Oxycodone, Pramipexole and Codeine.

[JoeR]

I am now on oxycodone 20mg tablets, 20mg morning and 20mg at night. I was on 8 Codeine phosphate 30mg tablets a day and one Pramipexole 0.52mg modified release tablets at night. Now I am on the oxycodone I do not take the codeine phosphate tab or the Pramipexole tablet. I cannot take the pramipexol and the oxycodone at the same time. It seems like an overdose. I am having some very bad nights, could this be withdrawal from the Pramipexole.

With the oxycodone I started on 5mg and gradually building up to 20mg twice a day. Should I go to 25mg morning and night.

Any suggestions could help I feel like I am going mad.

Thanks Joe

[SueJohnson]

It definitely could be the withdrawal from pramipexole. Especially if you stopped cold turkey. You need to wean off it. I would suggest you go back to the last dose that controlled your symptoms. 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 however with the extended release pramipexole you can't cut the pills. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer. I don't really understand why you can't take the oxycodone and the pramipexole at the same time as many do to help out with the symptoms especially as they near the end. However you are taking a high dose of oxycodone as the usual effective total daily dose is 10 to 30 mg a day. Definitely don't increase it.

[JoeR in reply to SueJohnson]

Thanks for the reply it's very kind of you. I am now on my previous dose. I see my pharmasist tomorrow. I will ask for pramipexole that I can cut in half and take it from there. I do take the oxycodone and pramipexole together and it is OK like you said. It must have been me and my nerves. Why can I not increase my oxycodone to 25mg morning and 25mg at night will this not help prevent my RLS and the pain. Any advice would be very welcome. Thanks Joe.

[SueJohnson in reply to JoeR]

You can ask your doctor, but 40 mg a day is already a high dose. You could also post the question on this forum to get advice from other users as I am not an expert on opioids.

[LotteM]

From our common experiences, it is most likely withdrawal from the pramipexole. You can either go up to your previous dose and then reduce slowly. Eg by half a 0.088mg tablet each time with about two weeks between each reduction. The increased symptoms due to the reduction should mostly settle during these two weeks. Also, if you follow this schedule, you may need less oxycodon to cover most of your symptoms. The last stages of the reduction of pramipexole will be the hardest. But maybe less than what you experience now.

Others will chime in too. Good luck.

[JoeR in reply to LotteM]

Thanks for the reply. Why should I not increase my oxycodone to 25mg morning and 25mg at night. Any help would be appreciated, thanks. Joe.

[LotteM in reply to JoeR]

Hi Joe, you can of course. If that is enough to offset what seems like withdrawal effects from stopping the pramipexole. Try and see. If you still have unbearable RLS / withdrawal symptoms, you can do as I suggested. Or stick it out.

There are almost always several options, and what you choose depends on various things, your own physical reactions as well as what you can deal with.

Anyway,I hope it settles soon and you can get by with a lower dose of oxycodon. Maybe in the evening only? 🤞🏼🤞🏼

[SueJohnson]

Check out the Mayo Clinic Updated Algorithm on RLS which discusses augmentation and the latest guidelines on RLS treatment at mayoclinicproceedings.org/a...

Have you had your ferritin checked? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms and can help with your augmentation. If not when you see your doctor ask for a full iron panel. Stop taking any iron supplements including multivitamins that have iron in them 48 hours before the test, fast after midnight and have your test in the morning. 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% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice.

[EYESWIDEOPEN17]

How was your transition to oxycodone since it’s been three months since your post? In the morning I take one-two 20mg oxy, 60mg morphine ER, and 600mg of horizant ER. (Gabby) around 11-1 I will take 2 (20mg) tabs, so 40mg of oxy then, around 3-5p I will need to take two more 20mg tabs. At bedtime I take 1-2 oxy plus one morphine, and the other horizant. I take other things throughout the day as well such as muscle relaxers. RLS, extreme disc deterioration from my C5-S5. Two failed lumbar fusions.