RLS regimen for occasional big flare-ups?

[707twitcher]

I’m in the process of switching from Pramipexole to Pregabalin. To help ease the transition - Just got a Rx today for buprenorphine/naloxone (2/.5mg); I intend to cut the strips into fourths.

Assuming all goes well with the rest of the transition, I’m wondering what people do to manage flare-ups? I react strongly to salty meals. With Pramipexole I would just take .5 mg instead of .25mg that night and I would be fine. With recent augmentation that changed to needing.75 mg.

While I try to minimize salt, we do dine out weekly or so, and that almost always means a salty meal. I’m hoping that I can either take an extra 75 mg of Pregabalin (or more if my ultimate dose is more than 150) or some buprenorphine. Wondering what other people do?

[SueJohnson]

You could do that but I would only add 25 mg as that might be enough. You could also ask the restaurant not to add any salt.

[ChrisColumbus]

Eating out is a pleasure that no one wants to give up entirely, and while we try to avoid our triggers - whether sugar, caffeine, aspartame, msg, alcohol, salt or whatever - it's not always possible.

I did have one of my own very occasional flare ups this weekend after choosing to eat out in the evening, having two drinks rather than one, a large meal, and having a sugary pudding. I knew that I'd suffer for this and did.

Talking to the restaurant about your triggers and choosing wisely off the menu - and restricting the amount one eats - can of course help. Choosing to eat out earlier in the day rather than in the evening, and - particularly in the case of salt- drinking plenty of water, can also help.

Not taking any meds for RLS myself I can't advise on that aspect. Personally I'd avoid additional medication if at all possible, but that's just me.

[Amrob]

Pregabalin is best taken at a stable dose, as opposed to switching dose as you propose. Personally I find moving between doses (even 25mg) affects my mood.It seems far simpler to reduce salt when dining out.

[tuckerdog109]

Curious what your symptoms are. Mine are extreme tingling in my extremities. Cut back to one Pramipexole at night and worked really well till these past couple of weeks. Had to step up to two. Also noticed alcohol beyond one drink is detrimental.

[707twitcher in reply to tuckerdog109]

Sounds like you’re experiencing augmentation - having to increase dosage to get the same effect. It’s likely to only get worse. My symptoms are different than yours - mine is more of a deep twitchy feeling and spasms about 20 or 30 seconds apart. Usually in one leg at a time, upper or lower. But it can also extend to arms and shoulders occasionally. I think everyone has their own set of symptoms but I’m not sure if your tingling could be anything different?

Salt has been my main trigger. But I think alcohol affects a lot of RLS sufferers.

I would strongly advise getting off Pramipexole. I found cannabis to be helpful in doing so, but mainly buprenorphine. Articles referenced here were helpful in getting my doctor to agree to give it to me. Now that I’ve been off it for almost two weeks, I’ve found that I can skip the buprenorphine (at least occasionally) and just take an iron supplement on an empty stomach right before bed and that seems to work.