What mg would I use of pramipexole , now on 2mg neupro patch with lots of skin irritations trying to taper down ?and how fast on pramipexole

[Caperry]

Coming off neupro patch

[Hidden]

I'm not sure what you're asking or what you're doing.

Can you explain further please?

[Caperry in reply to Hidden]

Trying to get off dopamine agonists I’m on Neupro patch 2 mg burning skin and blisters can I use pramipexole to get off dopamine agonists instead of patch because of skin irritation. Did not know how much pramipexole to use, I used to be on pramipexole then switched to Neupro patch have some left over wondering if it would work and not be so hard on skin

[Joolsg in reply to Caperry]

Why did you stop taking Pramipexole and switch to the patch?

[Caperry in reply to Joolsg]

It didn’t seem to be working then switched to patch and it worked but lots of skin problems trying to get off all dopamine agonists

[Caperry in reply to Caperry]

Having a lot of trouble

[Caperry in reply to Caperry]

On Gabapentin also

[Hidden in reply to Caperry]

Is it 1800mg gabapentin you're on?

Quite a high dose.

It can work alongside a dopamine agonist, but not while suffering augmentation or withdrawals.

In addition you may benefit from switching to pregabalin.

A reason for this is that pregabalin is more consistently and better absorbed than gabapentin.

[Caperry]

I did check with doctor no response , thanks so muchI’ll give it a try

[Caperry]

So I have 0.5. And in 2 week I’ll reduce by 1/4?

[Pennydreadful66]

Hi, I came off Pramipaxole not long back, worked well for me for many years but of course all good things come to an end eventually,

[Pennydreadful66]

Hi there,

I spent years on pramipaxol and they did me well but like all good things, it came to an end. My gp put me on the Nuepro patches gradually increasing the dose but the more I read about them I decided long term 'not a good idea' so sort assistance and I'm now reducing the patch dose. This week I go down to a 1 mg

Neupro patch for the next two weeks and then I start on 50mgs of Rotigotine twice a day, the dose will increase if [?] needed, which will probably be the case from what I've read.

This past week I've not suffered with RLS at all [?] which is a unbelievable, a blessing. My only change in my routine is, I've been sitting in a warm bath every night before bed and I just sit there with my legs just below the warm water and I read my book, I dont bathe I just chill and then I pat my legs dry and retire.

I've slept, uninterrupted for a whole week. I can't remember when I last did that. It may be a coincidence I don't know but its working for now? Of course the meds are working toooooooo, I know that but for now ?

[Covenant1962]

Manerva, can you help clear something up for me please? You talk about the smallest pramipexole tablets being 0.125mg. How come I have 0.088mg tablets? Different brands?

[Hidden in reply to Covenant1962]

You may have noticed that many medications come in the form of a "salt".

E.g. iron comes in the form of ferrous "sulphate", ferrous "fumarate" etc. These are "salts" of iron. This is because iron in itself is not soluble.

Try sucking a nail!

Similarly, Sodium Chloride is a salt In this case, sodium in itself cannot be ingested. Pure sodium is so reactive with water that even exposure to water vapour in the air causes it to burst into flames.

You cannot put sodium on your food, but you can put sodium chloride - table salt!

Sodium chloride is the "salt", sodium is the "base".

When sodium chloride is dissolved in water, it splits into "ions". Positive sodium ions and negative chloride ions, thus making the sodium (and chloride) available for use.

Pramipexole comes in the form of a salt. It will probably say on the package "pramipexole dihydrochloride" or even "pramipexole dihydrochloride monohydrate".

"pramipexole dihydrochloride monohydrate" is the salt and pramipexole is the base.

When dissolved in water, the pramipexole is released.

Consequently a molecule of the salt will be heavier than a molecule of pramipexole and a number of molecules of the salt will be heavier than the same number of molecules of the base, i.e. pramipexole.

Some people get tablets of "pramipexole" saying 0.125mg, some get tablets saying 0.088mg.

They are, in fact exactly the same amount of pramipexole. 0.088mg is the amount of "base" 0.125mg is the amount of salt. Or to put it another way, 0.125mg of the salt contains 0.088mg of pramipexole, the base.

Why some companies making it stating salt and others base or it differs in countries, I have no idea.

In the UK, I used to take generic pramipexole, the smallest size being 0.088mg. Mirapex, a brand of pramipexole, the smallest size is 0.125mg. They are the same!

It does lead to some confusion.

I usually try and figure out what any member writing about pramipexole is used to, the salt values or the base values and respond in the same.

I'm probably rambling now but I find the base values easier. I sometimes write them as micrograms (ug) not milligrams (mg) e.g. 0.088 mg = 88ug. because when it comes to splitting tablets it's easier to write the values in ug than mg.

E.g. I have to write "half a 0.125mg tablet" (21 characters) instead of 44g ( 4 characters) because I can never remember what half of 0.125mg is!

I don't like writing too much

😜

[Covenant1962 in reply to Hidden]

Thanks Manerva, crystal clear, excellent response

[Hidden in reply to Hidden]

We love you writing too much Manerva 😜

[Shewie]

So Manerva so what would I cut down 2mg of Sifrol if I want to start weening myself down I still haven’t found a Dr that knows something about RLS or a Neurologist but I figure if I start now then the time I find one I will already have a head start.

[Pennydreadful66]

Hi Manerva, my apologies to you and anyone who read my message.

You are correct , it should be read Pregabelin [not rotigotine} 50 mg tablets

twice a day, I assume for starters? Hopefullyt will remain so but I recall you saying in an earlier message Pregabelin is ok re: augmentation or did I get it wrong? I'd appreciate your input.

[Hidden in reply to Pennydreadful66]

I thought you may have meant pregabalin as it sounded the right dose.

The starting dose for pregabalin for RLS is 50-75mg per day, in one nightime dose. Drs oftem seem to get this mixed up because it's also used for other conditions for which it's better if the dose is split.

You may have to incease the dose. The rule is to increase it in steps of 50mg until it works. Then stick to that dose.

Be aware it can take 3 weeks to reach full effect.

A typical minimum effective dose for RLS is 150mg.

There seems to be contradictory information about pregabalin causing augmentation. I can only say that the risk is significantly lower than for dopamine agonists.

[Pennydreadful66 in reply to Hidden]

Thank you for that, I guess its a case of watch this space and I'll keep you informed, I'm at the heart clinic (GP) on the 9th for various tests so hopefully I'm in good hands, I will keep you informed re Meds etc, hopefully its works out, I'm a positive person on the whole and having slept well for over a week and no RLS symptoms (?) I'm hoping relaxing in my bedtime bath will continues to work.

[Pennydreadful66 in reply to Pennydreadful66]

With thanks, I'll update later when I'm on the pregabelin.

[Pennydreadful66 in reply to Pennydreadful66]

Fingers, eyes etc crossed, today is my last day on the neupro patches, I've weened down to 1 mg over the last two weeks. I will start on 'pregabalin' tomorrow and although my GP prescribed 50mg twice a day I have decided to take one dose of 100mg.

I feel nervous and excited at same time. During the last week I have experienced two of my worst nights ever with restless legs as my left leg, arm and upper body felt as if plugged in to the mains [not that I've experienced such a thing} but you get my meaning. I shot out of bed and ended up as I have many times over the years, rolling about on the lounge floor like a demented creature eventually falling asleep. Here's to the future?????

[LotteM in reply to Pennydreadful66]

Did you discuss with your doctor to make a clean swap? Did you discuss the alternative? That is starting the pregabalin prior to stopping the Neupro patch completely? I ask, because based on shared experiences on this forum, stopping the patch will lead to increased symptoms (withdrawal), while the pregabalin usually not works straight away but takes a few weeks to come to full effect. Also, you will need some time to find your effective dosis of pregabalin. Finally, the pregabalin, even when effective for RLS, may still be ineffective for the increased symptoms due to stopping the Neupro; these increased should be temporary, but may last several weeks, sometimes even longer.

I don't want to put you off, just make you aware of what may happen so that you ate prepared. Often people find they meed something extra after stopping a dopamine agonist. Some people get by on codeine/ otc cocodamol, others need something stronger like tramadol or oxycodon.

Anyway, I hope your swap works smoothly and that the pregabalin is effective for your RLS.

[Shewie]

Thank you Manerva I will look into it and find as much info as I can to give to my Dr when I find one as I am determined to get my life back thank you again.

[Pennydreadful66]

Thanks for that info, my gp I think is like many gps and not fully aware of how restless legs works {???] my gp said nothing about using something else to back as they say, the pregabelin. I anticipated there would be withdrawal effects and assumed a need to increase the dosage of pragabelin. I will give most things a go if it works but I am on other medications for heart issue so unsure whats safe.