Question

[Happychappy1945]

Sorry for being so dumb , but could you please tell me what augmentation means in relation to meds ?

[Madlegs1]

It is when the medication you are taking appears to not be working as well as it used to.You will be tempted to increase the dose, which works for a short time.

However, the RLS just keeps getting worse and affecting more areas of the body.

The only "cure" is to get off the medication - very carefully ,slowly and by very small amounts.

It mainly is caused by the Dopamine Agonist family, but other meds can cause it also.

[Happychappy1945 in reply to Madlegs1]

Thank you .

[SueJohnson]

The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen.

[Happychappy1945 in reply to SueJohnson]

Thank you Sue, now I understand a lot better.

[robertff3401 in reply to SueJohnson]

Sue I want to add one comment about your statement that augmentation is defined by having to increase your dosage of RLS medication to achieve relief OR your symptoms occur earlier in the day. I had an appointment with Dr. William Ondo, Houston Methodist, Houston, TX, a recognized expert in RLS, about 6 months ago. I had been on Pramipexole for several years and had doubled my dosage during that time span from 0.25 mg to 1.0 mg. However, I had not experienced RLS symptoms earlier in the day. After a thorough hour long examination followed by another hour of discussion, Dr. Ondo questioned that I had experienced augmentation even though I had doubled my dosage of Pramipexole because I had not experienced RLS symptoms earlier in the day. So his definition of augmentation seems to be the same as yours with an "and" instead of "or" in between the two symptoms. At the time I saw him, my RLS had already improved considerably because I had gotten my ferritin level up to 160. He has asked me to continue with Pramipexole to see how low a dosage I can tolerate, starting with 0.25 mg twice a day, since my ferritin level was up to 160. I take two 0.25 mg tablets, one at 3 pm and the second at 6 pm. I take 1 or 2 iron biscyclate tablets and 1 vitamin C tablet along with the second 0.25 mg tablet of Pramipexole. This dosage is working very well for me. I'm to report back to him soon during a zoom appointment. I was very surprised that he had me continue on Pramipexole. That I'm almost 92 years old may have factored into his decision. I actually thought that moving from Pramipexole to an Opioid was a better way to go.

[Lolly53 in reply to robertff3401]

You are seeing the best of the best doctors for RLS in my opinion. Dr. Ondo is my doctor also and I credit him for changing the quality of my life for the better when he started prescribing Methadone six years ago. I am sure he has good medical reasons for wanting you to stay on Pramipexole. Just wanting to affirm you in your choice of doctors and also to let others know of him. He is very well respected and is an expert in RLS management. Blessings!

[robertff3401 in reply to Lolly53]

Thanks for your reply Lolly 53. I realize that he is one of the best. I was not doubting that at all. I did a lot of research on Dr. Ondo. I even read some of his publications before deciding to make the appointment and traveling from my home near Ft. Worth to meet with him. What he suggested has worked out very well. Getting my ferritin level from 60 up to 160 has had a lot to do with the improvement in my RLS symptoms.

[Joolsg]

For dopamine agonists, it actually means the drugs themselves increase the severity of RLS. They feed the disease and make it much worse.No other drug, apart from tramadol, does this. They may lose effectiveness, like opioid for pain, but they don't make the disease itself more severe.

So augmentation means increase in severity of RLS, NOT increase in the dose, although increasing the dose WILL make things far worse.

[Happychappy1945 in reply to Joolsg]

Thank you Joolsg, Thank goodness I do not take tramadol any more, For pain I take Tapentadol SR 50mgs, one at night and pregabalin 25mgs, 2 in the morn and 3 at night also because I have osteoarthritis I take 2 osteo relief 665 3 times a day. Day time pain is manageable but night time not so good. My RLS always worse from about 6/7 o'clock at night onwards , I only get about 1.1/2 to 2hrs sleep at a time. Catch up during the day !!!

[SueJohnson in reply to Happychappy1945]

Are you still taking sifrol?

[Happychappy1945 in reply to SueJohnson]

Yes,I take point 125 and a half mcgs every night

[Happychappy1945 in reply to Happychappy1945]

Sorry I have just checked I take point 250 and a half mcgs a night

[Happychappy1945 in reply to SueJohnson]

Sue, I think I should explain why I was confused about my sifrol . My Dr sends my scripts direct to the chemist and they make up a "webster pack" for me, which is a pack with all my meds in for each and every day morning/ lunch/ dinner and night, so I do not ever see the pkt or the script. I did not realize I was on a higher dose !!!

[Horses7]

No question is a dumb question....augmentation is when your symptoms get worse, could be more often during the day or more severe. That's why the dopamine agonists are not the first line of treatment anymore for rls, the initial studies they did weren't very long, they didn't find out till after the fact that if people were on higher doses and/or taking it for a long time (10 yrs for me) that most people will get augmentation. It's very hard to come off these drugs, people often need another rls med to help them get off the dopamine agonists while they are slowly tapering to get off.