RLS and hydrocodone

[JakeRLS]

I have been taking Norco for the last 4 years and my dosage has been stable at two and a half tablets every night. This equates to a hydrocodone dose of 25 mg. Recently within the past 6 weeks my symptoms greatly worsened and now affect other parts of my body and start much earlier in the day. H is it possible to augment on hydrocodone or is it more likely that I have developed a tolerance problem or is my rls going crazy?

[Hidden]

Your query has raised a question for me which I've been puzzling over and haven't yet found an answer for.

The question is, is augmentation a qualitatively different phenomenon to non-augmented RLS or is a just a "worsening".

I guess the only way to know is if somebody with severe RLS to left it untreated tosee how severeit gets, i.e. if it spreads to other parts of the body and earlier in the day despite taking no medication. However, who's going to do that?

It is significant in your case because you do appear to suffering augmentation, but don't appear to be any medication known to cause it.

SO, is the norco causing the augmentation or is it due to a worsening of your RLS? Hard to say!

One of the signs of augmentation due to a medicine is if a reduction of the medicine causes symptoms to improve and an increase makes them worse.

Obviously, if the apparent augmentation is not due to the norco, then there must be some other factor.

Perhaps be good then to look if anything else has changed, have you started on any new medications, eating differenty etc.

Also a good idea to have test for iron deficiency, especially ferritin and if it is less than 75 start on an oral iron supplement.

See this link

sciencedirect.com/science/a...

I hope this is of some help.

[JakeRLS in reply to Hidden]

Minerva, thank you for your thoughtful response. A big question of mine was can hydrocodone or other narcotics cause augmentation? I haven't seen anything in the literature indicating that it can. Also, there have been no no changes to my diet or routine in general during this period. I forgot to mention that I take 150 mg of trazodone nightly and have been doing so for years. Does this matter?.. I will meet with my doctors in look into the ferritin test. Thanks again

[Hidden in reply to JakeRLS]

Trazodone shouldn't make any difference.

The only other medications I've heard may cause augmentation are tramadol and pregabalin/gabapentin.

However, in neither of these cases can it be dopaminergic augmentation, because they're not dopaminergic.

[JakeRLS in reply to Hidden]

Thanks again.

[Buddhacat in reply to JakeRLS]

Just for info. Trazadone sent my rls through the roof. You should never take it. I thought it would never stop the increase in discomfort. But it had gone away the next day and just back to "normal rls distress" which totally sucks on its own. Sometimes I wake up and right away my brain says I wish I were dead!.Lately the combo of lyrica and clonazepam has made a helpful difference. I hope you get better.

[JakeRLS in reply to Buddhacat]

Thank you for your thoughts. I never get the impression that the trazodone is affecting me but it seems like the legs sometimes kick in right after I take the Norco even though it's supposed to take 1 hour to be effective.

[Madlegs1]

Opiate Tolerance and augmentation- how are they different?Tolerance is where the body gets used to the medication ,and if not increased , patient a withdrawal symptoms.

With augmentation, the med is similarly in effective, but increasing it just makes the symptoms much worse.

Relating to your experience, I can only relate my own recent experience.

I'm on Oxycontin 10 X2, and Oxynorm 5 x1.

I was also on cetrizine 10 X1. For post nasal drip. I decided to stop the cetrizine and had a terrible week. I assumed I was experiencing tolerance, and had framed emails to my doctor and consultant looking for a change in opiates. It was only when I checked cetrizine withdrawal that I realised what had happened. ( When I started taking it ,I had checked was it ok to take it forever, and got absolutely no warning whatsoever)

I went back on the cetrizine and started weaning off protocol. I'm now on a 1/4tablet (2.5mg) and am getting on ok.

So--- a salutory warning.

This experience may have some echoes for you.?

Hope you get some relief soon.

All the best.

[JakeRLS in reply to Madlegs1]

It's a constant battle isn't it. Years sounds particularly distressful. Thanks for you help.

[69MPH]

There is no easy answer to your question. All three of your suggestions are possibilities. Tramadol has been known to cause augmentation for some but it is much more likely to relieve RLS. Other opioids are even less likely to present a problem, however it is possible that they all lose their effectiveness over time. Most antidepressants such as trazodone can, indeed, aggravate RLS. Some studies show that Wellbutrin is less likely than others to cause a problem. I was on two different antidepressants that both caused an increase of symptoms. I switched to Wellbutrin and didn't have a problem with it. And RLS can definitely get worse over time, including spreading to the arms and trunk.

I started taking Vicodin almost 20 years ago for RLS and it worked well for a number of years. Soon after ropinerole came onto the market I switched to it and it worked well. Now I alternate between tramadol and hydrocodne/acetaminophen for severe chronic pain and ropinerole and pramipexole for the RLS. The opioids alone don't relieve it anymore. If I don't take the ropinerole and pramipexole, dopamine agonists, I'll still have the problem. I take the ropinerole early in the evening and the pramipexole six or seven hours later. Occasionally I get augmentation. I'lll make a determination of which one is causing the augmentation, depending on when the symptoms start, and discontinue that one for about a month. I'll substitute carbidopa/levodopa for whichever one it is for that period. When I go back to the normal routine, all is well. I was recently diagnosed with a low level of iron so I now also take ferrous sulfate along with vitamin C, which helps absorption.

As you can see, your question is a complicated one and there is no one sure answer. You'll need to discuss it all with your doctor. It is less likely that the tramadol is causing augmentation than it is that it is losing its effectiveness. You might want to try a dopamine agonist such as the ropinerole instead. You might also want to discuss with him trying another antidepressant such as Wellbutrin. You should have your iron checked as well.

Whatever you decide, good luck with it. I hope you find a solution.

[JakeRLS in reply to 69MPH]

Thank you for your thoughts. Love you screen name by the way. I did take ropinirole among the first medications for the blamed condition. I thought I was set for life because it temporarily controlled my symptoms until it didn't. So I increased the dosage several times until I augmented. Overall it helped me for less than a year. Then it was a series of other drugs before the sleep doctor prescribed narcotic. Again I thought it was set for life but apparently not. Thanks for your thoughts though

[69MPH in reply to JakeRLS]

Thanks. Take my initials, add my age, and you've got my screen name. I've always said that everyone's car in America is monogrammed with my initials! I'm wondering, though, - do you take your trazodone and Norco at the same time every day? If so, might it be that the problem with your legs is from the trazodone and, just coincidentally, it starts shortly after you take the Norco? Just a thought...

[JakeRLS in reply to 69MPH]

Yes I do take both at approximately the same time the Norco about an hour before I actually go to bed and the trazodone 45 minutes later. This is the routine I've been following for several years. I'm reluctant to change the routine because it has worked and I I'm having trouble isolating whether it's the drugs or the condition. Hopefully I'll get some help from the doc. Why did you stop taking Norco? Had you tried increasing the dosage with only marginal improvement?

[69MPH in reply to JakeRLS]

Well, that blows that theory! And, no, I stopped taking it because it was an opioid and the ropinirole wasn't, so I wanted to try it. Since it worked just as well, I didn't go back to the Norco. Now, however, since I've been on the Norco for so long for the pain, it doesn't work for the restless legs anymore. One's body definitely gets used to opioids to the point that they don't work anymore without increasing the dosage, whatever condition they are taken for, which I why I alternate it with the tramadol.

I know you're hesitant to change your routine, but you might consider substituting something else for both the Norco and the trazodone, one at a time, kind of like you would when checking for food allergies, one at a time. You can discuss it all with your doctor. Good luck.

[JakeRLS in reply to 69MPH]

Thank you. I like your suggestion.

[69MPH in reply to JakeRLS]

Let us know how it goes.

[lorrinet]

I have been taking Dihydrocodeine (which I assume is the same as Dihydrocodone?) for over 20 years. As those years went by I found I had to take an earlier dose as well, plus another at around 4am. But this situation and dosage has remained stable for about 10 years, and while being up at 4-ish every night is a pain, I am used to it, and the alternative to taking this drug is unthinkable. It's my life, and that's that.

Over the past two years I've found that I can get away with trimming half a tab off my first dose (around 6.30, just before dinner. If I leave it until after dinner then the RLS hits me really hard) also from my last dose around 4am.

[JakeRLS in reply to lorrinet]

I'm glad your success has had staying power. Congratulations. You've given me hope. Thank you