difference between augmentation and rebound?

[daisydaisy26]

hello everyone, are these two different phenomena? My mom seems to suffer from rebound then. Still can’t figure out how to change her medications, because she is on pramipexole 0,375 plus neurontin 1200 mg at the same time, which is not common here it seems. If she tapers off pramipexole should she increase neurontine at the same time? Or taper off both and then start all over again with neurontine. She didn’t have any success with neurontine solo btw. And you can’t take an opioid with neurontine. A consult with a neurologist tomorrow, and my head is exploding.🙄

[Madlegs1]

Augmentation is when the medication needs to be increased to be as effective, but does not achieve that outcome, The symptoms just get worse, in the specific case of RLS and Pramipexol.Continuing the medication, even at higher doses, will only result in worse symptoms.

Rebound usually occurs with sleeping pills whereby taking them for a few days, and then stopping, causes even worse insomnia. Going back on the pills will solve the sleeping issue, but just lead to addiction.

They are quite similar, but very subtly different in terms of either increasing dosage or not.

I'm sure someone will correct this very layman's analysis.😝

[Madlegs1]

This is the RLS.org definition specifically for RLS. 😝

What is the difference between rebound and augmentation?Rebound, which may be confused with augmentation. Rebound is a flare-up of RLS symptoms as a medication • dose is wearing off. “End-of-dose rebound” typically • occurs in the early morning. This contrasts with • augmentation, where symptoms occur earlier in the • evening or afternoon.

rls.org › handoutsPDF

Augmentation: Diagnosis and Treatment

[SueJohnson]

The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen. Plus see Madleg1 answer from the rls.org on the difference between the 2.

No don't increase the Neurontin at the same time she weans off the pramipexole.

You say she didn't have any success with Neurontin alone. How much did she take? And if she didn't have any success with it, why is she taking it now and why is she considering increasing it?

[daisydaisy26 in reply to SueJohnson]

She used to take around 1200 mg, but it did nothing. So she begged for smth else and that’s when she was put on pramipexole initially on 0.125 mg. It worked wonderful for about 6 months then she started increasing the dose as advised by the doctor, and added about 900 mg neurontine. That was his recommendation - like if you took you daily dose of pramipexole and still have restless legs add neurontine. But still it doesn’t work every day, so she also has clonazepam for really bad days. Now she had some improvement after i/v iron - she is able to nap during daytime, but may get restless legs in the morning. Or two hours after her sleep in the night. Clonazepam works so so now, so to kick legs off she'd take another 0.125 mg pramipexole occasionally and it helps. Really don’t know how to get her off pramipexole and what are her options really. Been to maybe 6 neurologists.

[SueJohnson in reply to daisydaisy26]

If you can get her off pramipexole then after her withdrawal symptoms settle down after a few weeks then she can try increasing the Neurontin and it may work. The usual effective dose is 1200 to 1800 mg and the maximum dose is 3600 mg although she would be better switching to pregabalin above 1800 mg since it can be taken all at one time rather than in divided doses of 600 mg 2 hours apart. How about a low dose opioid like buprenorphine? Did she try the magnesium?

[daisydaisy26 in reply to SueJohnson]

I think to be able to take an opioid she will have to get off neurontin as it's dangerous to take both? The problem is my mom finds that pramipexole is like the only thing that helps and is not willing to get off it. Neurologist suggests trying levodopa instead of pramipexole, she explained that levodopa is like pure dopamine, while pramipexole is dopamine agonist so it binds with some receptors or smth like that. And RLS is caused by some disagreement in that whole system where dopamine is made and used (she mentioned hypothalamus). She also said that trazodone somehow interacts with dopamine, so it would be beneficial to take it. Mom already tried it but she was getting really dizzy from it. Probably will start on a much lower dose. So for now probably the plan is to reduce neurontine (since it doesn't work well with pramipexole it seems anyway), then add trazodone and see what happens, check iron after i/v iron, and may be if she is off neurontine, add opioid (or have it ready at least) to get off pramipexole, and maybe then start on Lyrica. She did take magnesium long time ago, probably it's worth trying again, I remember it should be taken apart from neurontin. Thank you, SueJohnson, for your quick replies, so very much appreciated❤️

[SueJohnson]

It's only dangerous to take both if she has any breathing problems. Many people on this forum are on both. Yes magnesium should be taken 3 hours apart from neurontin. Trazodone helps with depression and anxiety and may help RLS. I'm glad the plan doesn't include levodopa as that would be even harder to come off. To come off neurontin she should reduce by 100 to 200 mg every couple of weeks to avoid withdrawal symptoms. That way she will avoid them.