does anyone know if it’s safe to take 300-600 mg of Gabapentin while taking 600 mg of horizant and 2 mg of pramipexole?

[BluGenie]

details: I was taking 3-4 mg of pramipexole for my RLs. Developed augmentation. Sleep dr put me on 600 mg of horizant and supposed to taper the pram. I’m at 2 mg of pram. Today went to ortho for a back issue and waiting on mri appt. In the meantime ortho prescribed 300-600 mg of Gabapentin for the pain and maybe to reduce inflammation - not sure on that point. I am a type 2 diabetic so don’t want prednisone. Just wondering if safe to take horizant, Gabapentin and pram all in same day ?

[SueJohnson]

Yes

[LotteM]

You can combine gabapentin and pramipexole. Or horizant and pramipexole. Bit it seems a bit weird to add gabapentin to the horizant, as they are in the same class of medicines. I can only put forward the question as I don’t know enough about these two meds to say whether you can combine them. How is it different from -say- doubling your dose?

[BluGenie in reply to LotteM]

My understanding is that 600 mg of horizant is the most you should take of that. So don’t want to double it. Plus it’s a lot more expensive than just Gabapentin

[Joolsg]

Have you considered legal action? 4mg of Pramipexole is 8 times the FDA maximum.No doctor should prescribe that high a dose.

Please also report the augmentation as a side effect via the FDA so other doctors and patients become aware of the scale of the problem. It may prevent others starting on the downward spiral.

Reduce slowly, over at least 12 months on such a negligently high dose.

I'm not sure why a doctor would ADD gabapentin, rather than increase the horizant slightly. It's in the same class of anti epilepsy drugs as gabapentin, but with different absorption methods. But in the USA, it's more expensive.

Does the back doctor know you are already on Horizant?

Also, 600mg of horizant at this stage of withdrawal is a waste of money. The anti epilepsy drugs don't help your RLS until around 3 weeks after the last dose of Mirapex, so most people start them around a month before the last dose of Mirapex.

A more useful option during withdrawal is a low dose opioid to settle the increased RLS at each dose reduction.

Best of luck continuing the Mirapex refuction. It's tough but worth it.

[BluGenie in reply to Joolsg]

Thank you for the info Joolsg. I will need to digest all of this.

[bluechipx]

I've been on pramipexole for about 15 years, started at .125 mg and gradually increased to 1 mg. It's still working so I haven't tried other meds yet. I realize the knowledgeable people on this site say it is not the way to go so I'll most likely wean myself off pramipexole in the near future and follow the advice here. I was told 1 mg is a max dose for rls so I was surprised to hear the amount you have been prescribed. How long have you been taking pramipexole and what dose did you start off with?

[BluGenie in reply to bluechipx]

I was on mirapex first, then Ropinerole and finally Pramipexole. Prob on pram for about 6-7 years and started I believe at .5 mg. Honestly I can’t remember for sure. Hope that helps. Oh and weaning off is brutal-I’m sure you’ve heard that.

[SueJohnson in reply to bluechipx]

The maximum amount of pramipexole is .5 mg so you are already suffering augmentation since you are taking 1 mg which is twice the maximum dose.

I know I have told you this before but maybe you will finally listen and do something so I am giving it to you again.

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.

First off check if you are on the slow release pramipexole. The slow release ones usually have ER or XL after their name. If so you need to switch to the regular ropinirole (pramipexole) because the slow releases ones can't be cut.

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 or you may be able to reduce more quickly. 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. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it.

Ropinirole and pramipexole are no longer the first-line treatment for RLS, gabapentin or pregabalin are. They used to be the first-line treatment which is why so many doctors prescribed it but they are not uptodate on the current treatment recommendations. (Pregabalin is more expensive than gabapentin in the US.)

The beginning dose is usually 300 mg gabapentin (75 mg pregabalin) [If you are over 65 and susceptible to falls beginning dose is 100 mg (50 mg pregabalin.)] Start it 3 weeks before you are off ropinirole (pramipexole) although it won't be fully effective until you are off it for several weeks. After you are off ropinirole (pramipexole) for several weeks increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you.

Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. (You don't need to split the doses with pregabalin)

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. If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason (not sure about pregabalin). According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

Have you had your ferritin checked? If so what was it? That is the first thing a doctor should have done.You want your ferritin to be over 100 as improving it to that helps 60% of people with RLS and in some cases completely eliminates their RLS and you want your transferrin saturation to be between 20 and 45.

If not ask your doctor for a full iron panel. Stop taking any iron supplements including in a multivitamin 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. Have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. If your ferritin is less than 100 or your transferrin saturation is less than 20 ask for an iron infusion to quickly bring it up as this will help your withdrawal. If you can't get an infusion, let us know and we can advise you further.

Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

I also recommended Dr Berkowski to you. You would be wise to go see him.

[BluGenie in reply to SueJohnson]

Thank you Sue. I have had my ferritin level and saturation levels checked. They were low and I had a couple iron infusions. I am due for bloodwork very soon and will see if they have dropped. I will have to digest all the other info you gave. Been struggling to find the right doctor. I believe I may have one now that will be able to help me with this.

Again thank you for the info!

[bluechipx]

Mirapex is pramipexole. What are you planning to go to after weaning off pramipexole? Also, is pramipexole still working for you? Any negative effects?

[BluGenie in reply to bluechipx]

Pramipexole is not still working for me, which is why I was put on horizant and supposed to taper down the pram. I was also put on clonazepam at the same time as horizant to help with RLs and supposed to help me taper off the pram. Very long grueling process coming off pram.

[David7]

Hello, Please note Horizant is Gabapentin in a time released form. You can take them in the same day. 2-3mg of Pramipexole is quite a high dose!!

Try tapering off the pramioexole

Very S L O W L Y. You should take your gabapentin and Prami on the same day.

I usually take Gaba in the evening and 1 hr before bed with a small dose of Prami and

a small dose of Methadone. I'm still tapering off Prami, down to .125 mg.

Best wishes BluGenie,

David

[SueJohnson]

Sorry I missed that you are still taking 2 mg of pramipexole. If I am correct you were taking 2 mg of pramipexole 2 years ago. Since that is 4 times the maximum dose, you really need to come off it as you are still suffering from augmentation by definition .

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 or you may be able to reduce more quickly. 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. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it.

And once you are off it for several weeks the Horizant or gabapentin should help your RLS as well as your back pain. And you probably won't need the Horizant since your RLS should then be at night time only.

At that point, increase it by 100 mg every couple of days until you find the dose that works for you.

Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime.

If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason . According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin ."

Did you ever have your ferritin checked?