How to switch from pramipexole to pregabalin?

[Gibbel]

How to switch from pramipexole to pregabalin?I have been taking 0.7 mg of pramipexole 2 hours before bedtime for a long time without it helping particularly well. Now so plagued by augmentation that I actually can't sleep at night. Is plagued by both pain and restlessness in the legs and feet. During the day I don't feel anything. Neither the neurologist I have been to nor my usual doctor knows anything about tapering off or supplementing with opioids for refractory RLS. Would appreciate it if someone could help me with a taper schedule and suggest an opiod so I can maybe get some sleep at night. I am 82 years old, live in Denmark and here we are far behind in both knowledge of and treatment of refractory RLS.

[RLSHenrik]

I have changed to gabapentin with succes but i stil take pramipexol, I know it is not the right way but it is very helpfull, I take it like that:

for one week:

at 3 am: 300 mg of gabapentin

at 6 am: 300 mg of gabapentin and 2 X 0,18mg pramipexol

at 9 am ready for bed, sleep 7-8 hours without problems

If this is not enough to relief from RLS take, next week, 2x300mg gabapentin at 6 am,

else just contine with the 2x300mg gaba

Very important: consult your general practitioner, before you make changes to your medications.

best regards

[SueJohnson in reply to RLSHenrik]

I assume you meant PM - 😀. To get the maximum benefit from your gabapentin if you are only taking it for RLS at night, take 600 mg of gabapentin 1 to 2 hours before bedtime as the peak plasma level is 2 hours. If you need more take 300 mg 2 hours before this dose as separating it by 3 hours you will have diminished effects (you do need to separate it by 2 hours).

[Joolsg]

As you are 82, your doctors should monitor your withdrawal very carefully. Exhaustion causes falls during withdrawal.Your doctors should refer to the Mayo Clinic Algorithm and take full iron panel, morning, fasting blood tests and raise your serum iron above 60ųg/L and your serum ferritin above 200ųg/L by iron pills every other night or an iron infusion.

They should review and safely replace all trigger medicines( sedating anti histamines, anti depressants, statins, beta blockers and PPI gastric meds).

To switch from Pramipexole to pregabalin,reduce the Pramipexole by half a 0.088mg pill every 2 weeks. Start taking pregabalin around 5 weeks before the last dose of Pramipexole. Start at 50mg at night and add 25mg every 2 or 3 days up to 150mg. Stay at 150mg until you are off Pramipexole for 3 weeks.

If symptoms are not fully covered, you can slowly increase pregabalin by 25mg every few days up to 200mg. Monitor and adjust. The maximum dose for RLS is 450mg, but keep to the lowest effective dose to allow room for future increase.

Your doctors should also prescribe a low dose opioid like codeine, hydrocodone, oxycodone or tramadol to get you through withdrawal. The RLS will increase in severity at each dose reduction. You can slow down the reduction if it's unbearable and wait for symptoms to settle before reducing again.

It can be extremely difficult, with little to no sleep for the week after your last dose of Pramipexole.

For that reason, some doctors prescribe methadone or Buprenorphine during withdrawal and that can cover most of the withdrawal symptoms and can be continued thereafter.

Read the RLSUK website in full. It contains links to the Mayo algorithm and the medications used to treat refractory RLS, including doses and timings.

I wish you strength.

Many of us have been through it.

[SueJohnson]

To come off pramipexole reduce by .half of a .125 tablet 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. I recommend buprenorphine as it lasts 24 hours whereas most of the only last 4 to 6 hours and have to be taken that often or you will get mini withdrawals. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it. The beginning dose is usually 75 mg pregabalin. Normally one starts it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks. After that increase it by 25 mg pregabalin every couple of days until you find the dose that works for you. As I said before take it 1-2 hours before bedtime as the peak plasma level is 2 hours. Most of the side effects 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. I. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 200 to 300 mg pregabalin."

[Joolsg in reply to SueJohnson]

As Gibbel is 82, the recommended starting dose of pregabalin is 50mg. 75mg is for under 65 years old.

[SueJohnson in reply to Joolsg]

I'm aware of that, but I was started on that and had no problems. I was 81 at the time. Unless a person has many health problems with many medicines, my feeling is 75 mg is fine.

Also I haven't gotten any feedback from anyone over 65 saying this was too much.

OK for over 80 I will change to say it is recommended to start with 50 mg but my own feelings are that 75 mg is OK or something like that.

[Joolsg in reply to SueJohnson]

I suspect it's because many people have dizziness at first, and older people may therefore be more susceptible to falls.

[SueJohnson in reply to Joolsg]

This will be my new answer: If you are over 65 and susceptible to falls beginning dose is 100 mg (50 mg pregabalin).

[SueJohnson in reply to Joolsg]

Interestingly in looking back at his previous dose, he is already on 75 mg which was prescribed by his doctor.