Voltaren Gel and RLS

[LoverofParis2014]

Voltaren arthritis pain (dicoflenac gel 1%)Has one found this medication to aggravate RLS?

[SueJohnson]

It should be fine.

[SueJohnson]

Since you augmented on Requip you are likely to augment on pramipexole. It is no longer the first-line treatment for RLS, gabapentin or pregabalin is. It used to be the first-line treatment which is why so many doctors prescribed it but they are not uptodate on the current treatment recommendations. 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 you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your ferritin to be over 100 and your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice. To come off pramipexole, reduce by .125 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 (75 mg pregabalin). Start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks. After that increase it by 100 mg (25 mg pregabalin) 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. (You don't need to divide the doses on pregabalin) 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 (200 to 300 mg of pregabalin) daily." If you take magnesium take it at least 3 hours before taking gabapentin as it will interfere with the absorption of the gabapentin. 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 or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

[SueJohnson]

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, estrogen, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, using a standing desk, listening to music, meditation and yoga. Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[LoverofParis2014 in reply to SueJohnson]

Thanks so much Suefor your thorough reply. Recently restarted Estrogen cream because of UTI ‘s last summer, Following knee injury 10/3/22, another UTI which progressed to kidney infection. Treatment was delayed as my 5 yr old great gran had Covid. We care for her 5-6 days a week. Did not want to risk infecting someone else. Finally this past week was diagnosed with Interstitial Cystitis after years and years of intermittent symptoms. It is also autoimmune related problem I have learned. Diagnosed with Thyroiditis age 15 in 1956-there was not all the lab testing available. At 25 first pregnancy-developed large goiter and had partial thyroidectomy. In the 1980’s had multiple nodules develop in remaining thyroid tissue. Seen at John’sHopkins Hospital diagnosed Hashimoto’s thyroiditis. Recent research at Hopkins indicates Thyroid problems especially Hashimoto’s I believe, is probably a de facto cause of RLS.think I am the poster child for autoimmune disorders! Have dealt with endometriosis, still deal with IBS and significant hearing loss that studies are beginning to show is Hashimoto’s related. Also Fibrositis in late 1970 which later became known as Fibromyalgia and now considered autoimmune . I rarely mention that one because most people don’t believe it’s a true diseaseand label you as a crock! Some things I knew were immune related but recently learning about the others. Also learned my BP med Losartan with potassium, Celexa and some pain meds can aggravate.. Started medical cannabis in 2021, 5-7 mgm of indica for RLS (gummy form) and was like a charm until Sept 2022. Because of drowsy side effects could not increase dosage. Shortly there after had a fall with bad knee injury which caused many autoimmune flares. Because of sever knee pain was able to get rx for Xanax so I could sleep at night. Have currently taken it x 10 days and experience RLS during the day. I am afraid it’s the Xanax and stopping it as of tonight-unless you tell me it’s not related. Even with Xanax I awaken every 2 hours because of the interstitial cystitis and by 4 am cannot get back to sleep so I just get up. Last thing I will ask- for pain post op knee replacement, does Tylenol with codeine aggravate RLS. With previous knee surgery 24 years ago oxycodone did not relieve pain at all- just made me nauseous and dizzy.

I come from long line of thyroid disease both sides of family-at least 7 maternal cousins have it, my Dad had it and all 3 of my brother’s girls ( now in their 50’s) have it. Of all the autoimmune issues the RLS has been the worst. Currently I am hyperthyroid and before knee surgery must be seen by endocrinologist per orthopedic surgeon! Also have to see urologist who has specific interest in interstitial cystitis. Have live almost my whole life with autoimmune disorders and reluctant to whine because it’s too easy to wear people out if one complains. Will be 82 in March and praying to have at least 20 more years to feel GOOD on regular basis. Would appreciate knowing more about other meds that aggravateRLS. So sorry to dump so much on you. Now trying to figure out how to send this epistle to you !

[SueJohnson in reply to LoverofParis2014]

Oh my, you certainly have a lot of problems. Tylenol with codeine is fine.

[LoverofParis2014 in reply to SueJohnson]

Most people don’t know I deal with any issues except my husband and sons. W hen I mentioned fibromyalgia after diagnosis, I could “feel” eyeballs rolling-lol! Learned very quickly to keep my mouth shut! This site is hopefully totally anonymous I pray. If I had read my spiel on any site a few years ago my eyes would have been rolling too! Hashimoto’s seems to be the “gift” that keeps on giving. But finally I have a young PA who is now my primary care guy and have shared it all with him. Getting too darn old to bottle it any longer.

[flo_IarFachYrHaf in reply to LoverofParis2014]

It is so helpful reading of how other people deal with things or related health issues. I have, compared to my mother, mild RLS and these days (I suppose I've had problems since a teenager) it seems, mostly, to be ok in bed. My mum (85) has terrible problems with RLS and uses magnesium spray and struggles a lot, her legs occasionally violently move and it makes a bad back worse. I am a bit auto-immune-y, endometriosis, psoriatic arthritis/tendonitis, then GP said fibromyalgia, finally best guess Lupus; had osteo-arthritis in my neck for 20 years or more. Brother has Hashimoto's, he's recently had just over half of thyroid removed - my Mum (a goitre, removed), her brother and my grandmother all had various thyroid issues!!

Wish you the best with finding the treatments/foods etc that work for you.

[SueJohnson in reply to flo_IarFachYrHaf]

What is your mother doing for her RLS and what are you doing and does it control your symptoms?

[flo_IarFachYrHaf in reply to SueJohnson]

Mother is using a magnesium spray - the company changed the formula so she now needs 3 applications during the evening. she has been taking a liquid iron supplement for 5 weeks - after I said to ask the GP about it (she's had restless leg some years). GP recommended she try iron supplement but didn't do blood test, pharmacy recommended the liquid, she's just had about 4 nights where she didn't have problems in bed - and less in the evening too. So we are hoping this might continue.

I sit on floor with legs straight out in front and hot water bottle at base of spine as soon as I feel the pre-restlessness, it usually works. Gets tricky if in a car! On Sunday because I was in my Zoom Quaker meeting I tried bending up my knees up alternately, but had to go sit on floor in the end. So I can usually get rid of mine like that - when travelling I sometimes take the herb valerian, which is a muscle relaxant and it sometimes helps - codeine can help too.

[SueJohnson in reply to flo_IarFachYrHaf]

That's good that your mother seems to be helped by the iron. But if it doesn't continue, when she sees her doctor she should ask for medicine for her RLS. Above all she shouldn't let her doctor prescribe a dopamine agonist like ropinirole (requip) or pramipexole (mirapex). They used to be the first line treatment for RLS, but no longer are because of the danger of augmentation. Instead she should ask him to prescribe gabapentin or pregabalin. Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). It will take 3 weeks to be fully effective. After that she should increase it by 100 mg (25 mg pregabalin)every couple of days until she finds the dose that works for her. She should take it 1 to 2 hours before bedtime. If she needs more than 600 mg, she should take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If she needs more than 1200 mg, she should take the extra 6 hours before bedtime. (She doesn't need to divide the doses on pregabalin) 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 (200 to 300 mg pregabalin) daily." Ifs she takes magnesium she shouldn't take it within 3 hours of taking gabapentin as it will interfere with the absorption of the gabapentin. Have her check out the Mayo Clinic Updated Algorithm on RLS which will tell her everything she wants to know including about its treatment and refer her doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it at Https://mayoclinicproceedings.org/a...

You could also benefit from this. Have you had your ferritin checked? Improving it to 100 or more helps 60% of those with RLS and in sometimes completely removes symptoms. When you see your doctor ask 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 you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your ferritin to be over 100 and you want your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice.

[LoverofParis2014 in reply to SueJohnson]

of all the issues I have to deal with, Restless legs Syndrome is the worst! Thanks for info regarding Tylenol with codeine. Trying to have my ducks in a row regarding pain meds after total knee replacement. Might be on morphine pump overnight after surgery. Any insight on morphine or Dilaudid for post op pain . By law will only have opiates for two weeks for post operative pain. I hear the first two weeks are brutal.

[SueJohnson in reply to LoverofParis2014]

Both should be good. For the surgery tell your doctors and anesthesiologists about your RLS and its symptoms and that you need your medicine and ask if there will be any drug interactions with what they will give you. Also talk with the patient representative ahead of time. It is a good idea to bring your own medicine, but don't tell them you have it since they will insist on giving you medicine prescribed by the hospital. That way if they don't follow through you can take the medicine you brought. Tell them not to give you any sedating antihistamines or sedating anti-nausea medications. Instead insist they use Zofran for anti-nausea. You can download the Medical Alert Card that you can show your doctors, that tells them about the condition and what will happen after surgery and what medicines to avoid at rlshelp.org/ although you will need to join the RLS foundation. An international membership is $40, but they have some good information on it and you get their monthly magazine. However the safe antidepressants listed on medical alert card are not antidepressants: Lamotrigine, Carbamazepine, Oxcarbazepine.

[LoverofParis2014 in reply to SueJohnson]

oh great suggestions and info. Never signed up for the Restless Legs Group because of cost. Doing it today

[LoverofParis2014 in reply to SueJohnson]

Will send list of meds and supplements tonight. I am worn out from getting all that info typed out. The knee injury is torn meniscus (cartilage) and/ or torn ACL plus a Baker’s cyst behind the knee that was probably injured. Takes talent folks! Have to laugh to keep my sanity.

[LoverofParis2014 in reply to SueJohnson]

Also much arthritis both knees, hips and L4-L5 spine aggravated by the fall.

[Eryl in reply to LoverofParis2014]

As arthritis is an inlammatory disease I wpuld suggest to you that you wpuld benefit from redicing the systemic inflammation caised by foods that you are eating. Search online for 'foods that causd inflammation'.

[LoverofParis2014 in reply to Eryl]

Thanks for that reminder. Need to do that-have been aware of night shade plants never focused on it because I love those foods. Ready to bite the bullet now.

[Eryl in reply to LoverofParis2014]

If you Google foods that cause inflammation you'll find that the worst culprits are carb rich foods like dbresd and sugary foods and refined seed oils.

[VENEER in reply to SueJohnson]

Hi Sue, I'm 67 years old and as far back as I can remember have alwayas had RLS symptoms and currently take Ropinirole 2mg twice a day, one at tea time 4 pm and one at 8pm but this does not alwways keep it at bay? The real reason of sending this reply is to mention that my Labido seems to have dropped right off since having taken Gabapentin which I stopped about 12 months ago as this might be a cause but I think Ropinorole also creates a similar situation if this is the case can you offer any alternative solution to avoid these less common side effect.

[SueJohnson in reply to VENEER]

Unfortunately both ropinirole and gabapentin can reduce labido although it is an uncommon side effect for both. But since you stopped gabapentin 12 months ago, it is unlikely that is a cause. There are 4 options if you come off ropinirole 1) try gabapentin again 2) Try pregabalin. Although they are basically the same drug except you don't need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. 3) Opioids 4) dipyridamole. It has helped some people on this forum and another forum I am on and has completely eliminated RLS in some. In the winter 2022 edition of Night Walkers, the publication of RLS.org there is an article by Sergi Ferre about dipyridamole discussing the effectiveness of it in a 2 week double blind placebo controlled study showing it completely ameliorated all symptoms. The study was by Dr. Garcia Borreguero movementdisorders.onlinelib... sciencedirect.com/science/a... movementdisorders.onlinelib...

For all of these you need to come off ropinirole first which is not easy. 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. Dopamine agonists like ropinirole are no longer the first line treatment for RLS. Gabapentin or pregabalin is. The beginning dose is usually 300 mg gabapentin (75 mg pregabalin). Start it 3 weeks before you are off ropinirole although it won't be fully effective until you are off it for several weeks. And the lingering effects of ropinirole may still affect your libido for aq number of weeks so you think it is the gabapentin or pregabalin. After that increase it by 100 mg (25 mg pregabalin) 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. (You don't need to split the doses with pregabalin) 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 (200 to 300 mg pregabalin) daily." 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 you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your ferritin to be over 100 and your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice. 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 or s/he would never have prescribed a dopamine agonist atHttps://mayoclinicproceedings.org/a... Also see me list above of things that make RLS worse and those that help RLS.

[ChrisColumbus]

I use Voltarol (2.32% Diclofenac diethylammonium) without problems. That's not to say that someone may not report otherwise... See Sue's replies for other important tips.

[LoverofParis2014 in reply to ChrisColumbus]

thanks Chris! Having lots of issues- need knee replacement asap, injury has set off so many auto immune problems. Getting suspicious of every medication I am on. How do I find Sue’s reply?

[ChrisColumbus]

Sue Replied 3 times to you several hours before mine and I can see them still, so I can't imagine why they aren't visible to you?

[musicforme1]

I use Volterol but I find it doesn’t aggravate RLS.

[Heavyd65]

I use dicoflenac gel daily on the top of my feet an on my right knee for severe arthritis. It is moderately effective for the pain and actually effective for my RLS because it relives the burning and aching sensation that is a trigger for my RLS.

[LoverofParis2014 in reply to Heavyd65]

Thank so much for info!!!

[Eryl]

I haven't used Voltaren but I have usrd Voltarol which I guess is very similar in containing the same active ingrediemt and fpund that it relieved my rls. This is because it has anti inflammatpry properties amd I believe that inflammation of the nerves is a major cause of rls.

[Annty]

Actually the opposite for me but we're all different when it comes to some meds. I find that any additional stimulus at night drives my legs crazy, even a slight touch can do it. If I'm in pain the relief of that additional trigger with voltarol gel or similar I find helpfull.

Hopefully some others will have helpfull advice.

[LoverofParis2014 in reply to Annty]

thanks so much. After the responses here, I am using the Voltaren gel consistently for the hip pain!

[Meagain22]

I think it's called Voltarol gel in the UK and I use the high strength one, over 2 percent, regularly for pain (dodgy knee and hip). So I put it directly onto my knee and surrounding area, not every day but perhaps 3 to 5 times a week. I have never noticed any link with my RLS at all. Thank god.