medication rotation

[teakabeagle]

My RLS doctor, who I have found to be most knowledgeable about RLS put me on Buprenorphine,( .5 mg is my lowest effective dose). I was on Pramipexole without significant augmentation, but discontinued gradually after starting the Bup. After a year of Bup only, after the dopamine receptors have “reset” he prefers alternating one day of Bup with one day of .125 mg of Prami!? He uses this protocol extensively in his practice without augmentation from the Prami at the low dose. He feels the alternating medication prevents tolerance to both medications. I have not needed any increase in the Bup over the last 7 months.

am I am unable to find any information about this rotation or combination of medication. Anyone out there ever heard of this?

[SueJohnson]

Don't do it! If you haven't needed more buprenorphine in the last 7 months it is unlikely you will need more.

[SueJohnson]

Besides there is more of a danger of withdrawal symptoms from the buprenorphine if you do it.

[teakabeagle in reply to SueJohnson]

I’ve had several days when I could not take the Bup for various reasons and didn’t seem to be an issue other than the RLS kicking in. Interestingly, no worse than it ever was in intensity or duration. I’ve discussed my concerns and he’s ok if I don’t want to do that, which I don’t. I’ve just never heard of tha, nor can I find any research on it. He’s well researched and knows way more about RLS and the neuropathology than any other doctor I’ve been to for the RLS, so it’s an interesting approach.

He uses the protocol with about 25 patients currently and hasn’t had any issues with withdrawal on such a low dose of Bup. Maybe because of the long half life? Most of his patients take 1-2 mg of Bup a night. He has had patients develop tolerance, and it is very hard to increase doses of Bup in this area. The pharmacists have become militant about long term opiod use. I had a hard time with them first time I had a refill. Took two weeks before we could get them to refill. I haven’t had any trouble since. As I take such a low dose I only refill every 3 months.

[SueJohnson in reply to teakabeagle]

I'm glad you don't want to do it.

[Joolsg]

He is making a massive assumption that the dopamine receptors WILL reset.Other RLS experts do NOT think this happens. Many believe the dopamine receptors are permanently damagec by dopamine agonists.

It sounds like a foolhardy plan.

[teakabeagle in reply to Joolsg]

How does one know if the receptors are damaged or reset? I had a major depressive episode when I stopped the Prami which makes sense if the receptors are not working well and Dopamine can’t be utilized, but that cleared on its own after a month or two. Coincidence? Just part of the final withdrawal( took 2 months to withdraw)? Maybe they reset? I don’t know of a way to test that, but I’d do it if there were.

[SueJohnson in reply to teakabeagle]

If dopamine receptors are damaged then gabapentin and pregabalin won't work even in high doses and the uptake of iron is also damaged.

[Joolsg in reply to teakabeagle]

It's common for people to suffer depression after stopping dopamine agonists and some NEVER recover. Anhedonia is a known complication.It seems as though you've escaped damage so far, but going back on Pramipexole is a risk factor you don't need.

Buprenorphine is working for you, and Dr Winkelman's opioid register is showing RLS patients stay on the same low dose for decades. So, stay on Buprenorphine and don't switch/rotate with Pramipexole.

[Maymount]

Just wondering if tramadol is the same as buprenorphine? I'm weaning off prami and take one 50mg tramadol at 5oc. Currently down to 3 of .088mg prami. Was taking 5 of them. Wld the bupren help to reduce prami faster? I just want to be rid of prami. My GP is not well informed about RLS. Just kept telling me to take another tab when I complained that it wasn't working( which I foolishly did!) Anyway I'm so glad I joined this site. I'm well informed now!

[SueJohnson in reply to Maymount]

They are both opioids and one won't help more than the other - it all depends on the dose you take.