My GP put me on Mirtazapine to help me sleep and also to help with insomnia and anxiety.
My legs were affected very badly by my RLS. It felt as if something was crawling through my muscles and I had to constantly move. I begged her to take me off them. She did not realise that it would affect my RL so much.
She changed me to Pregabalin but my ankles, calves and thighs swelled up so much I had to keep taking off my trousers as soon as I got home.
I am now on Zopiclone. I have to say that it is helping with sleep and a little with my RL. The only problem is you can only take it 2-3 times a week.
I do hope this will get my body clock working so that I don't stay awake all night reading.
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ChrisDB
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Chris,Your GP should have taken full panel fasting blood tests. If she hasn't, ask for them.
Raising serum ferritin above 100, preferably 200 can resolve the majority of RLS cases.
All anti depressants worsen RLS. So Mirtazapine would definitely trigger worsened RLS.
Pregabalin is first line treatment amongst experts, so it's good your doctor initially prescribed this rather than Ropinirole or Pramipexole which are dopamine agonists and the usual first choice in the UK. Do NOT take dopamine agonists. They eventually make RLS much worse and getting off them is hellish.
It's a shame you had such severe leg swelling on pregabalin. It is a common side effect, but clearly you reacted very severely.
Zoplicone doesn't treat RLS- it just knocks you out so you may not notice the RLS. It can't be taken long term.
Ask for another appointment to arrange blood tests and ask for codeine to take at night to cover the RLS symptoms.
Opioids like codeine and co codamol are highly effective at low dose for RLS and do not usually cause addiction unless there's a history of drug abuse.
Welcome to the forum. You will find lots of helpful advice here and plenty of support.
Let me expand on Joolsg reply. Have you had your ferritin checked? If so, what was it? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. 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, don't eat a heavy meat meal the night before, fast after midnight and have your test in the morning before 9 am if possible. 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.
You might want to try switching to gabapentin. Although they are basically the same drug except you need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. Multiply the pregabalin amount by 6 to get the correct dose. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. If you take magnesium, even in a multivitamin, don't take it within 3 hours of the gabapentin as it reduces the absorption of the gabapentin. If you take calcium don't take it within 2 hours for the same reason.
If you need an anti-depressant, and I suspect you don't since you were prescribed Mirtazapine for sleep, there are 2 anti-depressants that are safe for RLS - trazodone and Wellbutrin. Trazodone also treats anxiety and insomnia.
Buspar treats anxiety and may actually help RLS.
Meanwhile 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, eating late at night, 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, vibration devices, 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.
Insomnia, anxiety and RLS can commonly by caused by systemic inflammation which is commonly caused by ingesting sugar and refined starch (bread etc.) and consumption of refined seed oils which cause oxidative stress. youtu.be/JVl1X0fb1uA
I just finished reading Chris Palmer's book Brain Energy - basically it's diet causing a plethora of mental issues by hijacking mitochondria production. He's on a lot of podcasts. Well worth a read or listen.
Hello and welcome ChrisDB. I see you and I have a lot in common - essential thrombocythaemia and hydroxycarbamide. I do hope your treatment is going well as mine seems to be at present. We are not far apart in age - I am 81 and diagnosed two and a half years ago.
You will probably have been told not to take iron, even in the form of meat in your diet, so unfortunately what you are being told regarding raising your serum ferritin does not apply.
I see you are on omeprazole and this and other PPIs do affect RLS. I would require a PPI but have to make do with Gaviscon or Gaviscon Advance and this seems to be working OK.
I am now taking sublingual buprenorphine for my severe RLS and I am getting much better sleep although not nearly enough, but about 5 hours nightly which is fine.
For many years I was treated with 30 mg. codeine at bedtime and this kept me reasonably free of RLS. Although I know it can interfere with sleep it actually did not do this with me. If my GP some time back had let me increase the codeine I would probably not have had to go on to stronger opiates.
If I can help at all or try to answer any questions you might have please do not hesitate to contact or (either on here or by private message). Good Wishes
hi my doctor also put me on mirtazapine for similar reasons. I took it for 3 nights, awful stuff, worsened the RLS and I was a complete zombie, how can anyone function on it . I am sticking with tramadol it works for me .
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