Quick refresher, after 5 years of PLM, (not realising it was something medical, not a reaction to work stress). I spent 5 years on Sertraline, only to find it the cause apparently of occasional fall off the wall depression, I was put on Pramipexole in November. The quantity was four tablets each night of 0.088mg (written on the box). This knocked the PLM on the head and gave me a peaceful sleep, and nothing else. Manerva has been such a help to me, even with my clumsy non-technospeak.
I now notice that although the leg kicking is not returning, the style of dreams are (which could be a precursor to the return of the PLM). I mention this as I am due to re-order my repeat prescription.
Do I need to contact my doc? Am I getting ahead of myself?
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Spurdog1
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Absolutely call your doctor, maybe it can slowed or reversed by approaching the doc now. If you have to show the doc this post of yours.
Davidus
Hi Spurdog.
Some points to think about.
The starting dose of pramipexole is ONE 0.088mg tab, not 4.
If that works then it should NOT be increased.
If one doesn't work increase to two.
Some experts say it should be increased no more than that, although some authorities say 0.54mg (6 X 0.088mg) is the maximum.
Either way the risk of suffering dopaminergic augmentation due to taking 0.36mg pramipexole ( 4 tabs) is 7% year on year. So 7% the first year, 14% the next etc.
"Loss of efficacy" which is what you're beginning to experience now, is the precursor of augmentation.
You need to avoid this, it's hell and can cause permanent damage.
To avoid this there are three things
1) Have blood tests for iron deficiency. If your ferritin is less than 75 start on an oral iron supplement.
2) Check that there aren't any exacerbating factors making your RLS/PLM worse. This can include a host of medicines, the main ones being SSRI antidepressants and sedating antihistamines.
3) Wean slowly off pramipexole and replace it with a NON dopamine agonist, e.g. an a.pha 2 delta ligand.
You will it seems, have to educate your doctor about how to treat RLS/PLMD and augmentation. It appears they have no idea.
I am on Pramipexole, but because of augmentation the first time I stopped it, now back on it but only take one every other night along with Clonazepam.
Progress. I am now down to two and and a half tablets per night (close to Manerva's suggested tolerance level). A bit of an odd night last night, I think kicking may have returned, but hey, down to a more reasonable level. I'm not too worried and think I'll stay on Pramipexole. The question is do I cut out the half pill. That decision will be made in a week's time. Depends on the next eight nights of sleep.
The bear came, and i was kicking him away, but he kept coming back. However i was unaware of physical movement of my body, Hmmm!
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