How do I switch from Ropinirole to Gabapentin?

[67Waterman]

Having recently come to this Forum, I have been reading hundreds of your posts over the last few days. I would very much appreciate some advice. I currently take 0.25mg Ropinirole during the day and 0.50mg Ropinirole in the evening, which is getting less and less effective. I have a prescription now for Gabapentin, but do not know (1) when and how much to take with my current Ropinirole tablets, (2) how long I must wait until I can start reducing the Ropinirole, and (3) if I drop the dosage of the Ropinirole, how much should I be increasing the amount of Gabapentin. Obviously my doctor has little knowledge or understanding of RLS. With many thanks.

[Elffindoe]

Hi, perhaps I can give you some guidance.

Firstly, you should take as much gabapentin as your doctor prescribes.

I may be wrong but it sounds like he/she has just given you a load of gabapentin and left you to your own devices.

If this is simply because they dont know they should have looked it up. This is a potent drug.

If they had, it would go something like this -

The starting dose is 300mg per day (under 65 yrs) or 100mg per day (over 65 years).

You can then increase it in 300mg or 100mg steps at the rate of 100mg every 1 to 2 days (or 300mg every 3 to 7 days. Until it works!

This is a slight problem if you are taking ropinirole at the same time because you won't really know if it's working or not until a few weeks after stopping the ropinirole.

You should only take it at night and note that side effects at first include dizziness, drowsiness and difficulty walkung. Hence a risk of falling.

These should fade within a few weeks.

Also note that gabapentin does not work straight away.

Also note that it doesn't work very well whilst suffering augmentation or withdrawing from ropinirole.

You are suffering augmentation now that's why you have to take ropinirole during the day.

I suggest then you do not increase the gabapentin to more than 900mg until you've entitely stopped the ropinirole for a few weeks.

You can start the gabapentin now.

It's best to slowly reduce the dose of ropinirole in increments of no more than 0.25mg. If you get severe withdrawal effects then try reducing in steps of 0.125mg.

After reducing the dose, stay on that dose for at least two weeks.

It is very important that you ask your doctor for blood tests for serum iron, transferrin saturation, ferritin and haemoglobin.

If all these are OK, then the recommendations are

1) of ferritin is less than 75 start taking an oral iron supplement. See recent posts on how to do this.

2) if ferritin is between 76 and 100 seek an IV iron infusion.

Check to see if you have any agfravating factors. Read tecent posts about this.

[67Waterman in reply to Elffindoe]

Hello Elffindoe. Wonderful name ... but curious as to why you are not Elfindoe (ie one "f"). but thank you so much for your response - truly. After reading all the posts on here, I asked my GP to prescribe Gabapentin - which he did - but he knows little about RLS. I have blood tests booked in during the next couple of months, and have insisted on the FULL range of iron tests. In the meantime, I will take your suggestions regarding Gabapentin dosages. Well done for being the torch that is lighting a bit of a way in this horrible journey. I was also interested to read about the effect of glutamate in RLS - it seems like it does have such a significant effect. Many sincere thanks again. Sally

[Jimbartlett in reply to 67Waterman]

Hi Sally,

I have been reading your post from 2 years ago and would like to hear how you are now. I am currently coming off Ropinirole and starting Gabapentin . Ropinirole is down to 1 mg so 4 weeks to go at 0.25mg reduction per week and Gabapentin at 600 mg per day. But what an awful journey this is, can't sit down for more than 30 minutes without having to get up and walk around no matter how tired. Is this how it was for you or am I doing something wrong ?

[67Waterman in reply to Jimbartlett]

Hi Jim.

You poor thing. My heart goes out to you.

Gabapentin did not work for me at all ... and I was taking a total of 900mg. I then switched to Pregabalin (450mg in one go just before bed time). I add 0.125mg Ropinirole to this.

And to be honest, this does not work either particularly well. I get a couple of hours sleep if I am lucky, and then wake up with "shuffles" (as I call it). I then usually take another 0.125mg Ropinirole or a couple of Co-codamol.

I might get another couple of hours sleep, but usually wake up shuffling again. Although I am lucky, now that I am off a strong dose of Ropinirole, I no longer get the daytime RLs (which was caused by augmentation).

I am having a phone call with my RLs specialist in September when I am going to ask to be put on Buprenorphine, because I am very very tired of having this incredibly draining condition for the last 40 years with little respite.

All I can say is that there are so many people like you and me on this Forum and around the world - I hope one day that they really put some money into finding out more about this condition, and hopefully make life more bearable for us all.

Warmest regards, Sally

[SueJohnson]

Also you should not take 900 mg in one dose as the absorption is less if you take more than 600 mg. Therefore for 900 mg you would take 300 mg 4 hours before bedtime and 600 mg 2 hours before bedtime. Then follow this guidance: If you take more than 600 mg but less than 1300 mg, take 600 mg 2 hours before bedtime and the difference 4 hours before bedtime. If you take 1300 mg but less than 1900 mg take 600 mg 2 hours before bedtime, then 600 mg 4 hours before bedtime and the difference 6 hours before bedtime

[LondonRLS]

Thank you for your post, 67Waterman. My partner is at the same point, but on about 5mg Ropinirole daily. So helpful to see the post from Elffindoe!