zolmitriptan?

[Ruffabug]

Does anyone know if Zolmitriptan, for migraines, makes RLS worse. My doctor has increased my dose per tablet from 2.5 mg to 5 mg. I never had any reaction with my legs on the lower dose but since taking the 5 mg twice last night I’ve had mad legs all day. The migraine was a humdinger and I’m told I can take a second one if it hasnt lifted after two hours. Having a bad migraine and RLS at the same time is pants.

[SueJohnson]

As far as I can find out it is safe for RLS. Have you changed anything else around the same time, supplements, food exercise,etc?

[Ruffabug in reply to SueJohnson]

Thank you for your quick reply Sue. Ok so I can rule that one out. No, no other changes so I think it might be the augmentation kicking in again. It has been starting earlier when I try to have a nap on the afternoon. I normally am walking about in the morning but couldn’t today so that didn’t help. Am hoping for a good night s sleep tonight. Who knows?

[ChrisColumbus]

Like Sue I can't find any references to zolmitriptan (Zomig) and RLS. Perhaps it is DA augmentation as you suggest... But note info from the BNF and NICE below.

I note that according to the British National Formulary it is not licensed for use in the elderly (over 65), but presumably your doctor has decided to make an exception in your case.

BNF also states that common side effects can include 'limb discomfort', but I can't find a useful definition of that term so don't know what form the 'discomfort' may take. You might ask your doctor.

NICE also warns that triptans should be used with caution in people taking bupropion, selective serotonin reuptake inhibitors (SSRIs), selective noradrenaline reuptake inhibitors (SNRIs), lithium, sibutramine, ondansetron, St John's wort, tapentadol (because of the small risk of serotonin syndrome). I don't know whether any of this is relevant, but note that you mention ondansetron in your Bio: if you are taking any of the above you should go back to your doctor.

WebMD also warns of possible rare serotonin syndrome, one of the symptoms of which is 'muscle twitching'...

[Ruthmary in reply to ChrisColumbus]

Hi Cc. Thanks for your reply. Yes my Neurologist has let me continue with Triptans I think as my heart is healthy. I am not on any of those anti depressants. Is the Ondansetron significant? I take this for nausea with the migraines but sometimes I use prochlorperzine as it dissolves in the mouth and works more quickly.. I took that one on Sun/ Mon night. The only other drugs I am on are Gabapentin. Oh and Ropinerole and Neupro.

[ChrisColumbus in reply to Ruthmary]

Ondansetron is one of the drugs that NICE list in their 'caution using with triptans' list. It is not flagged as a 'Severe' interaction, and hopefully your doctor is aware of the possible interaction and is monitoring your response.

[Ruffabug in reply to ChrisColumbus]

Thanks for that info. I will bear it in mind. I took a lot of Ondansetron when I was having chemo for most of last year but my migraines, weirdly, were not very bad. They came back badly this year but I have had Botox treatment and that has reduced the frequency a huge amount. I still get about one a month whereas before it was 2-3 a week! BTW I don’t know why my username came up as Ruthmary. I think I used that for a while when I first joined which was about ten years ago!

[ChrisColumbus in reply to Ruffabug]

Yes, I guessed you were probably one and the same person: you used Ruthmary 9 and 10 years ago! (I've got a couple of previous alteregos too!)

[SueJohnson in reply to ChrisColumbus]

Just curious. What were your alteregos?

[ChrisColumbus in reply to SueJohnson]

I dont recall now: they're both somewhere amongst the Hidden.

[SueJohnson in reply to Ruthmary]

Why are you taking both ropinirole and Neupro? 9 years ago you said you were taking 4 mg ropinirole, the maximum amount and wanted to come off it. Neupro is another dopamine agonist. 3 mg is the maximum. And if you are taking gabapentin for RLS it isn't going to help you while you are of ropinirole and Neupro.

I suspect if you are taking both ropinirole and Neupro you are suffering from augmentation. The equivalent amount of ropinirole to 1 mg of Neupro is 1.5 mg. So it wouldn't take much combining the 2 to be over the maximum amount.

You were 71 years old 9 years ago so must be 80 years old now. It is only going to get worse so you should really get off these horrible drugs now while you are relatively young.

First switch to all ropinirole adding 1.5 mg ropinirole for each 1 mg Neupro. (don't be fooled by them saying you are less likely to suffer from augmentation on Neupro - that isn't true)

To come off ropinirole reduce by .25 mg 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.

I don't know how much gabapentin you are already taking so I will give you advice as though you aren't taking any. The beginning dose is usually 300 mg gabapentin. It won't be fully effective until you are off ropinirole for several weeks. After you are off ropinirole for several weeks 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.

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 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 ."

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...

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, artificial sweeteners, carbs, foods high in sodium(salt), foods that cause inflammation, ice cream, eating late at night, oestrogen (estrogen) including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, C, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse.

Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[Ruffabug in reply to SueJohnson]

Dear Sue, thank you for your long reply. If you read my profile, as Ruffabug, you will see I have terminal cancer which is why my neurologist has let me go way above the advisory limit for the DAs. I had to make the decision to either wean myself off them or stay on and increase when I get the augmentation. It is a difficult one because my oncologist gave me approx six months to live in January this year so I should be gone by now but am still here and without any of the symptoms from the cancer apart from extreme fatigue. However my other health problems I. E migraines, IBS and RLS ( severe refractory) are worse than ever. I am on a 4 mg. Neupro and 1.5 mg Ropinerole. BTW I am coming up to 79. I have read the algorithm from the Mayo clinic and given it to my neurologist who has taken it on board. He says I can have Buprenorphine when the DAs stop working which he says they will. But I am very concerned that it won’t suit me. I am prone to constipation and the other side effect is weight loss which they tell me I will get from the cancer. So I will be like a skeleton. So I may now consider weaning off the DAs. I was on 1200 mg Gabapentin and you told me a week or so back that it wouldn’t be doing me any good so I am weaning off that first by 100 mg a fortnight. I think I need to do that first. Then when off the DAs ( if I get to do that) could go back on them. You see I have a lot going on. Maybe you were reading my posts from when I was Ruthmary and not recent ones as Ruffabug. Sorry to confuse. I worry day and night about my legs at the end of life together with cancer symptoms.

[Ruffabug in reply to Ruffabug]

I had my iron checked last week and the ferritin is 134.2 and transferrin 2.93g/L(2.5-3.8). So I assume those are ok.

[SueJohnson in reply to Ruffabug]

Yes although some experts believe it should be over 200.

[SueJohnson in reply to Ruffabug]

You are right. I was reading your post from Ruthmary. And it was confusing since you are on this post as both Ruffabug and Ruthmary and I missed your comment and Chris that you are the same person. You might want to delete the Ruthmary profile.

Don't wean off the DAs. Increase them as necessary. to get relief from your RLS so you won't need opioids except later for pain you might have from your cancer. You certainly don't need the withdrawal effects and suffering you would get from that. For that matter there is no harm in continuing to use the gabapentin.

[Ruffabug in reply to SueJohnson]

Can you tell me how I can delete that old username? I can’t find it!

[SueJohnson in reply to Ruffabug]

Try reaching out to [e-mail] as Kaarina suggests. I have found them very helpful.

[Kaarina Administrator]

I am not sure that you can delete your old username of Ruthmary. Why not just post using your latest username of Ruffabug to avoid confusion.

You could reach out to HealthUnlocked [e-mail] and hopefully they can help you.

I am aware that you can only update your username twice but that is not what has happened here.

Perhaps someone on the forum may know of a way! Sorry I cannot help you with this.

[Ruffabug in reply to Kaarina]

I do. But somehow people have have found my old username. Thanks.