Does Rotigotine cause augmentation?

[Snowdrop1947]

The legs are still and I can hardly believe it. Having slowly withdrawn from taking ropinerole , I am now wearing a 2mg Rotigotine patch and all seems well but for how long. Has anyone had experience of augmentation with this drug as I can’t bear the thought of going through that again?

[Joolsg]

I really hope you don't go through it again but statistically, the odds are against you.

Make sure your serum iron is above 60 & serum ferritin above 250 as evidence shows raising brain iron can reduce risk of augmentation.

You know the signs so as soon as you recognise them, see your doctor to start non dopamine agonist treatment.

I hope you have several years RLS free.

[Snowdrop1947 in reply to Joolsg]

Daily drugs : 600 gabapentin 300gabapentin and then 600 again. Also targinact twice daily.

Iron levels as they should be and no iron infusions in U.K.

So that’s it nowhere else to go with this ‘hellish’ condition.

[Joolsg in reply to Snowdrop1947]

Interesting that you're taking 3 separate drugs for RLS. Why did you go back on a dopamine agonist? Didn't Targinact and gabapentin help?

Iv iron infusions are available in the UK. But you have to go round in circles to get them. I persuaded the haematology team at St George's in Tooting to give me an Injectafer infusion in 2019. Sadly didn't help as I'm in the 20% group for whom raising iron doesn't help.

[Snowdrop1947 in reply to Joolsg]

No unfortunately they didn’t which was why ropinerole was introduced into the ‘mix’ . It was wonderful for a while until augmentation occurred, with a vengeance! Enjoying the peace while it lasts.

[Hidden in reply to Snowdrop1947]

Just to clarify that I've understood your position correctly.

It seems you were suffering augmentation due to ropinirole and you stopped taking it.

Am I right in thinking that the augmentation stopped then?

It then seems you were taking gabapentin and targinact and they didn't work.

Can you clarify if this means you had no augmentation, but RLS was still occuring at night?

I note you're taking gabapentin 600mg, 300mg and 600mg. I assume this is morning midday and night.

If you're only taking it for RLS, I'm not clear why you're taking it 3 times a day.

If it's the case that after stopping ropinirole you only got RLS at night, there doesn't seem to be any reason for taking it during the day.

In order to get a more effective dose at night it might be better to take 2/3rd the daily dose before bedtime and 1/3rd 2 to 3 hours before that. You might even find you might be able to reduce the dose.

However, since you're already taking 1500mg a day, it might be more effective to switch to an equivalent dose of pregabalin which only needs to be taken once a day.

Apologies if my assumptions are incorrect.

The other factor is a matter of timing. The most pertinent thing about this is how long it was after you stopped the ropinirole before you started the patch. If it was only a short time, then you may have been suffering withdrawal effects.