Exhaustion and nausea

[GaryHB]

I have a question I hope someone may have an answer for. After 20 years of being on Pramipexole I stopped it overnight. It was not a good idea. Anyway I persevered and tried a bunch of meds - Pregabalin first, then Trazadone with Codeine, then Gabapentin. Nothing worked. This went on for a year without any meaningful progress. I was then prescribed slow release Tramadol - it worked for rls but caused chronic exhaustion. The Doc changed it to regular Tramadol and that was better. It caused Insomnia however and so I was prescribed Trazadone 150mg for sleep. I was on Tramadol - taking it 3 x daily for 6 months and Trazadone but was concerned about Tolerance. It was then I joined this forum and someone mentioned Kratom. I stopped Tramadol and started on Kratom with Trazadone which I continued with for 6 months. It worked brilliantly at first but then slowly it seemed I was having to take more to get the same effect. So after 6 months I asked my Doc to go back on Tramadol - my Doc will not consider anything else. I slowly eased off the Kratom and took Tramadol. The Tramadol works brilliantly but causes Insomnia. I take 3 x 50mg over a few hours at night and since starting it I have had no rls at all. I have been taking it for a month now. The Trazadone has some effect on the Insomnia but not a lot so my sleep is erratic. I am up most nights for 3 to 4 hours. However I have a problem. Most days, by lunch time I have terrible nausea and exhaustion, agitation and heart palpitations. It gets worse as the afternoon progresses. The night time tramadol eases it only partially. Looking back over my health journal which I have kept, this exhaustion and nausea and generally feeling ill has accompanied every med I have tried except Gabapentin. So for the last 2 years I have struggled with this exhaustion, palpitations and feeling ill. Would anyone of the kind people who have helped me in the past have any suggestions on why this is happening and what I could do? Many thanks.

[GaryHB]

I forgot to add - I have also had a persistent struggle with feeling low since I stopped Pramipexole.

[SueJohnson]

Have you had your magnesium checked? It can cause heart palpitations as can the tramadol. I know Joolsg has mentioned taking 25 mg of pregabalin stopped hers. For nausea zolfram (ondansetron) is best but you may not be able to get it. Others are Kytril (Sustol, Granisetron, Sancuso), Anzemet (Dolasetron), Zofran. For insomnia there is Ambien (zolpidem), zopiclone & lunesta. Discuss these with your doctor.

[GaryHB in reply to SueJohnson]

Thanks Sue. I will raise these with my doctor.

[Joolsg]

Depression is very common after getting off DAs. Trazodone is the only available safe anti depressant here in the UK.The insomnia, nausea, exhaustion & palpitations are common side effects of opioids.

It is probably the tramadol/kratom causing it.

I used medical cannabis for a week and it stopped my nausea. For the opioid anxiety & heart palpitations I take a low dose of pregabalin (25mg) and it really helps.

You say your GP will only prescribe tramadol. Tramadol is the ONLY opioid that also causes worsening of RLS, so watch out for that. Oxycontin is specifically mentioned by NICE and your GP should therefore be able to prescribe it. You could consider seeing a knowledgeable neurologist or sleep doctor privately, and they might prescribe a different opioid.

So, I suggest you discuss all this with your GP and ask for a small dose of pregabalin or gabapentin, which will hopefully reduce anxiety & heart palpitations and allow more sleep.

[GaryHB in reply to Joolsg]

Thanks Jools. That is really helpful. I agree - I think it is opioids causing this. I will speak to my doctor and see what he says.

[Madlegs1]

If you are taking a whack of Tramadol at night and it lasts only about 6 hours, then I imagine you are suffering withdrawal for the next day.

Opioids should be taken evenly throughout the 24 hrs.

Insomnia is a normal result of opioids, and reduces after a few weeks.

I agree with the others on the rest of the advice.

[GaryHB in reply to Madlegs1]

Thank you for your reply. I had wondered if it was withdrawals?

[Amrob]

I second MadLegs in that it may be interdose withdrawal that you're experiencing.

If many of the medications you tried were done within months of stopping pramipexole, it may be that you were experiencing dopamine agonist withdrawal syndrome at the time. This may have meant that your body hadn't reached a point of stasis when trying the new meds. Also, changing medications frequent can affect one's physiology - possibly moreso than suggested in the literature.

It might be worth trying gabapentin - or even pregabalin - again.

[GaryHB]

Yes I had been thinking that myself. Thanks for the reply - it is really helpful.

[RLSLearner]

RLS is a real bastard...

[GaryHB in reply to RLSLearner]

100%

[Nikos64 in reply to RLSLearner]

Great comment! I couldn’t think of a better description for what we’re going thru.

[RLSLearner]

Yes Tramadol is the only non Dopamine Agonist that causes augmentation. That should be enough reason for your GP to look at another opiate or Gabapentin

[GaryHB in reply to RLSLearner]

Thank you. True.

[Dotmowatee]

I have been taking slow release oxycontin with no side effects at all. I am in the UK, my doctor listened to me and with an email from the neurologist , prescribed it.

[GaryHB]

That is good to hear - thanks.

[Goldy700]

A possibility to consider would be medical cannabis with THC as it is wonderful for insomnia and also nausea.

[GaryHB in reply to Goldy700]

I may try that thank you.

[Goldy700 in reply to GaryHB]

It is worth noting that cannnabis works on the serotonergic pathway which is different from the one taken by Opioids and Dopamine drugs - so a good one to take for withdrawals.

[GaryHB in reply to Goldy700]

Thank you I will remember that.

[GaryHB]

Thank you to everyone who took the time to reach out and reply. I went to my Doctor and he agreed these struggles are probably attached to the opioids. He suggested we go back to Pregabalin, now that I have been off Pramipexole for nearly 2 years, and see if it works. This was a great result and what I hoped for. I have started on a small dose, 75mg, and already I am experiencing a huge difference. I am sleeping well, I have no strange 'jerks' when I am falling asleep. In addition I feel more rested. I hope I come off the Trazadone slowly in time. Again - thank you!