some ideas.

[RLSofManyYears]

HiI was on Ropinirole for several years and then switched to Pramipexole 0.088mg. I am also taking 300mg Pregabalin.

I suffered augmentation with the Ropinirole, and then I started needing a higher dose with the Pramipexole . So I came off the Pramipexole and started taking Temgesic 200ugm. This has worked for me although it might be difficult getting a prescription in the UK as it is an opioid. However it is a "safe" opioid, stronger than Codeine, but not addictive.

I do hope you manage to find a suitable solution.