Sinimet?

[Bks429]

Ny neuro has prescribed Sinimet IN ADDITION to the Mirapex I am already taking. (nights have been bad.) I’m like - another nasty drug? Anyone taking this or have any comments, etc.? My RLS was GREAT. Taking iron and was sleeping well, etc. It has returned with a vengeance and that was his solution?

[Hidden]

Oh dear!

You perhaps need to see another neurologist. Preferably one who knows something about RLS.

I see you had an iron infusion which really helped, then your RLS started creeping back again. I believe you've also been on pramipexole for some time. Possibly you've recently increased it?

Unfortunately IV infusions can effectively treat RLS, but they do not cure it. Your ferritin level will probably have dropped again and it's not so easy to maintain it above 100 by oral supplements only.

I suspect that you are suffering dopaminergic augmentation due to taking the pramipexole, or at least starting to suffer it.

In which case you may well find that, although the sinemet may help a little at first, I would imagine in a short time augmentation will really start.

If you haven't yet suffered augmentation, you should try and prevent it because once suffered it will limit your future treatment options. One way it can be prevented is to NOT take the Sinemet.

Sinemet contains L Dopa and should not be taken on a regular basis for RLS. Really it's used for Parkinson's disease.

L Dopa is significantly more likely to cause augmentation than pramipexole. If you start taking it then I imagine that your RLS will consequently get worse.

Basically put, if a dopamine agonist like pramipexole starts to lose efficacy or cause augmentation then it's not a good idea to give you something that will cause you even more harm.

If a dopamine agonist fails or causes augmentation then the recommended way to deal with it to stop ALL dopaminergic agents and switch to a non- dopaminergic alternative.

The alternatives are either an alpha 2 delta ligand, Neurontin (gabapentin), Lyrica (pregabalin) or Horizant (gabapentin enacarbil) OR for "refractory" RLS an opioid.

You should also see if you're doing naything that can make RLS worse. For example there's quite a large number of other medications that make RLS worse.

see this link

uptodate.com/contents/treat...