Like most others in the group, you have to adjust the medication based on what works constantly. I have taken 1.5 tablet Sifrol 0.18 divided into three occasions, and Gabapentin 3x300 divided into two occasions, and it has worked very well for six months. Now the effect has diminished, and I think it is the Sifrol that haunts with augmentation (I have had it before).
Instead of stepping down gradually, I thought I would try to quit abruptly. I am aware that it can be a couple of tough weeks, but I have the opportunity to work the next few weeks minimally and can try to scrape together some sleep during the 24 hours of the day.
Does anybody have experience with this? I have read that by taking a break with Sifrol for a couple of weeks; there is a greater probability of avoiding augmentation. All tips are accepted,'
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tomashagg
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Hi, I'm not qualified to give medical advice but one thing is sure, it's not advisable to quit pramipexole. cold turkey.
You should be able to read this on the patient leaflet. It may be a small risk but there is a risk of neuroleptic malignant syndrome.
I am confused by the dosages you mention.
If you mean you take 1.5 mg per day this is the dose of salt i.e. pramipexole dihydrochloride. If this is split into 3, that's three doses of 0.5 mg (salt).
1.5 mg is twice the maximum recommended dose, so if you have augmentation it's no surprise.
I may have this wrong because you also mention 0.18 mg, which is the dose of base i.e. pramipexole.
If so, I'm further confused because 0.18 mg base is the same as 0.25 salt.
Hence if you're only taking 3 X 0.18mg (0.25mg) then your daily dose is 0.75mg (salt). that is 0.54mg base - the maximum.
Even at this dose the risk of augmentation is high.
I'm not sure why you're taking the pramipexole 3 X a day. If this because you have symptoms earlier in the day, then if you didn't originallis y experience these then this a sign of augmentation. If you've had it before then you are more likely to have it again.
I have read that other members have had some success by taking pramipexole holidays, but I seem to recall that they're usually longer than two weeks.
After only two weeks I don't think you can be sure that all the pramipexole is out of your system.
However these are just some thoughts and what you choose to is a personal choice depending on your own preferences and situation.
My choice when taking pramipexole 0.75mg was to wean off it slowly and I've never taken it again.
First, I take 0,18 mg Sifrol tablet which is the lowest dose you can get in Sweden. 1,5 tablet gives 0,27 mg on a daily basis and the highest dose recommended is 0,54. So my dose is half of the recommended dose.
Yes I have had augumentation before taken 0,35 mg to many years. To handle this it is common to advice to split your dose in three separate occasion.
I have tried to switch to Gabapentin, and then I slowly reduced my Sifrol during a six months period. Unfortunaly I realised that using only Gabapentin does not work for me. I really tried it for several months but then I start to use both Gabapentin and Sifrol and for 6-8 months I have slept like a baby. But now The symptoms. have started again.
Notice, in my swedish RLS facebook group, there are many people using that combination of Gabapentin/Sifrol.
Sodium is a "base" in this case a mineral. You won't find it normally because it reacts violently with water. However it combines with chlorine ( normally a gas) to form sodium chloride. a salt.
Similarly potassium reacts violently with water and also combines with chlorine to form potassium chloride a salt.
Copper is a base, metal which can combine with suplhur and oxygen to form copper sulphate. A salt.
When these sakts are dissolved in water they split into "ions".
Sodium and chlorine ions.
Potassium and chlorine ions
Copper and sulphate ions.
Pramipexole is a complex molecule (a base) which for practical.purposes is combined with hydrogen, oxygen and chlorine to form pramipexole dihydrochoride (a salt). When this dissolved in water it releases the pramipexole.
(Dihydrocodeine incidentally is an opioid drug).
Since there are more elements in a salt e.g sodium and chloride than there is in base e.g. sodium, then a salt weighs more than the base contained in it.
Hence pramipexole dihydrochloride weighs more than the pramipexole in it.
In this case 0.125mg.of the salt contains 0.088mg of pramipexole.
Some people that take this drug pick up on the fact that tablets are 0.125mg or 0.25 mg etc. Others pick up.on the fact.that tablets are 0.088 mg or 0.18 mg etc.
But really 0.125 or 0.088 are the same dose as are 0.25 or 0.18.
I don't honestly know why this is done for pramipexole.
I've read of people taking a break from dopamine agonists and restarting but usually the break is at least 3 months. Otherwise you will have 2 weeks of hellish symptoms every time you stop the Sifrol. I withdrew slowly from Ropinirole but still had a traumatic withdrawal with 2 weeks of very little/zero sleep. I couldn't face doing that more than once every 10 years!
I know augmentation from sifrol very well. When it starts I do cold turkey, switch to other medications (that dont work for me as well as sifrot but better than nothing), suffer for 1-2 weeks and then my body is clean and reacts to sifrol as it should. I know this scheme for 6 years now.
Hi, just to clarify, Neuroleptic Malignant Syndrome can be a reaction to taking "antipsychotic drugs", as the article you refer to says. These drugs lower dopamine levels.
Note also that a defect in D2 dopamine receptor sites contributes to the syndrome.
RLS is partly due to a defect in D2 receptor sites.
Dopamine agonists on the other hand have the opposite effect in that they stimulate the D2 sites and raise dopamine levels. After taking an agonist for a while your system comes to rely on it so that when you stop taking a DA, dopamine levels fall and D2 sites don't work so well.
Hence stopping a DA has the same effect as takingan antipsychotic.
Note that taking a DA can cause psychotic symptoms.
You could say DAs and antipsychotics are opposites.
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