Go back on Pramaprexol?

[SteveWess]

I was on Miropex/Pramaprexol for 15 years for RLS until I augmented late 2021. I phased out the Pramapexol slowly as recommended by this site and Mayo Clinic(complete hell),as I began Gabapentin. I hated the side effects so switched to Pregabalin,which I also hated.

I now take 100 MG of Tramadol and Indica THC about two hours before bed,which works effectively for now. I take no other medication for my health, I exercise daily,and am in good physical shape.

My doctor suggested that since I took such a long holiday from Pramaprexol that maybe I should go back on it and could possibly get another 15 years of relief.

Has anyone done this or believe it could work?

[SueJohnson]

Since the tramadol and Indica THC work, why take a chance.

[Madlegs1]

It is highly unlikely that you will get the same length with another visit to Prami or even any other DA .

But it's just possible you could get a few months.

But, as Sue says, why bother?

[Joolsg]

No. It will not work. You will very quickly augment again and have to go through another hellish withdrawal. Augmentation causes the D1 dopamine receptors to become 'over stimulated' and they then fire up causing the intense, severe RLS. If you take another dopamine agonist it will very quickly fire up those D1 receptors.Dr. Buchfuhrer also believes DAs permanently damage the dopamine receptors and that is why pregabalin and gabapentin don't seem to work well for many of us that have been in DAs and experienced augmentation.

If the tramadol and Indica are working well why would your doctor suggest a drug that is no longer prescribed by the top RLS experts? Is he aware of the Mayo algorithm?

If the tramadol becomes ineffective ( it is the only opioid that also causes augmentation) you could then switch to pregabalin, gabapentin or Horizant or another low dose opioid like codeine, Oxycontin or methadone or Buprenorphine.

[yorkie24]

No, no, no! Please don't be tempted to do this. I agree totally with the previous replies. Remind yourself of the trauma of augmentation, as it will happen again. Remind yourself of the trauma of withdrawal, as it will happen again. You have found a solution for your RLS so stick with that. Personally I have found a combination of gabapentin and codeine works for me (after augmenting on pramipexole).

[Bumble34 in reply to yorkie24]

Interesting combo, can I ask what dosage?

[SteveWess in reply to Bumble34]

I begged for something to help me sleep after about four miserable nights of no sleep with Pregabalin. My doctor gave me 50 mg of Tramadol and it allowed me to sleep a solid 4 - 5 hours, which was great. After a week of one 50 mg Tramadol, and increased to two (total of 100 mg) and it helped significantly. My wife told me to try some Inidica in addition. Therefore, I started taking 1.0 ml of Indica RSO Tenture along with the the two 50 mg Tramadol and it worked! I get 8 hours of sleep (although I go to the bathroom every 2.5 to 3.0 hours during the night) consistently and feel very relaxed and comfortable when I go to sleep.

I take the combo about 2 - 3 hours before bed and it is best on an empty stomach (even if I eat subsequently).

My only concern is feeling the need to increase the Tramadol dosage over time, but I guess I will cross that bridge when it happens.

Let me know if you try this and if it works for you.

[yorkie24 in reply to Bumble34]

My normal regime is 300mg Gabapentin at 19.30 and 21.30. I also take 30mg Codeine at 18.30 (when symptoms used to start), 60mg at 22.30 (bedtime) and 30mg at 03.00 (RLS usually wakes me around then!) I usually find that with 15 minutes of taking the codeine my symptoms subside. The maximum dosage is 240mg per day, minimum 4 hours apart. I have been on this dosage for about 18 months now. Sometimes if the symptoms kick in early afternoon I will take 30mg then. Occasionally I do sleep right through but this isn't too often but on average I sleep for 6-8 hours so I'm not complaining! Best wishes.

[Bumble34 in reply to yorkie24]

Thanks for that, I`m glad you are getting some relief, I did try codeine earlier this year I needed 90mg in one go to supress the symptoms but that dose also kept me awake.

[SueJohnson in reply to yorkie24]

There is no need to separate the gabapentin doses since you are only taking 600 mg. I would suggest taking 600 mg 1 to 2 hours before bed. However, 600 mg of gabapentin is a very low dose so it is no wonder it is not working completely. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." Ask your doctor for 100 mg capsules and 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. If you take magnesium, take it at least 3 hours before gabapentin as it interferes with the absorption.of gabapentin.

[yorkie24 in reply to SueJohnson]

Thank you for your kind observation. However, in the past I was taking a higher dose of gabapentin and this did very little, if anything at all, to help with my symptoms. Possibly because of the high level of augmentation I was suffering. My symptoms only improved when I started taking codeine and this is why I reduced the gabapentin to a lower dose. This 'mix' seems to work for me, thank goodness, though I do appreciate it will not work for everyone.