Ropinirole and Gabapentin

[Shaunygee]

Hi All,

I'm 53 and based in the UK.

I've had steadily worsening RLS and been taking 2mg of Ropinirole for around 8 years now. Over the last year my symptoms have got a lot worse and in the last couple of months I've developed spasms and jerking, mainly in my right shoulder (I've nearly punched myself in the face a couple of times when I'm in bed!). I 'think' I'm probably starting to augment, so I made an appointment to speak to the doctor. He admitted he knew very little about RLS but suggested I start taking 300 mg of Gabapentin on top of the Ropinirole. So a couple of quick questions for the life saving experts on this forum;

a. Is it ok to take the two together?

b. Would it be ok to start gradually lowering the dose or Ropinirole once I'm taking the Gabapentin?

All the best,

Shaun

[Madlegs1]

Yes, and yes.However, the gabapentin will not help in any way to assuage the awful withdrawals you will experience from lowering the Rop.

Sorry to be so hard, but this is an extremely common situation.

You can increase the Gabapentin to 900mg- slowly over 4weeks. It takes that length of time to become effective.

You may reduce the Rop very slowly and by the smallest doses possible. At first ,it will be a breeze, and you'll wonder what all the fuss is about. Until nearing the end. Then you will attain the Knowledge.

At that point you will be demanding that your doctor give you help- valium, sleeping pills and tramadol.

Please read about " management of augmentation" by M Buchfurer et al. Possibly a link to iron the pinned posts on this page somewhere.

Good luck- and keep in touch.

[Hidden]

Just to agree with Madlegs brilliant advice.

I can add a couple of things which Madlegs has missed. This is unusual because it's normally me that misses them and Madlegs adds them to me.

One is try to get some blood tests for serum iron, transferrin and ferritin. If the first are too low you may have iron deficiency anaemia in which case you need some iron therapy.

If the first two are OK, but ferritin is below 75 then you should consider starting on an oral iron supplement because you may have brion iron deficiency, (a cause of RLS).

If your ferritin is above 75 but below 200 then you should consider seeking some other iron therapy.

Madlegs also usually mentions "triggers", that is, things that can make RLS worse.

Quick acting triggers include alcohol, sugar and caffeine. Longer acting factors that can make RLS worse are a host of different drugs mainly antidepressants and sedating antihistamines but also many others.

Irion and triggers should be considered when augmentation is suspected.

[Joolsg]

I agree with Madlegs and Manerva. Once you've hit augmentation, the only solution is to reduce the Ropinirole by 0 25mg every 2 weeks. Gabapentin won't help until you're through withdrawal which is sadly, usually hell on earth. I used tramadol 50mg every 4 hours during the last 2-3 weeks of withdrawal and cannabis. Cannabis was the only thing that helped!.At least your GP has admitted he doesn't know about augmentation. But augmentation won't stop until dopamine agonists are completely out of your system.