Pregabalin side effects and time frames. Help needed :)

[TheGiz]

My doctor was keen for me to try pregabalin and take me off Tramadol ,which works very well for my RLS but I only take every other day as I am wary about dependence. But it meant I slept well only the nights I took Tramadol. I've started on 75mg and would like some help/advice with the drug. I took it for 2 nights and side effects were primarily causing bloating uncomfortable stomach and mild nausea that didn't really dissipate. Also my RLS symptoms were the worst I've ever experienced. I'm not sure what to do. Is this normal? Should I increase the dosage as recommended or should I have got some benefit on the 75mg?

[bumblebee_tuna]

How much Tramadol are you taking? Patients with RLS very rarely become dependent, it is very different than taking an opioid for pain.

I'm not sure I would change here, 75mg Pregabalin is nothing, you need at least 200mg? I don't remember the starting point.

[TheGiz in reply to bumblebee_tuna]

Taking 50mg every other day which is usually enough to ward off symptoms pretty good. I've tried 100mg and that definitely works better but I only do that once a week as my doctor is nervous about that amount. If I took 100mg every day I'm sure I'd be symptom free but I'm just hesitant to take that much.

[Amrob]

If Tramadol is working for you, then it's working for you. If you don't have access to any other doctors to prescribe Tramadol then it is difficult.

75mg of pregabalin is next to nothing. The fact that you're not getting any relief on that doesn't mean it doesn't work. It may just mean your dose isn't high enough.

The average effective dose is just over 300mg.

The best thing to do is to increase your dose slightly to see what works best for you. Ideally you'd increase by 25mg per night, as it's always better to increase slowly where possible.

If side effects are problematic, sit on a lower dose until your body gets used to the medication.

One thing to note is that Tramadol is the only opioid to cause augmentation (worsening of symptoms). It doesn't happen in all cases and people can take Tramadol successfully for years.

[SueJohnson]

It takes 3 weeks for pregabalin to be fully effective so don't increase until then. After that increase it by 25 mg every couple of days until you find the dose that works for you. Take it 1 to 2 hours before bedtime. Most of the side effects of 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 200 to 300 mg 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 at Https://mayoclinicproceedings.org/a...

If you find the side effects are still ones you can't live with, post back here and I can give you some advice.

There is no reason to not take tramadol every day. There is also no reason to worry about dependence especially since your doctor wants to wean you off it. That can be done whether you are taking it every day or every other day.

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.

[TheGiz in reply to SueJohnson]

Thanks Sue for your insight. As you suggested in an earlier post of mine I asked my doctor about switching to buprenorphine but in New Zealand it's only prescribed for addiction purposes, mostly for those coming off opiods I think. I could potentially get access to it but I would need to be referred to a neurologist first which will take a few months. Do you think that'd be worth it to switch from tramadol?

Regarding the pregabalin I've taken a few days off to try and relieve side effects and I'll restart soon. So is it normal for it to have no effect on RLS symptoms for 3 weeks until you start upping dosage? Seems odd that my symptoms were even worse for those few nights also. It's just a bit frustrating as Tramadol definitely works but as you said it can cause augmentation and even worsen symptoms long term.

[SueJohnson in reply to TheGiz]

If the tramadol is working for you I would stay on it and take it every night. The usual effective dose according to the Mayo Clinic Updated Algorithm is 100 mg to 200 mg so I would push for 100 mg, Print out the section on opioids on the Mayo Clinic Algorithm and show it to your doctor at the link I gave you before. I wouldn't worry about dependence since you can always wean yourself off them and even if you eventually have augmentation it is not nearly so hard to wean off as the dopamine agonists.

On the other hand since it would take a few months to be referred to a neurologist if you did suffer from augmentation it would make sense to start now.

The pregabalin can have an effect on RLS before 3 weeks, it just is not fully effective until then so one shouldn't start increasing it before 3 weeks.

[67Waterman]

Seems a very lose dose of Pregabalin ... I started on 300mg and went up to 450mg. But it just did not work for me.

I am now back to 150mg Pregabalin together with 10mg Oxycodone (same as Tramadol) - and I have to say that this is the best combination for relief of RLS that I have had in 40 years.

[coldfeet7]

If you consult drug-drug interaction databases they show a MAJOR warning for interactions between pregabalin and tramadol or oxycodone.

drugs.com/interactions-chec...