Weaning off Requip? Any suggestions?

[Littlegran]

I take 4 mg of Requip and 600 mg gabapentin at night for my RLS. I would like to wean off Requip. Can anyone suggest how I can do that safely?

[SueJohnson]

Welcome to the forum. You will find lots of help, support and understanding here.

To come off ropinirole (requip), reduce by .25 mg every 2 weeks or so. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it.

Gabapentin won't be fully effective until you are off ropinirole 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 as the peak plasma level is 2 hours. 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. If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin 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). According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

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 ask your doctor for a full iron panel. Stop taking any iron supplements 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. 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. If your ferritin is less than 100 or your transferrin saturation is less than 20 ask for an iron infusion to quickly bring it up as this will help your withdrawal. If you can't get an infusion, let us know and we can advise you further.

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...

[Littlegran in reply to SueJohnson]

Thank you for your response. Here is my situation. I have had RLS for many years. When I finally found a doctor who knew what it was, I was given 300 mg of Gabapentin. Much later, I went to a neurologist who increased the Gabapentin to 600 mg daily. Then later, he added Mirapex which was not helpful. Then, he added 4 mg of Requip to take at night with the Gabapentin. So, currently, I am taking 4 mg of Requip and 600 mg of Gabapentin at night. I also take 600 mg of Gabapentin in the morning. I would like to quit the Requip because I am tired of taking too much medicine. I am 78 years old, and I think I am taking too much medicine. I also take Halcion and Xanax at night to sleep. As you can see, lots of medicine. As for my Ferritin levels, they have never been above 66. My satuation levels are at 35%. I do not take any iron supplements except what is in a multivitamin.

I just would like to know how to get off the 4 mg Requip safely.

Thanks for any help.

[SueJohnson in reply to Littlegran]

You are wise to want to get off the requip especially as you are at the max dose as up to 70% of people will eventually suffer augmentation according to the Mayo Clinic Updated Algorithm on RLS which believe me you don't want because it can be hell to come off it and the longer you are on it, the harder it will be to come off it and the more likely your dopamine receptors will be damaged so that the now first line treatments for RLS gabapentin and pregabalin won't work.

There is no reason to take gabapentin in the morning unless you have symptoms then. And if you do then you are probably augmenting on the requip. You can switch and take the 600 mg from the morning to the night as I directed or you can move just 300 to the evening and reduce the other 300 mg by 150 mg every 2 weeks or so . Don't just cut out that 600 mg or you will have withdrawal symptoms.

Do you need both halcion and xanax to sleep? That sounds like overkill. I would wean off the halcion .

Since your ferritin is low, Take 325 mg of ferrous sulfate which contains 65 mg of elemental iron, the normal amount used to increase ones ferritin, or 50 mg to 75 mg (which is elemental iron) of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption. Ferrous sulfate is fine for most people, but if you have problems with constipation, iron bisglycinate is better. Take it every other day, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption. If you take magnesium, calcium or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after. Don't take your iron tablets before or after exercise since inflammation peaks after a workout, don't take tumeric as it can interfere with the absorption of iron or at least take it in the morning if you take your iron at night. If you take thyroid medicine don't take it within 4 hours. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months

[SueJohnson]

Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium(salt), foods that cause inflammation, foods high in glutamate, ice cream, eating late at night, estrogen including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, eating late at night, 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 (Epsom salts), vitamins B1, B3, B6, B12, D3, K2, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse.

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.

[Littlegran in reply to SueJohnson]

Thank you for your message. For OTC, I take Tums for the calcium, D3. Probiotic, Pepic AC, and a multiple vitamin.

[Joolsg]

I agree with Sue.0.25mg every 2 weeks.

Withdrawal symptoms are hellish for the vast majority and you should ensure you have help for the final 2 weeks after the last dose.