Rotigatine

[Lyndabutt]

Just commenced Rotigatine patches.on 3mgs but it hasn’t had the effect I would have thought.I still have RLS all evening although not as bad as usual.Has anyone had experience of patches not working.

[Madlegs1]

What other medications are you on?

[Lyndabutt in reply to Madlegs1]

None

[Lyndabutt in reply to Lyndabutt]

Do you mean for RLS or other things because I take statins,thyroxine and bets blockers

[Madlegs1 in reply to Lyndabutt]

Thanks. Some of those are causing your problems.Elfindoe has addressed them, so I won't reboil the cabbage!😜

All the best.

It is really difficult to find ones way through the medical minefield.

[Elffindoe]

Hi, there's several possible explanations why the patch is not working. One is possibly due to any other medications you're taking that might interfere with it. I think this is unlikely, but its's possibly why Madlegs is asking.

If you've previously taken another drug for RLS such as pramipexole or ropinirole and you had problems with either, this could explain why the patch isn't working. Another reason for Madlegs to ask.

A third reason I can think of for it not working. I say this because dopamine agonists, (DAs), rotigotine, ropinirole or pramipexole are miraculous in having an almost immediate effect.

If this is so and the rotigotine isn't working then it's quite possible if this your first treatment for RLS, that you don't actually have RLS.

I have to ask then, who says you have?

Assuming you do have RLS then-

if this is the first treatment you've been offered for your RLS then I'm sorry to say whoever prescribed it is not up to date with the recommended management of RLS.

Rotigotine is one of three drugs called dopamine agonists (DAs) traditionally prescribed for RLS.

These drugs are no longer recommended for the first treatment for RLS.

If it's not the first treatment you've been offered and any other RLS medication you're either already taking or previously took is also a DA, that you're now prescribed a second DA is worrying.

I think this also is partly why Madlegs asks about any other medications you're on.

The other reason he asks is because there are many medications which can make RLS worse, hence stopping, if possible, the other medication can, in some cases relieve your RLS.

Up to date recommendations for the management of RLS suggest 3 things.

1) Iron therapy as indicated by blood tests

2) The identification of aggravating factors and if possible eliminating them. This is usually other medications, but could be dietary or related to inflammation. It also includes everyday RLS triggers such as alcohol, sugar, nicotine or caffeine.

Lastly

3) medication. The current recommended treatments for RLS are called alpha 2 delta ligands, pregabalin or gabapentin. NOT a DA such as rotigotine.

The reason for this is the high risk of major complications caused by DAs.

Even if a DA were to be prescribed, it is essential that the dose be kept to a minimum to avoid complications. 3mg is not a minimum.

Please see this link.

mayoclinicproceedings.org/a...

I hope this informs you better.

I can only say further that if your doctor isn't aware of how to manage RLD, then it's possible they're not able to diagnose it correctly either.

[Lyndabutt in reply to Elffindoe]

Thank you for your reply.I was on Ropinirol for 2 years.I was taking 1.25mg split into 2 doses.My problem with it was that I took 0.5 at 4 pm then slept all evening.It did relieve my RLS though.

[Elffindoe in reply to Lyndabutt]

Hi again.

I note you take other medications. Of these beta blockers and some statins can make RLS worse. Thyroid dysfunction can also affect RLS.

Some thoughts about the ropinirole.

The first I wonder, if it was working and you've stopped it, why is that? What happened that made you make the change to rotigotine?

Your answer to this may explain why the patch doesn't appear to be working.

The second is why did you split the dose of ropinirole and take it so early, i.e. at 4pm. Did you always do this or did you start doing it because your symptoms began to start earlier?

Your answer to this may also explain why the patch isn't working.

What time do your symptoms start now?

If ropinirole, a DA was causing any problem or failing then switching to another DA, rotigotine, is ultimately going to have the same result.

Of note also is that you've switched from an immediate release DA to an extended release, the patch. This means that although the patch contains more DA than the dose of ropinirole you had the amount of it in your blood stream may be lower when you need it most, i.e. at night.

It isn't advisable to increase the dose of rotigotine however. 4mg is the maximum and that would carry a higher risk of causing complications.

Sorry to ask so many questions, but answers to these may help explain your problem.

You make no mention of your iron levels or any therapy you're having. Since iron deficiency is the main cause of RLS, this is something you should consider.

I suspect that you may need to switch from rotigotine to something else.

[Lyndabutt in reply to Elffindoe]

Thank you for your reply.I did have my iron levels checked and GP said they were over 100.I have had RLS for 40 years but only the last 4 years has it become a big problem and needed medication.It never started until 8 pm ish but soon after taking Ropinirol it started at 4 ish so I had to take Ropinirol early.The problem was that I was sleepy all evening and couldn’tgo out ect so thought that I would try Rotigatine.

[Elffindoe in reply to Lyndabutt]

Hi and thanks for the clarification.

As regards the iron, it d oes seem that your level Of 100, if by this you mean ferritin, is reasonable. You couLd still benEfit frOm raising it More if you can., say at least 200.

As regards the ropinirole/rotigotine.

AS you were taking ropiunirole, a dopamine agonist (DA) and symptoms started eaRlier, this is a sign of augmentation, which is a common major complication of taking a DA.

Switching to rotigotine isn't really a good solution for this because it is also a DA and causes the same problem in short time. It has already failed and if you continue, you may find your symptoms get even worse. This is augmentation.

The best solution to augmentation is to stop taking ANY and all DAs and switch to a non-DA medication. Typically tbis is pregabalin or gabapentin. If these fail to work then there are other options.

Note that it is dangerous to stop taking any DA suddenly and if you decide to reduce it and stop it, you need to do this quite slowly otherwise you can experience severe withdrawal effects.

I suggest you read some other posts in the forum about augmentation and weaning off DAs.

[Lyndabutt]

Thank you for your advice.yes I would like to stop taking DAs but I’m very apprehensive about withdrawal.