Why is pramipexole bad?

[bluechipx]

I've been on pramipexole for fifteen years and unless I miss a dose it seems to be working. It seems everyone here is trying to get off it for some reason. I'm sure the advice to get off it is valid but I seem to be doing alright on it except possibly moderate insomnia. I feel the amount of knowledge on this forum is miles above my well meaning doctors limited knowledge on rls. Of course I'd never tell him that!

[ChrisColumbus]

Pramipexole, like ropinirole and rotigotine, is a dopamine agonist. The Mayo Algorithm, written by a panel of experts for the RLS Foundation, says:

"Dopamine agonists are an effective treatment option for RLS and were formerly used for first-line treatment of RLS. However, because of increasing awareness of the high incidence of dopamine agonist–induced worsening of RLS symptoms known as augmentation and the risk for development of impulse control disorders, alpha2-delta ligands should, when not contraindicated, be tried first".

The majority of users - some experts say all - will eventually experience this augmentation (after weeks, months or years) where they have to keep taking more of the drug to less and less effect. Impulse control disorders - an inability to control impulses and behaviours - affects a significant minority.

Coming off the dopamine agonist to switch to another effective treatment is very slow and difficult, particularly after suffering augmentation.

I see from your profile that you have increased your dose from the original .125 to 1mg a day: the Mayo Algorithm states that "the acceptable maximum daily dose is 0.5 mg in most patients".

You are augmenting and need advice from people who have been through this like Joolsg and SueJohnson who I've tagged.

UPDATE: I see that Sue previously gave you advice on augmentation, how to come off pramipexole, and related info about RLS triggers and treatments including opioids...

[TheDoDahMan in reply to ChrisColumbus]

Another solidly helpful response to an inquiry here. Thank you for your continual participation on this site.