I've been on Tramadol for almost a year now but am beginning to augment. I have been referred to a neurologist but don't expect an appointment until some time next year. In the meantime my GP is putting me on codeine.
Does anyone have any advice about changing from Tramadol to codeine? The GP said I could just stop the Tramadol and start the codeine at 30mg although he's happy for me to gradually increase the dose up to 80mg if I need to.
Tramadol is the only opioid that causes augmentation, so yes, it's best to switch.Tramadol 50mg is stronger than 30mg codeine, so although you can make a straight switch, you may find your RLS isn't covered.
You may have to try the same dose of codeine to avoid RLS.
That's so helpful, thank you!
Are you sure it's augmentation rather than tolerance? There will be no withdrawals switching from one opioid to another.
My symptoms have increased and are especially bad in my arms and hands which is what happened when I was on Ropinerole. I've heard, as Joolsg said that Tramadole is the only opioid that causes augmentation.
Ah that does sound like augmentation. Huge good luck.
Thank you!
Hello, so happy you found a neurologist that will prescribe an opioide.Have you tried Gabapentin yet? If not, talk to your Neuro about adding it to your RLS medicines. Gaba and Codeine are a good combination for RLS. Low dose Methadone 5mg. Is also very good.
All the best!
David
I've not seen the neurologist yet - that will probably happen next year! I've been on Gabapentin but not only did it not take all the symptoms away, I felt awful while I was on it. Interesting about combining though, something to talk to the neurologist about - when I get there!
If you consider combining you might want to consider pregabalin. Although it is basically the same drug as gabapentin except you don't need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other.
Ah - I went on to pregabalin after I found that gabapentin didn't work - very similar problems.
I know everyone is different but I've been on Tramadol for 15+ years and it works great for my RLS. I take 100 mg of Tramadol plus one pramipexole and it works great.
That's great news! It's lovely to hear when things work.
Quick update - came off tramadol, went on codeine last night - legs and arms went crazy. Got three hours sleep at 8 am when I gave up and took another codeine. Anyone know how long it takes for tramadol to go through the system?
On googling it appears to be about two days but hopefully someone else will reply to your question as well. Hope you get more sleep tonight.
Thank you! I did manage to get a very good sleep last night and feel better in myself than I have for ages. So glad I'm off the Tramadol.
Hi Restless, your situation is very interesting and what I would expect once stopping Tramadol after being on a low dose for a year. I don’t believe you were experiencing augmentation, but rather tolerance to the opiate part of the Tramadol and suffering due to the dopamine antagonist (called SNRI) part of the Tramadol . See my recent post.
In other words, the Tramadol did not down-regulate your receptors as the DAs do, but very possibly just the opposite. I’m realizing that Tramadol is not an acceptable “long term” solution to RLS. Just too painful. You use it for a short period to come off the DAs (or some other stronger opiate you want to come off of) and to up-regulate your receptors, all at the same time ✨. Then switch to codeine as you have successfully done.
There’s no way you could stop a DA then be sleeping well two days after stopping it by just taking codeine. So it may have felt like augmentation, but in reality what you felt was no different than say someone on Effexor (also an SNRI) who is pre-disposed to RLS. Alas, no pain, no gain. You suffered, but in the process you helped your dopamine receptors and that is why you “feel better than you have in ages.”.
Tramadol should be used more like an antibiotic, only it’s an anti-da 😐 Tramadol up-regulates what has been down-regulated by the DA (say over a 3 month period), provides more than decent relief from RLS, but then it’s time to move on before your brain develops tolerance to its pain relieving qualities and you’re left with the uncomfortable dopamine antagonist portion of it.
I see you have a healthy ferritin level. Please try iron anyways - one time 🙏. Try it exactly this way. Take around 50 mg of ferrous bisglycinate around two to three hours before bed, on an empty stomach. If you’re like me, you should feel the RLS diminish greatly in an hour or two. Then proceed with the codeine as needed. If the iron did nothing for you then drop it, or keep taking it in the hopes that raising your ferritin even higher will help in the long run. If it does help then you just scored a home run!
Meds 
Meds for treatment - Prozac!!!
Has anyone had rls change to something else?
No meds anyone?
Blood pressure meds and RL
