Pramipexol

[Smurff]

Can anyone please explain what augmentation actually means please in a simplified way ! As you all know I'm on a very high dose , I'm on them in the evening now also in morning am I correct in thinking it means I will be craving more (augmentation) and what sort of damage a high dose can cause , I'm in contact with my gp to reduce dosage slowly

[Joolsg]

Augmentation means increase in intensity of RLS symptoms, the symptoms starting earlier and moving to other body parts.

[Moonwalker1967 in reply to Joolsg]

Yup, I agree on the above. I got painful legs all day. Needed to take them earlier every night. Left with waking up at 5.00 am every morning plus this strange muscular pain in my legs. To make things worse for the first time I experienced restless arms! It was spooky. Needed to try to calm down my left arm with my right hand. I am trying to get off Pramipexole all together now.

[Joolsg in reply to Moonwalker1967]

Classic augmentation. Read pinned post below. You definitely have to start decreasing very slowly now. Don't increase the dose and don't try Ropinirole or the Neupro patch.Raise your ferritin as well.

[Moonwalker1967 in reply to Joolsg]

Do I end up taking nothing then? Will just go back to hot baths in Epson salts, leg messages and walking then. Stick to magnesium plus vitamin B6 and B12.Will be tough as I will be totally sleep deprived again.

[Joolsg in reply to Moonwalker1967]

No - you switch meds. The first line treatment for RLS now is pregabalin. You start taking it 3 weeks before your planned last dose of Pramipexole. Increase by 25mg every 2 days until you're at 150/200mg.It won't be effective until about 2 weeks after the last dose of Pramipexole because the withdrawal symptoms are too powerful. It's harder to get off Pramipexole than heroin.

During the withdrawal you go 4 dsys and nights without sleep and with constant, intense RLS. You are tempted to stop but by carrying on you get through it and the daytime RLS disappears. The pregabalin then kicks in and you sleep.

Hundreds of us have been in your position.

Pregabalin works for most but if mot, there are low dose opioids like Targinact( Oxycontin) or tramadol or Buprenorphine.

[Bganim1947 in reply to Moonwalker1967]

No you don’t have to give up. Talk to your doctor about your augmentation symptoms ASAP and have him/her begin to transition you onto different meds like Pregabalin and Tramadol. Pregabalin is an alpha legand (not sure about the spelling).

I had to do this with Ropinerol. It was my pharmacist who actually sat down with me and recommended a beginning dosage for those two meds, then wrote out on paper a safe transitioning schedule. For me it was: 100 mgs of Pregabalin & 100 mgs of Tramadol 3x/day at 8 AM, 3 PM and 10 PM. This is based on how long these meds will remain active in your system. Then take that schedule to your doctor and ask him/her to write the script that way. Your doc may suggest Gabapentin over Pregabalin — both are alpha legands and thus will not cause augmentation—but Pregabalin is much better and causes fewer side effects.

IMPORTANT: When you get on this transitioning schedule, stick to it faithfully. If you skip dosage times or take them later than scheduled, your symptoms will start to come back.

Depending on who you are, and your medical and prescription history, it may be suggested that you get on some other meds than Pregabalin and Tramadol or they may not work for you you. You can work that out by talking with your doctor and pharmacist. But DO NOT allow them to put you on another dopamine agonist, it will just trigger augmentation again.

[Whymelord in reply to Moonwalker1967]

Hi,yes that sounds like me,I'm taking 0.18 Pramipexole, I stretch and twist my legs until they are soo painful ,my arms and upper back get really restless, I have to keep rubbing my arms and squeezing them to ease the feeling,was prescribed 2 Pramipexole but trying very hard to take just 1 at night.not much help really, and as for my gp,he simply ignores me if I ring to talk about how much I'm suffering,just says something like "aw I know it's a mystery"

[LotteM in reply to Whymelord]

Hi whymylord. In that case you firmly answer to your gp "indeed it WAS, 20 or more years ago, but not any longer. RLS is well enough understood these days and there is a good treatment protocol. It can be found in the NICE guidelines and in the Mayo Clinic Proceedings of 2021. Please listen to me and read these."

You can then add: "What I am describing to you is called augmentation of the RLS symptoms and that is treated by very slowly reducing the pramipexole (or ropinirole), adding an opioid temporarily to help with the increased symptoms and starting pregabalin several weeks before the last dose of pramipexole (or ropinirole)."

It may help to bring these words printed as well to hand over. Together with a link to or a print of the relevant NICE guidelines and the Mayo Clinic paper. Hope this is useful. There is more relevant info, especially the morning fasting iron panel and iron, especially ferritin and transferrin saturation values. But above is the main message. It IS KNOWN and there IS treatment. Good luck.

[Elaniemarie in reply to Joolsg]

Augmentation is when the meds taken to relieve the symptoms actually start to cause them!

[Joolsg in reply to Elaniemarie]

Well they increase the intensity of RLS and make it more severe. Full description can be found at RLS-UK and rls.org.

Text

[radair0502]

Augmentation is when a med stops working and the condition gets worse than it was before the medication. To augment is to raise something… like an augmented chord in music involves a raised note. Good luck.

[Bganim1947]

Some dopamine agonist medications like Ropinerol and Pramipexole will backfire on the body and begin to intensify all the worse symptoms of RLS, making the symptoms unbearable. And as Joolsg says those aggregating sensations will often increase so much they will start to move into other parts of the body like the torso, arms and even hands. Then you have to very very slowly reduce the dosage of the medication until you can get off it. Those medications should never be prescribed, in my opinion.