I have been taking pregabilin 150 mg early evening which has been very effective up until recently, for my RLS. I have complex medical issues and have recently had an iron infusion. I have a 12 hour abdominal surgery due on 26 th September.
I would just like clarification that augmentation is what I am experiencing. I can feel the restlessness creeping back in …. Not only in my legs but my arms and neck too. I am finding it hard to relax and just read or watch tv without fidgeting . I have experienced this feeling before and eventually contacted my gp and was prescribed pregabilin . I walked the house for nights on end .
my ferritin is fine ….. my anaemia is due to my bowel being damaged …. Too complex to go into .
I guess I just want to know is this augmentation ?
I have contacted my gp but cannot get an appointment as yet. Also would this mean that my pregabilin dose would be increased or I would be tried in another drug ? I want to have a bit of an idea about everything when I get to speak to my gp.
with everything going on at the moment it’s quite unfortunate that this has happened . Please if anyone could help with their experience/ knowledge of this , I would be very grateful.
Written by
Esme2007
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Augmentation is a worsening of the disease itself, caused by the medication.Dopamine agonists( Ropinirole, Pramipexole & Neupro Patch) are the main culprits, although drug induced worsening has been reported on tramadol as well.
It is unlikely that pregabalin is worsening the RLS, but low brain iron could definitely be the reason for this worsening.
Iron infusions can help overcome poor gut absorption and your serum ferritin needs to be above 100, preferably 200.
I suspect your worsening RLS may settle, but, if not, 150mg pregabalin is an average dose and there is room to increase. The max dose for RLS is 450mg.
Make sure you're not on meds that worsen RLS ( sedating anti histamines, anti depressants, PPI gastric meds, statins, beta blockers) and when you have surgery, tell the anaesthetic team that the usual anti emetics will worsen your RLS. Ask for Zofran.
hi many thanks for your early response. It is very much appreciated. I started to take antihistamines about 6 weeks ago for hay fever and was wondering if this could be messing things around. I’m on paroxetine and take codeine when my pain is very bad with my tummy problems.
Thank you so very much for taking the time to reply .
Paroxetine is a SSRI antidepressant and they are known to make RLS worse. Trazodone and wellbutrin are safe for RLS.
What is the antihistamine you are taking? The only safe ones for RLS are allegra, claritin, clarinex and zyrtec. And other can make RLS worse.
You say your ferritin is fine. Many doctors will tell you this but what is fine for others is not fine for those of us with RLS. Do you know what it is? If not ask your doctor. Also, how recently was it tested?
Sedating anti histamines trigger RLS. As Sue advises, there are safe options. I use cetirizine and it doesn't worsen my RLS.As Sue advises, Paroxetine also triggers/worsens RLS.
If you take it for depression, trazodone is a safe alternative, so discuss a safe switch.
If you take it for anxiety, pregabalin should help that, particularly if you increase the dose. Alternatively, you could use a benzodiazepene, occasionally as they do lead to tolerance quite quickly.
I know this is a way off but for your 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 from what they will give you. Also talk with the patient representative ahead of time. Tell them not to give you any sedating antihistamines or sedating anti-nausea medications. Instead insist they use Zofran (ondansetron) 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. Also there is a 2 page handout "Surgery and RLS: Patient Guide" on the RLS Foundation website which is very helpful. Also "Hospitalization Checklist for the Patient with RLS"
I would definitely consider any changes you have made recently including to your lifestyle. 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 including HRT, 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, fennel, 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, CBD, 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.
By the way it would really help us to give you advice if you would indicate on your profile what country you live in and your gender.
I second what Jools and Sue have posted. The culprit is likely to be any changes you've made in recent weeks. It could be the anti histamine you've started or even the iron infusion. Iron infusions can affect the gut, causing inflammation and gastritis type symptoms. This could in turn affect your RLS. If this is the case, you'd expect it to settle in time.
I've found I have needed to increase my dose of pregabalin with time. I think my disorder (mostly PLM but some RLS) is simply getting worse with age as opposed to augmentation. Also, I have had knee surgery twice and in both cases I had quite a few days of much worse symptoms within 2-3 weeks of surgery. I'm not sure what made my symptoms worse but to plausible hypotheses are: 1) I was given a drug with the anesthesia that makes RLS/PLM worse, 2) I had an effect from stopping the opioids I was given for pain.
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