Advice please

[Hoochybaby]

Hello

I have been taking Pregabalin 150 mg and codeine 60mg for some time now and it is no longer effective. My Neurologist wants me to go back on to Pramipexole which I have taken in the past before I had augmented and came off the drug.

My neurologist wants me to start on a low dosage of pramipexole 0.088 mg

My question is should I cut back gradually on the Pregabalin and codeine while taking the pramipexole? My neurologist wasn’t quite clear about this!

Should I for example take 75 mg Pregabalin and 30 mg codeine at the same time as well as the 0.088 mg pramipexole? What combination would you suggest as a starter in point?

[Hidden]

I honestly have no idea what's best for you.

I only have some ideas.

One is that maximum dose of pregabalin for RLS is 450mg. Unless, of course if side effects are intolerable for you.

Two is that codeine isn't the best opioid for RLS, it's too weak. Oxycodone is recommended for severe RLS when dopamine agonists have failed.

Three, if I was in your position I would never try pramipexole again. Once you've experienced augmentation you're more likely to experience it again. Why take something that's just going to make things worse.

In addition, if I were ever again agree to a dopamine agonist, it wouldn't be pramipexole, it's the worst thing for augmentation. Ropinirole is less likely to cause augmentation and rotigotine the least.

If you do want to go ahead I'd suggest you only reduce one thing at a time.

Reducing the doses by a half I think much too fast, especially at the same time.

I know you can take any combination of any two of the three things you mention. I'm not entirely sure if it's a good idea to combine all three.

I'm not luckily, in your position, but I think if I was, I might first ask for a more potent opioid, not a higher dose and not a dopamine agonist.

[Hoochybaby in reply to Hidden]

Thanks for your reply

i was given the option of Pramipexole or rotigotine patches!

I haven’t heard of rotigotine before could you expand please

[Hoochybaby in reply to Hoochybaby]

I would like to add that I am just about managing with a dosage of 150 mg pregabalin and 60mg codeine do you think I should cut my losses and stick to this regime

[Hidden in reply to Hoochybaby]

The three dopamine agonists used for RLS are pramipexole, ropinirole or rotigotine. Pramipexole is the most potent, but most likely to cause augmentation. Ropinirole and rotigotine are less likely to. Rotigotine has the advantage that it is an extended release patch. However many people report it causes a skin rash.

It really is your choice, but if you're just about managing with 150mg pregabalin then I'd see if you can get a more potent opioid.

[Joolsg]

I agree with Manerva. I would try a stronger opioid rather than go back on pramipexole. If your doctor is anti opioid, try to find a doctor who knows.more about RLS and low dose opioids.