Pregabalin advice please

[GaryHB]

Hi all. I have 3 questions which I hope to get some guidance on.

I was taking 3 tramadol (150mg) and 150mg Trazadone which generally prevented all rls and helped me sleep. However I battled exhaustion every afternoon. My Doctor agreed to give me Pregabalin which I have now been on for 2 weeks. He prescribed 1 tablet twice a day but I gathered from this forum that its best to take it as a single dose at night. I started with 75mg at night - I took it for 3 days. Then I increased to 2 tablets - 150mg. So currently I am on 150mg Tramadol at night, 150mg Pregabalin and 150mg Trazadone. My Doctor suggested a low dose of Pregabalin combined with a low dose of Tramadol might work best. After beginning Pregabalin, I have felt so much better in my mood and very little afternoon exhaustion. I did try 3 Pregabalin a few nights ago and felt great the next day.

Question 1 - what dose of Pregabalin should I am to be on?

Question 2 - which of the other 2 should I be able to reduce or stop based on me now being on Pregabalin?

Question 3 - my memory seems to be shot on Pregabalin. I just cannot remember any names. Is this common? Will it improve?

Any advice would be appreciated.

[SueJohnson]

You are increasing the pregabalin too fast. It takes 3 weeks to be effective so the normal recommendation is to take the 75 mg for 3 weeks and then increase by 25 mg every couple of days until you find the dose that works for you. Waiting 3 weeks also gives your system time to get used to it so you are less like to have side effects that bother you like poor memory. Also side effects may disappear after a few weeks and can be dose dependent. You may not need 150 mg especially in combination with tramadol, although the usual effective dose taken alone is 200 to 300 mg. I would go back to the 75 mg and wait until 3 weeks has passed. If the memory problems continue after 3 weeks I would wait another couple of weeks or so to see if they go away.

I don't see any reason to reduce the trazodone.

[GaryHB in reply to SueJohnson]

Thank you for your valued reply Sue. I appreciate it. I will head your advice. I have a few more questions: On 150mg Tramadol I have no rls at all - so if I add Pregabalin to my meds, how will I know what dose is right since the Tramadol prevents me having rls? Should I scale down the tramadol while I increase the Pregabalin? I am just not sure what I am aiming at? My second question concerns insomnia - its bad - I think its Tramadol. Ay advice on what I do? My sleep patterns are bad. Thank you for your valued advice.

[SueJohnson in reply to GaryHB]

You are just going to have to experiment. I would suggest once you get to 150 mg of pregabalin try reducing the tramadol by 50 mg. Unfortunately they can't be cut. If you have symptoms increase the pregabalin by 25 mg every two days until the symptoms stop. Then you can repeat the process.

Ambien, zopiclone & lunesta all relieve the insomnia but as you come off tramadol and increase the pregabalin you will probably find you don't need it as pregabalin helps most people sleep.

[GaryHB in reply to SueJohnson]

Thank you - so appreciate the advice!

[RLSLearner]

Tramadol has been implicated in augmentation so minimal dose or weaning off is desirable. Generally I would advise listen to Sue!

[GaryHB in reply to RLSLearner]

What would constitute minimal dose do you think?

[RLSLearner]

The MAYO Clinic paper - The Appropriate Use of Opioids in the

Treatment of Refractory Restless Legs Syndrome said usual effective dose forTramadol in RLS is 100-200mg with a starting dose of 50mg.

[GaryHB in reply to RLSLearner]

Cheers.

[Toast5577]

I think that splitting the dose may not be a great strategy. I understand that for RLS taking it all in the evening works best. I take 400mg at bedtime. It took a while to get used to it but now it’s fine. I was getting terrible augmentation from tramadol so I had to (slowly) switch to methadone. Pregabalin and methadone have been a miracle combination for me. They take care of my severe RLS virtually 100% (occasional night with mild symptoms) with very little side effects (more groggy in the morning). I hope you can find a physician that works with you (and keepers up to date on best practices) to find a good cocktail for you.

[GaryHB in reply to Toast5577]

Thanks for your reply. Appreciated. My Docs are averse to most opiates. Tramadol is about the most they will do.

[wildlegs in reply to GaryHB]

I take one 50 mg tablet at 6 pm and another at 8 pm and 2 mg of pramipexole at the same time and it works 95% of the time, for me.

[GaryHB in reply to wildlegs]

Ok thanks - that is a help.

[Toast5577]

that is unfortunate. I had bad augmentation (I think you can find literature to support that side effect) from tramadol. It’s so strange that a medication can both help and cause a symptom! It used to be believed that Tramadol couldn’t be addictive. That had been proven to be false. There really is no scientific/medical reason to give tramadol over methadone. I hope your docs do some research and open up their eyes. Good luck to you!

[wildlegs]

I’ve never taken pregabalin but I do take Tramadol and have for 20+ years. I take 100 mg and 1 mg of pramipexole every day and it’s been great.

[GaryHB in reply to wildlegs]

Do you take 100mg Tramadol at once?

[GaryHB]

Wow that is encouraging! Thank you! I may try to reduce the Tramadol to 100mg myself.

[Birdland]

Hope you find the optimum meds and doses. I took tramadol for a while. Worked great for my RLS but gave me horrible insomnia.

[GaryHB in reply to Birdland]

Same here! Thanks.