getting off a low dose of pramipexole

[Cather]

I was on Permax and Mirapex at .05 mg for rls for about 20 years, before augmentation set in. I reduced the Mirapex slowly, then went off completely for 7 months. Experiencing depression and anxiety, and sleep interrupted by rls , I went back on 3 years ago and have stayed on .125 by taking a 14 day "drug holiday," about every 5 months. So far, so good. I am considering reducing to .088 or .066. Does anyone know if mirapex comes in that dose? Any suggestions as to what I should do now? My doctor suggested methadone, but I don't want to go on opiates.

[Elffindoe]

BOTH Permax and Mirapex are dopamine agonists.

If you're going to wean off one, you best wean off both.

I suspect that when you stopped Mirapex, you suffered DAWS ( Dopamine Agonist Withdrawal Syndrome).

There is no treatment for this except symptomatic relief. This makes it difficult to withdraw from dopamine agonists.

A LOW dose of a high potency opioid can be used for RLS and can be effective without experiencing the "feared" consequences of opioid use.

I suggest you google DAWS

[Madlegs1]

Low dose methadone is an excellent drug for controlling rls.It has been used long-term for a number of years. More often in USA because it has a bad name in UK.

But if you are being offered it, then it is certainly an opportunity to be considered carefully.

[Elffindoe]

PS.

I forgot to say the smallest tab is 0.088mg = 88ug.

To. get 44ug cut the tabs in half.

To get 22ug cut in quarters.

66ug = one half plus one quarter.

[LotteM]

Cather, you already got good replies from Madlegs and Elffindoe. I just want to refer you to two recent papers on the management of RLS. Ine is specifically about the use of opioids for RLS. It may settle your mind about the methadone.

mayoclinicproceedings.org/a...

mayoclinicproceedings.org/a...

[Gmc54]

You are so lucky to be offered methadone.

[patioRN]

I had a terrible time with DAWS, which lasted several months. Between that and the side effects Mirapex caused in the first place, I’d take methadone over Mirapex any day.

[involuntarydancer]

If you are in Europe you can get pramipexole (mirapex) in 0.088mg doses. The doses are different in the US but there is a 0.088mg tablet equivalent. If you reduce you should do so very slowly (as I’m sure you already know).

I agree with all the others. If you are being offered methadone it is probably worth trying unless you have counter-indications such as central sleep apnea. If you have already successfully withdrawn from pramipexole you will be well able for the withdrawal symptoms if you decide to discontinue methadone.

Finally, though I’m sure you know this, you should ensure that your serum ferritin is above 100.