Ropinirole to gabapentin

[danamias]

I am in the process of moving from ropinirole to gabapentin. I'm now at 900mg of gabapentin and heading for 1200, and down to 3mg from 4mg of ropinirole. No obvious side effects so far. Any advice on staggering gabapentin across the day? I would have thought the aim is to eliminate RLS both during the day and at night. So I'm wondering if I should be taking gabapentin across the day; for example every four hours as soon as I wake up. The holy grail for me would be to get to a point where I can lie down during the day for a nap symptom-free. Any thoughts? Thanks.

[SueJohnson]

Did you have symptoms during the day when ropinirole was working or before you started ropinirole? If not, then the daytime symptoms are from the fact you were augmenting and will disappear after you are off ropinirole for a few weeks. Unless you found your symptoms decreased as you increased the gabapentin, I would not increase it anymore at night until you are off ropinirole for a few weeks. For your daytime symptoms you can follow the same rule as at night. 600 mg 1 to 2 hours before your nap and 300 mg 4 hours before your nap. I, too, at age 80, augmented on ropinirole and switched to gabapentin and wanted to nap after lunch and experimented with taking gabapentin during the day without success until I was off ropinirole and found the dose of gabapentin that worked for me at night, and then I had no daytime symptoms.

[Myturn1st in reply to SueJohnson]

Do you find that gabapinton causes weight gain? We are looking into switching to gab from ropinirole but I’m a diabetic and can’t afford the weight gain if so.

[SueJohnson in reply to Myturn1st]

I only gained a couple of pounds. It may increase your appetite and it may not but you can control that.

[SueJohnson in reply to Myturn1st]

If you do decide to switch that would be an excellent decision, since ropinirole is no longer the first-line treatment for RLS? Up to 70% of patients will suffer from augmentation which believe me you don't want. It used to be the first-line treatment which is why so many doctors prescribed it but they are not up to date on the current treatment recommendations. Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it as yours obviously isn't at

Https://mayoclinicproceedings.org/a... Also have you had your ferritin checked? If it is below 100 improving it to 100 or more helps 60% of patients and in some will completely eliminate their symptoms. If you haven't had your ferritin checked, ask your doctor for a full iron panel. Stop taking any iron supplements 48 hours before the test and fast after midnight. Have your test in the morning when your ferritin is lowest. When you get the results, ask for your ferritin and transferrin saturation numbers. You want your ferritin to be over 100. If your ferritin is less than 75 then take 325 mg of ferrous sulfate with 100 mg of vitamin C or some orange juice since that helps its absorption. Take it every other day at least 1 hour before a meal or coffee and at least 2 hours after a meal or coffee since iron is absorbed better on an empty stomach and preferably at night. If you have problems with constipation switch to iron bisglycinate. If your ferritin is between 75 and 100 or if your transferrin saturation is below 20, you probably need an iron infusion since iron isn't absorbed as well above 75. If you take magnesium take it at least 2 hours apart since it interferes with the absorption of iron. Don't take tumeric as it interferes with the absorption of iron. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after 8 weeks if you have an iron infusion or after 3 months if you are taking iron tablets To come off ropinirole, reduce by .25 mg every 2 weeks or so. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end.. But in the long run, you will be glad you came off it. On the gabapentin, beginning dose is usually 300 mg gabapentin or 100 mg if you are over the age of 65. Start it 3 weeks before you are off ropinirole although it won't be fully effective until you are off it for several weeks. After that 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 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." If you take magnesium take it at least 3 hours before taking gabapentin as it will interfere with the absorption of the gabapentin.

[Myturn1st in reply to SueJohnson]

Thank you fir all of that information but not I’m terrified of augmentation and weaning 😢

[danamias in reply to SueJohnson]

Thanks Sue - very helpful 🙂

[Joolsg]

I agree with Sue.Daytime severe RLS is common on Ropinirole.

Keep reducing the Ropinirole and don't increase the gabapentin until you're at 0.25mg of Ropinirole.

[danamias in reply to Joolsg]

What's the thinking behind not increasing gabapentin until at 0.25 of ropinirole? Thanks 🙂

[Joolsg in reply to danamias]

Because the withdrawal symptoms will be very strong once you drop the last 0.25mg for at least 3 weeks so that is when you will need the added benefit of increased gabapentin.Gabapentin generally does not help while you're symptoms are severe in augmentation.