Hello. I have RLS as well as REM Sleep Disorder. For the RSD I am taking 20 mg of Melatonin and for the RLS I am taking 100 mg of Tramadol and 100 mg of Pregabalin. I had trouble with augmentation on just 75 mg of Tramadol so my Sleep Doctor upped the dose to 100 and added the Pregabalin. So far, I am doing quite well on this dosage and combination of drugs. I am wondering if anyone else takes these meds and if they have augmented with them. I was to the point where I was getting the creepy- crawly sensation not only in my legs, but also in my arms and trunk. I do not want to go through that again so I am looking for any advice to be proactive with my meds. I see my Doctor later this month. I am new here and also wonder if upping the Tramadol when I was augmenting was a common solution. I thought not but was not sure. Thank you for any advice!!
Pregabalin and Tramadol: Hello. I have... - Restless Legs Syn...
Pregabalin and Tramadol
Wow, you are Superwoman. I’ve never met anyone who could tolerate 20mg of melatonin, RLS aside. I had mild and intermittent RLS since I was about 12. I don’t think I even knew it had a name until I was in my 30s. It wasn’t even a problem when I was pregnant. When I was about 40 I thought it might be a good idea to take a little melatonin. I took .5 mg. My RLS turned into the devil incarnate. It was in all parts of my body. I never made the connection to the melatonin. I saw on the internet to just take some iron at night. It worked, that first night. When I increased the melatonin to 1mg the 25mg of ferrous bisglycinate no longer worked. I went back on the internet and read that melatonin can trigger symptoms. The day I stopped the melatonin my RLS went quiet and I stopped the iron as well. Nothing good lasts forever. Slowly the RLS became a regular guest in my bed and I am back on the iron.
I fully agree with San Andreas. 20mg of melatonin is insane. It will also have a severe side effect of triggering RLS.
I sometimes take 0.25 Mel, and even at that low dose I can feel the tickly wicklies coming on.
Why are you taking it?
Also ,if you are augmenting on tramadol, why on earth would you increase the dose?
I really don't understand the medical care you are undergoing, unless it's some sort of weird experiment.
I really can't advise,except to lower the Mel down to acceptable levels, and tweak the tramadol/ pregabalin doses.
It may not be augmentation at all, but rather high dose of Mel.
Good luck.
Hello. I appreciate your advice. I take the melatonin on advice from my Doctor at the Mayo Clinic. It is the only thing that will stop my legs and arms from thrashing out in my sleep due to REM Sleep Behavior Disorder. I am not certain why the Tramadol was increased but I go back to the Mayo this month and I will ask. I think it may be a transition from Tramadol to the Pregabalin and the Pregabalin will be increased when the Tramadol is weaned off. Thanks again.
Are they sure it's REM sleep disorder?Many people with RLS also have PLMD and that causes you to 'thrash about' at night.I honestly think you have RLS and PLMD and therefore reducing the melatonin will ease your nighttime thrashing.
Pregabalin works well for both RLS and PLMD.
Did you start the melatonin before or after the tramadol and pregabalin? I think you will need to look at the timeline of events and symptoms.
Has the nighttime thrashing stopped on melatonin?
I see you're in the USA. This is a UK based help forum but we have visitors from everywhere.
Where are you? There are several excellent RLS centres and many experts in the USA and it might be worth seeing one soon to sort out your meds and situation and get confirmation about the REM sleep disorder which could be PLMD.
Hello. Yes, I am in the USA and my Sleep Doctor is at the Mayo Clinic. The melatonin has stopped the RBD completely. If it is unintentionaly affecting my RLS, I need to speak with my Doctor at the Mayo to see if there is an alternative treatment. Thank you!
You are in the best possible place for RLS. Hopefully your sleep doctor will consult his colleagues who wrote the Mayo algorithm on RLS to find out how to resolve your daytime breakthrough RLS while still giving you cover for the nighttime REM sleep disorder.It may be a difficult balancing act but getting off tramadol may be their advice as it's the only opioid that causes augmentation as it raises serotonin.
Let us know what happens.
I fully agree with the others. Melatonin is known to make RLS worse. I would stop taking it. If you need something to sleep, there are safe substitutes like ativan and xanax. Or there are OTC ones like valerian, chamomile, hops, L-tryptophan, 5-HTP, glycine, and GABA. Also the pregabalin is a low dose so could be increased if need be. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 200 to 300 mg of gabapentin daily." Have you had your ferritin tested?
Augmentation means increase in severity of RLS symptoms. It only happens with dopamine agonists and tramadol.
Signs of augmentation are
RLS is more severe
RLS starts earlier
RLS affects other body parts ( arms, hands, trunk, head).
Increasing the dose doesn't help. So if the RLS continues and keeps affecting your arms, it would appear to be augmentation.
(Tolerance means your drug dose no longer covers the RLS symptoms so you increase the dose and the symptoms go back to what they were.)
If you're experiencing augmentation on tramadol, then the solution is to get off it and switch to another drug like Oxycontin or codeine or Buprenorphine or up the dose of pregabalin.
I agree with others that melatonin worsens RLS for the vast majority with RLS.
If you experienced augmentation on tramadol, increasing the dose is just kicking the can down the road - you're going to experience augmentation again once your body adjusts to the new dose. The pregabalin is probably what's keeping the augmentation at bay for now. I hate to say it, but it might be time to slowly ween off the tramadol and maybe try pregabalin by itself.
That’s a relatively small dose of Tramadol. I was on 400mg a day plus 100mg of morphine tablets, co-codymol and Duluxotine. Not all for RLS as I have fibromyalgia and lower back issues. Like you I’m on 100mg of Tramadol but use a Buprenorphine patch 35mc now. The Tramadol doesn’t seem to help with RLS or augment it but I use it for breakthrough pain. Surprisingly the patch has helped with my RLS as an added bonus. I would say reduced it by 75%.
It does not make sense to me to wean off tramadol and then go up on pregabalin. Go up on the pregabalin to help tolerate your RLS while (and after) you decrease your tramadol.
If possible I’d consider stopping Melatonin. For me melatonin gives me terrible RLS. I’d also get off the pregabalin. For me pregabalin caused great weight gain and I found it difficult waking up in the morning. Good luck!!
I'm sorry you had side effects from pregabalin but everybody is different and chihuahualuver is not having side effects from it. It can completely control RLS in many people.
You’re absolutely correct Sue. Everyone is different and I should’ve pointed this out. It’s just that for me the side effects were pronounced. I slept a lot, gained 25lbs of weight and according to my wife snored a lot.
Are you saying that the Mayo Algorithm advises melatonin because if you are that is not true?
Hi. No, I don’t know about the algorithm. I am just saying my Doctor at the Mayo has me take melatonin for REM Sleep Behavior Disorder. The Tramadol and Pregabalin are for my RLS.
My reply was to Niepowiem. But the algorithm I was referring to is the Mayo Clinic Updated Algorithm on RLS which is the latest advice on the treatment of RLS at Https://mayoclinicproceedings.org/a... I strongly advise you to read it.
No, saying that chihuahualuver is under the care of the Mayo Clinic and they don't seem to be following their own algorithm on RLS.As niepowiem mentions, it could be a junior doctor who is not familiar with the full details of the algorithm.
Ahh - thank you for the translation.
Uhmm - the definition of a hard core drug is "a narcotic that is considered relatively strong and likely to cause addiction" thefreedictionary.com/hard+...
Maybe she's seeing someone in a different department. I agree it seems strange that the Mayo Clinic would put someone with severe RLS on such a high dose of melatonin.
No no no to the melatonin…it is known to worsen RLS.
Thank you! I didn’t know melatonin worsened RLS before reading about it today and n this forum. I will need to speak with my Sleep Doctor to see if there is something else to help the REM Sleep Behavior Disorder. See the article below. I hope there is something besides melatonin. Thanks again.
Summary:A Mayo Clinic study shows that melatonin successfully alleviates many patients' symptoms of REM-sleep behavior disorder (RBD), a violent sleep condition that manifests during rapid eye movement (REM) sleep, a stage of deep sleep in which most dreaming occurs
Clonazepam is highly effective in treating REM Sleep Disorder and won't hurt RLS. webmd.com/sleep-disorders/r...
No advice, but experience. I had been using 6mg Ropinirole for 10 years or more, and was advised to to a gradual change over to Pregablinup to 450 mg. It became obvious that 400mg Pregab. would not control my RLS, but when Ropinirole came down to 2 mg my insomnia was diminished. I have settled for the time being with 400 mg Pregam, 2 mg Ropinirole + at bedtime 0.5m Ropini.I augmentation is a problem, try 24 hour slow release and that may help. William Potter. Cardiff UK
The problem with slow release is it only delays the augmentation and it is even harder to get off the slow release than the regular.
Tramadol efficiency
Tramadol for RLS
Switching from three meds to one (Pregabalin, clonazepam, and ropinerole) - I hope! I hate ropinerole! I need help. 
Pregabalin
