I've received plenty of great info from previous posts and need some help again. I've been on tramadol periodically for last 2 years, currently take 50mg once in evening. I understand that's a low dose for RLS but it has been sufficient to eliminate my night time symptoms. Until recently. I've started taking 100mg a couple of nights a week if I've had a few nights of mild RLS symptoms which has been the case in the last month. My doctor is pretty good but I know he's concerned about having to up my dose, and I'm nervous to ask for more. Sue has suggested buprenorphine but unfortunately that is only available to opoid addicts and also in New Zealand the drug here is modified for that use, so my pharmacist said it wouldn't work as it should as the chemistry is altered. Can anyone speak to that? Anyway, if augmentation does happen with tramadol for me, what is next best option? Is it codeine or one of the Oxycontin type drugs (which scare me). One last thing is I am having 2 side effects on tramadol which I am managing ok and that's an increase in anxiety, especially in the morning waking up and skin itching. Any suggestions with that? I do have paxam available to use if my anxiety is bad.
Tramadol augmentation, what next? - Restless Legs Syn...
Tramadol augmentation, what next?
For the itching you might want to try claritin, allegra or zyrtec. I would be reluctant to take paxam with the tramadol . I wouldn't be afraid of Oxycontin. Just be aware that you would need to take it every 4 to 6 hours to avoid mini withdrawals. Codeine is fine too. And then there is dipyridamole. It has helped some people on this forum and another forum I am on and has completely eliminated RLS in some. It is not appropriate if you have low blood pressure. You might want to discuss this with your doctor.In the winter 2022 edition of Night Walkers, the publication of RLS.org there is an article by Sergi Ferre about dipyridamole discussing the effectiveness of it in a 2 week double blind placebo controlled study showing it completely ameliorated all symptoms. The study was by Dr. Garcia Borreguero movementdisorders.onlinelib... sciencedirect.com/science/a...
As always thanks so much Sue for your comments. Such a shame I can't try buprenorphine but tramadol is working pretty well just concerned long term if my dose has to increase but as you've told me 100-200mg is a common dose so I have plenty of wiggle room. Regarding Paxam I've been taking that for almost 30 years as needed and I'm pretty comfortable with using it. No addiction issues whatsoever, although my doctor seemed almost more concerned about that than the tramadol. Maybe mixing them was his issue.
Yes it is taking them together.
The chance of augmentation on tramadol on such a low dose are small. But anything can happen. Are you saying you take the tramadol intermittently? Thus not every night? If so, chance of augmentation then is even lower. If you RLS is relatively mild and intermittent, try as much to do without medicines. I assume you have gotten your iron status as high as possible and still safe? And tried magnesium? Corrected any vitamin deficiencies if present etc? A massage gun or therapulse like devices may also be very helpful if your RLS is relatively mild. I hope it is.
My RLS was quite bad at night. My sleep was pretty horrific and I did all the recommended stuff. Had an iron infusion which made no difference. I now take tramadol every night, for the last 3 months. Previously it was intermittent. But I've found symptoms are returning which is why I've started taking 100mg a couple of nights a week. It definitely feels like augmentation is happening.
CBD has often helped me with getting off opiates.
Yes, it can be. Or a worsening of your symptoms. Trying to find another effective medicine seems wise. Codeine is a weaker painkiller than tramadol. Oxycontin combined with naloxone (Targinact) is licensed in the EU for RLS, don't know about NZ. The problem is that it often doesn't work the claimed length of time (12h). Also, given your experience, you really need to find what works for you, as we are all different in how we and our RLS respond to the medicines.
Don't be afraid of your doctor, be frank. S/he is there to help you. And I don't understand the pharmacists remark. Buprenorphine works indeed different from other opioids, it only partly binds to the main opioid receptor mu and is an antagonist for the kappa and delta opioid receptors. Maybe that is where your pharmacist alluded to? Or that for cessation of smoking often the variant combined with naloxone is prescribed. Be aware if you discuss this route that far lower doses are needed for RLS than for other uses. Sublingual pills work for many at a dose of 0.4mg. Some need higher doses up to about 2mg.
The other painkilling alternative is methadon. But you already know all this?
I hope you find something that works. It may take a while, but starts with a good chat with your doctor.
Thanks for that information Lotte. I think I'll see if I can go up to 100mg Tramadol and see if that works. I obviously tried all the other non opiod drugs first and none of them were good for me or my RLS. Like everyone in this forum first you need to find a drug that treats the symptoms and seems like the 2nd battle is having long term success with a drug. Regarding my pharmacists comments about buprenorphine. His explanation to me was that the version of the drug we get in New Zealand is not the same as elsewhere as its been modified for specific use in helping opiod addicts. I don't however know any technical stuff about that. He just said it probably wouldn't be much use to me.
Kia ora,
What you may be experiencing, on intermittent Tramadol , is mini withdrawals.
Opioids need to be taken consistently.
I'll repeat that for those of ye who are slow of reading.
Opioids MUST BE TAKEN CONSISTENTLY.
certainly no fear of Augmentation.
Itching is part of the bedding in process of taking opioids.
As Sue says. Don't be afraid of Oxycontin. I've been on it for over 7 years, and would kill anyone suggesting that I stop taking it. It has been the saving of my life.
Eurax (if available in Kiwi land) is helpful for the itching. It is a cream in a tube.
Good luck.
Hello MadlegsIn connection with tranadol withdrawal I would imagine its the definition of withdrawal? I have taken tramadol for some years now. I started with 50mg each night when coming off Ropinirole!! & continued taking tramadol . I found that to be more effective it was necessary to increase my nightly prescription to 100.mg about 3 years ago. If the term withdrawal can be applied to tramadol when it is necessary to increase the prescription to 150mg then I seem to be experiencing the effects of withdrawal? For the last 8 weeks it has been necessary to increase my dose to 150mg. My problem is that with this increase itching has been recently horrendous with areas on my arms & legs which ironically has kept me awake whilst the rls has been better controlled. Last night was the worst I have experienced. I creamed my arms and then covered them with wet cold 'facecloths'. The wet cold treatment was wonderful in reducing the itching. Interestingly I only suffered itching when the dose crept up to 150mg? I would be interested in asking my doctor for an approprate cream and your help here will be appreciated. AND if tramadol is having to be increased with the associated severe itching would it be useful if one can break the cycle by going onto another remedy such as Gabepentine or Probaglin for say 3 months?
Malcolm UK aged 77
I repeat my advice in the previous answer.
If you are taking Tramadol only at night, and it is a short acting version, then you will get withdrawal from the period of time not covered by the opioid.
It is not enough to just take an opioid for night time only. What happens when you wake up and your body craves it's fix?
As for itching -- it is part of the initial opioid experience. But if the dose is being increased constantly, then the itching will continue.
It is your bodies response to the "poison".
I don't know if antihistamines will help. Just make sure it is not a drowsy one.
I use Cetrizine for post nasal drip ,and don't experience RLS with it.
I hope you can get good help from your doctor.
All the best.
It has not been my experience that "opioids must be taken consistently." I've been on Codeine-Tylenol 3 for the past year, and only take it as needed, which ranges from every third night to every night. I have not experienced any withdrawal or any other adverse symptom.
I’ve augmented on Tramadol, but I was on it for 8+y and was taking 150mg.
Recently, I was switched to oxycodone 5mg immediate release. There was an adjustment period of about 3 weeks but once things settled down, that dose was enough and it works better than Tramadol. Tramadol affects several neurotransmitters unlike opioids which is why there’s a period you’ll be quite unsettled if you switch to it.
The other thing you should be aware of is that in the US at least oxycodone is tightly regulated and is Schedule 2. So every month you’ll need to contact your doctor for a prescription. Also some pharmacies may not have it since there’s an oxycodone shortage in the U.S. thanks to the DEA and the opioid epidemic.
Best of luck getting relief. But rest assured you will find it if you have the right doctor
I used to take codeine,then tramadol and now morphine. As with all opiods tolerance can occur as the body gets used to the drug and you have to up the dose. That's why I have changed meds 3 times. I have found that taking a month's drug holiday helps. The efficacy of the drug then kicks back in.
I’ve been on Tramadol and nothing else for about 12 yrs. My augmentation did t start till after about 6 yrs. I started with one 50mg tab. After the 6 years I noticed that my RLS was starting much earlier and after trial and experimenting I started to take one pill at 5:30 pm, and the other at 10:30. My RLS started at 7:30 pm but I learned early on to medicate ahead so I wouldn’t get full blown RLS all over , Tramadol takes about two hrs. for me to kick in. I have a great doctor who listens to me and decided to educate himself about RLS . NOW, after 12 years I have been feeling a bit of augmentation again, I told my doctor and he prescribed what would be needed for a dose of 3x daily, but what I do is take my two regular dose and if I feel uncomfortable I will take another 1/2 so it’s 125 mg only and that is working well for me. I fret the day I need more so I stay as conservative as possible, I don’t want to take anything stronger. I don’t know if I helped any for you but I just wanted to share since I’m a Tramadol patient. Good luck. What I have heard in the past is that on Tramadol the max daily is 400 mg. If I’m wrong with that info please correct me, I would like to know too.
Methadone may be a great choice for you. It works well for RLS.
I can’t help you with other options, but thought it might help you to know if my experience with Tramadol
I took Tramadol for about 3 years, initially for sciatica, and was on the maximum dose for at least a year. Tried coming off it after I’d had surgery and the withdrawal was hell, so went back on it for another couple of years before weaning off it slowly. Before taking Tramadol my RLS had settled down to only bothering me for a few days a month, and was only ever in my thighs. As I was weaning off I found my RLS had spread to my neck, left arm and shoulder and base of my spine. Plus I was experiencing severe RLS in my legs every night and suffering from insomnia. I realised that Tramadol had caused permanent augmentation of my RLS. It’s now nearly 5 years since I stopped taking Tramadol and I’m still struggling with RLS in my legs and base of spine pretty much every night. I haven’t had a really bad attack in my arm and neck for a while, thankfully, but that could change.
All I would say to anyone contemplating taking Tramadol for RLS or any reason is DON’T! It’s totally messed me up and I wish I’d never heard of it. I didn’t need any meds for it before, hardly suffered and now I struggle badly every night. Codeine seems to help, so I’ve started using that, but would never have been in this position if it hadn’t been for Tramadol.
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