My GP initially prescribed me pramipexole which I have been taking for the last two months (one 88 microgram tablet) around 10 pm. This successfully stop my restless legs but, through this forum, I learned of the danger of augmentation. Having drawn this to the attention of my GP he agreed to switch me to Gabapentin.
I have just started this - one 300mg tablet two days ago,, two yesterday and I should take three today. So far side effect is I am getting a better sleep. So far I have taken them around 10pm as well as the pramipexole.
My questions - when should I discontinue the pramipexole and when should I take the gabapentin. All together in the evening or spread through the day?
Thanks in advance for advice given 😄
Written by
countryboy111
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It takes 3 weeks for the gabapentin to become fully effective. The usual advice is to start with 300 mg and wait 3 weeks. Meanwhile you should stop taking the pramipexole. If this produces symptoms that don't settle within 2 weeks then take a half tablet and wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer. The gabapentin won't be fully effective until you are off it for several weeks. After that increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime. 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. Most of the side effects of gabapentin or pregabalin will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason (not sure about pregabalin). Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...
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.
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, 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.
Ferritin level was over 300. I have also changed my blood pressure medication as it was a calcium channel blocker, reduced my antidepressant with the intention of tapering off of it. Only medication my doctor said there was no replacement for was my levothyroxine.
I did a similar journey- I halfed the tablet every other night for a month then just half for another month before stopping, I also started on pregablin about 4 weeks before I came off Prami. For me it was a bumpy journey, RLS got a little worse as I came off prami, and ended up taking some codeine to help. My RLS is more manageable without prami and I was really glad to see the back of it! Best of luck with your journey
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