switching from pramipexole to pregabaline

[nutville]

I have been on pramipexole for RLS for 8 years and experience augmentation, meaning even hi doses do not work anymore. Now my neurologist has given me pregabaline. My question is how to slowly and safely switch from one to the other. Does anyone has experience with this?

[Joolsg]

It's best to very slowly reduce the Pramipexole by halfs 0.088 pill every 2 weeks and you might need a low dose opioid to help with withdrawal symptoms.Start the pregabalin 4 weeks before the planned last dose of Pramipexole and start with 25mg and increase by 25mg every 3 days until you reach 150mg. Take pregabalin at night.

The pregabalin won't really help until about 3 weeks after the last dose of Pramipexole as your D1 dopamine receptors take time to settle down.

The RLS should then settle and you may need to increase the pregabalin up to 300mg a night.

Make sure your serum ferritin is above 100, preferably 200 as that will help reduce symptoms.

Wishing you strength and I hope it isn't too traumatic.

[nutville in reply to Joolsg]

Thank you!! This is great advice!

[SueJohnson]

I notice that 2 years ago you were suffering from augmentation from pramipexole and switching to gabapentin. What happened?

[nutville in reply to SueJohnson]

True. But I didn't proceed with the new medication and just kept taking pramipexol, because if I didn't my RLS went through the roof, almost literally!

[SueJohnson]

Joolsg is right about your ferritin. Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. When you see your doctor ask for a full iron panel. Stop taking any iron supplements 48 hours before the test, fast after midnight and have your test in the morning when your ferritin is lowest. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your transferrin saturation to be over 20% but less than 45%. If your transferrin saturation is OK, then if your ferritin is less than 75 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 preferably at night 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. 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 may 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 can interfere 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.

[nutville]

"Several months...?!" Wow. But thx for the advice.