Alternating meds

[WelbyB]

I wonder if anyone else has experience with a RLS therapy method of alternating .375 mg Pramipexole and Methadone 20-30 mg every 10 days? I also use marijuana which helps maybe 40% for about an hour. My case is very severe with many previous pharmacologic failures including Alpha 2 Ligands, Buprenorphine and other painkillers, Dipyridamole, full time dopamine agonists, diet, and holistic management. My condition was controlled quite well with Pramipexole for over 20 years before alleged augmentation. It was miserable weaning off it for two years. The only other thing that helped was Methadone 20mg, but it was only about 70% effective. My specialist (Dr. B in California) recommending the alternation method has very good credentials. The theory is that it is safer against augmentation for the Pram and tolerance/addiction issues with the Methadone. So far after one month it is working OK. There are still some bad nights especially with the Methadone period. Any comments or suggestions are welcome.

[SueJohnson]

Dr B is a well recognized expert in RLS so anything he recommends is bound to be good as your experiencing. Talk to him about your bad nights during the methadone period.

[Memmy]

Glad you have found something to help. I have been alternating pramipexol with other meds for a long time and I think it helps against augmentation. I take 0.09 mirapexin for a week and then tramadol for 2 days. I sometimes use OTC paracetamol and codeine too. If I have a bad attack I take 1/4 teaspoon Kratom. Hope this helps

[Joolsg]

I would defer to anything Dr. Buchfuhrer suggests. He sees thousands of RLS patients every year so he is one of the most knowledgeable doctors out there.As you have exhausted all the alternatives to Pramipexole, Dr. Buchfuhrer's drug rotation seems like the best solution to cover your severe, refractory RLS.

I know of only one or two people who practise drug rotation with a DA and there are periods when the RLS flares up after the switch, but it seems to give them more good night's on average than staying on one drug.

I hope you are managing to get several good night's sleep every week.

[WelbyB]

Thank you to all three of my respected responders. It reinforces what I thought already. It is a reasonable treatment plan for a refractory case like mine. I didn't mention iron infusions as well in my previous list. It is far from perfect but is probably the best we have now. I just keep hoping that a better solution comes soon. Maybe this helps someone else in my situation who doesn't have as good of access to an outstanding RLS specialist like Dr. B.

[Jetto]

methadone is the only thing that stops my pain. Don’t need much.

10mg worked until I got sick with PMR and needed prednisone then I needed 20mg

since. When PMR goes away?? Got me.

MiraPex works great for a little while then it makes it worse for most of us.

It is called augmentation, look it up.

You might feel better if you stopped taken it. Get off Miapex very slowly.

Few don’t have this problem but I know some that did not go into Augmentation for 10 years.

Lyrica works for some people.

Gabapentin works for many.

Jetto

[Rayme]

Hi Welby, thank you for your post regarding the recommendation to you by Dr B to alternate Pramipexole and Methadone. It's helpful for those of us who can't access the expertise. I have severe RL and will be trialing various meds until it is at least somewhat resolved and I like the idea of alternative meds every 10days To maybe avoid problems in the future. All the best for wellness.