Is an opiate the way to go?

[ELECTRONTRAV]

I currently take 100mg Pregabalin and use 2mg Neupro patch (Rotigotine) and these are to control my RLS. However I have been on them for several years and they seem to be becoming much less effective starting about 4 months ago, I think I am getting into augmentation, particularly with the Neupro . I will be seeing my doctor on Friday and would like any suggestions for alternatives. I am seriously thinking about Targinact which is supposed to be a non constipating opoide as I know that 100mcg of Buprenorphine (Temgesic) is very effective but causes constipation. Any suggestions welcome. Best Regards to all.

[Madlegs1]

If you can go without any medications is the ideal outcome.First- have got your irons checked.? Ferritin should be over 200.

Secondly- have you checked your lifestyle for any triggers? These could be medications-- statins, antidepressants, antihistamines and loads more.

Food and drinks can also set off the RLS.

Alcohol, preservatives, sulphates, rising agents, msg- in any of its 200 iterations. Artificial sweeteners, high sugars and so on. Keep a diary .

Only when these issues have been addressed ,should you contemplate medications.

You could try a very short course of Pramipexol to diagnose whether it is actually RLS. If Prami ( up to 0.2mg )doesn't whack it on the head by day 2, then you don't have RLS.

After that you can look at Pregabalin or Gabapentin, and then progress to the opiates. Buprenorphin seems to be flavour of the month .

Some people find comfort with Kratom and cannabis, depending on what's available or legal, wherever they are.

Also some people do various combos of these drugs.

Everyone is different.

Specific to your situation Buprenorphin should work. All opioids are constipating.

A healthy diet , avoiding all processed foods and including roughage, will avoid most problems. And plenty of liquids.

Good luck.

[Elffindoe]

Hi

I believe you have a few options.

One is that you may be augmenting from the neupro, in which case the pregabalin may not be very effective. 100mg pregabalin is also a relatively low dose.

Your first option is to wean off the neurpro and increase the pregabalin. This will of course have no imediate effect. You'd have to stop the neupro completely for full effect.

Two is that you seek a prescription for an opioid. I would still suggest you wean off the neupro.

a) With this option you could ask for an opioid in conjunction with the pregabalin and this could be a low potency opioid such as codeine or tramadol.

Or b) you could ask for opioid monotherapy i.e. just an opioid and also wean off the pregabalin.

There are advantages to both

The advantage of a) is that you could have a lower dose of each and you are more likely to get a prescription for a low potency opioid than a high potency one.

The advantage of b) is that a low dose of a high potency opioid may be more effective with less risk of addiction.

Targinact is oxycodone with naloxone. This is supposed, I believe, to counteract constipation. It will only be a low dose of naloxone, a higher dose would neutralise the effect of the opioid. Hence I don't know how effective the naloxone will be.

I believe that buprenorphine may have advantages over oxycodone and you can still take additional measures to prevent constipation.

[ziggypiggy]

All the suggestions made in the replies are good advice. Chances are when it comes to starting patients on opioids each doctor has their own preferences on where they start and how they go from there. Some are more open to suggestions than others. Opioids do work very well for RLS, it's what comes along with them that can be problematic.

Most RLS patients are very responsible and diligent when it comes to using opioids to treat RLS simply due to the fact that to do otherwise is counterproductive and not in their best interest.

Both doctor and patient need to be aware that barring a more effective treatment for you it is likely you will be on opioids longterm/life and that small incremental increases in dosage are to be expected based on the evidence that the disease gets worse as we age and tolerance.

Obviously, if you are exhibiting abusive behavior like asking for refills ahead of time or requesting frequent increases in dosage you will most likely be taken off of opiods.

You need to also be aware that not all doctors will be open to prescribing opioids for RLS. So even though your current physician may it's no guarantee, if you have to change doctors or they move on, that the next one will continue the treatment. My doctor of 25 yrs told me last visit that he would write a letter for me in my chart when the dreaded day comes but that there are no guarantees.

It comes down to reward/risk analysis which is different for everyone of us for any medication.

Yes, constipation can sometimes be an issue. Also, some of use deal with sleep onset delay while using opiates. I'm waiting to hear from more people that are switching to buprenorphine to see what they have to say about insomnia.

Good luck.

[joepublic]

Targinact is not free from constipation - it's been causing me problems from day one but I take other meds to help with that, somewhat patchy results though.

[Elffindoe in reply to joepublic]

You need to be careful of taking laxative medications long term.

Like DAs and augmentation, long term use of laxatives can result in worsening constipation.

The solution is possibly to use doetary remedies for constipation, with occasional use of laxatives.

By laxatives I mean meds that stimulate peristalsis.

[joepublic in reply to Elffindoe]

GP said it was OK???

[Elffindoe in reply to joepublic]

You'd expect a dcotor to know better!

I'm afraid this may not be the best link, but it's the first I found

rosewoodranch.com/laxative-...

This looks like a useful site

healthline.com/health/const...

[joepublic in reply to Elffindoe]

Interesting but I am not abusing it - I take Senna two tabs a day.

[Elffindoe in reply to joepublic]

I appreciate you're not actually abusing it, but the article does show that prolonged use is not advisable. Particularly laxatives that stimulate peristalsis, e.g. senna. The problem is that prolonged use can "numb" the nerves that produce peristalsis.

I use senna occasionally when necessary, it's relatively mild. I wouldn't use it regularly when there are many other options.

I don't usually write such things without tnhere being some foudnation to them and afgter even that, it' onoy information and individuakls can make their own decison about whether it apllies to themslf or not.

The worst case of constipation I've come across was a young boy. His parents became worried that he normally had a "motion" at least once every 4 months, but this time it had been five months.

It turned out he had a condition called Hirschsprung's disease which is where the nerves causing peristalsis are missing.

[joepublic in reply to Elffindoe]

Point taken - I'll try dietary solutions where possible. Diverticultis doesn't help either.

[Elffindoe in reply to joepublic]

Ouch, no it doesn't!

Sorry.