Augmentation & Tramadol? What next

[m1946]

Not sure what to do now.

I came off 0.5mg Ropinirole about 4 years ago and found 100mg of Tramadol was sufficient to give me on most nights 8 hours sleep.

But I seem now to be developing augmentation. I am writing this after 3 hours sleep!

I have stretched my legs but still suffering.

I am now wondering about Pregabalin or Gabentine. Which of these would be best and what are the side affects?

Observations will be most welcome

[Madlegs1]

Really- your next step would be to go onto Oxycontin in some form.I presume you've checked ferritin and any other possible triggers?

[m1946 in reply to Madlegs1]

Yes! My most recent blood test shows an increase in Ferritin levels to 184?

[Madlegs1 in reply to m1946]

Then blood iron doesn't seem to be your cause.

I would still check medications and food triggers. Keep an intake diary.

As regards getting off Tramadol and going onto an alpha2 ligand ( gabapentin or Pregabalin) there will be the withdrawal challenges.

Transferring straight onto another opioid will be an easier step.

That is, if your Dr will facilitate.

Tramadol does have a small history of augmentation, whereas OXY does not.

Whatever road you go ,. Good luck.

[Bluepainter in reply to Madlegs1]

Does codeine have any history of augmentation?

[Madlegs1 in reply to Bluepainter]

I don't think so.But it is quite a weak opioid and possibly, with your history, won't do much for your rls.

Personally I found codeine to be highly addictive and avoid it at all costs.

[SueJohnson]

I always suggest one start with gabapentin rather than pregabalin as it can be increased in smaller doses (100 mg). Once you find the correct dose you can switch to pregabalin if you like or stay on gabapentin. They are basically the same except that you don't need to divide the dose of pregabalin but can just take one dose (Divide the gabapentin dose by 6 to find the equivalent pregabalin amount). If you do decide to take gabapentin it takes at least 3 weeks to be effective, Beginning dose is usually 300 mg gabapentin or 100 mg gabapentin since you are over 65. After the 3 weeks increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. Most of the side effects of gabapentin or pregabalin will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." Don't take magnesium within 3 hours of gabapentin as it interferes with the absorption.of gabapentin.

[Jumpey]

Hi ,are you sure it's augmentation or is it because the Tramadol has stopped working due to tolerance? I used to take Tramadol and periodically it would stop working. I would take a month's drug holiday and it would kick in again.Good luck.x

[ookla in reply to Jumpey]

Jumpey - What would you take for your symptoms during your month off of tramadol?

[Jumpey in reply to ookla]

I initially used Kratom but had to stop because it eventually caused oesopha pain. But that could work for you.After that I took nothing for a month.

[help3]

both made me gain weight. now i take 1-.5 ropinirole and kratom at night. sleep like a baby

[Nikos64]

I would go back on 100mg Tramadol if you can find a doctor that really understands RLS Gabapentin and Pregabalin are probably not strong enough and in the case of pregabalin have serious side effects like over sleeping and weight gain. I speak from experience too.