Help please

[Rangers52]

Hi I had to come off pregabalin 3 weeks ago because of the horrendous weight gain I have to say it was working well apart from the weight gain, I've had terrible nights ever since and I've tried cbd oil and a massage mat in bed, needless to say none have worked, im waiting to get blood results from the doctors to check my ferritin and in the mean time I'm swallowing zopiclone every night just to get a sleep, any advice would be grately appreciated thanks

[SueJohnson]

3 possibilities. Since pregabalin worked you might want try gabapentin. Although they are basically the same drug except you 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. Pregabalin is more likely to cause weight gain. I only gained 2 pounds on gabapentin. Multiply the pregabalin amount by 6 to get the correct dose. 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, don't take it within 3 hours of the gabapentin as it reduces the absorption of the gabapentin. If you take calcium don't take it within 2 hours for the same reason.

If you find you also gain weight on gabapentin, come off it slowly to avoid withdrawal effects as you probably did with the pregabalin although since you won't be on it as long it will be quicker.

Another one to try is dipyridamole. You might want to discuss this with your doctor. It has helped some people on this forum and another forum I am on and has completely eliminated RLS in some. In the winter 2022 edition of Night Walkers, the publication of RLS.org there is an article by Sergi Ferre about dipyridamole discussing the effectiveness of it in a 2 week double blind placebo controlled study showing it completely ameliorated all symptoms. The study was by Dr. Garcia Borreguero movementdisorders.onlinelib... sciencedirect.com/science/a...

Take it on an empty stomach. (fats inhibit absorption) about 1-1/2 to 2 hours before bed. If you have headaches they tend to disappear or lessen after around 5 days.

The third possibilities is a low dose opioid although many doctors won't prescribe them.

I would recommend buprenorphine or methadone as they are long lasting. Most of the others last only 4 to 6 hours and need to be taken that often or you will have mini withdrawals. If you are prescribed one of the others be sure you are given enough to take them that often.

[Rangers52 in reply to SueJohnson]

Thank you I will speak to the doctor and see what she says x

[Rangers52 in reply to SueJohnson]

Hi sue I got my blood results the ferritin is 106 and my transferin is 2.39

[DesertOasis in reply to Rangers52]

Ranger, are you still on the SSRI? Did you ever try taking the ferrous bisglycinate before bed?

[Rangers52 in reply to DesertOasis]

Yes and yes I take 20 mg at night. Are my ferritin and transferin level normal?

[DesertOasis in reply to Rangers52]

I’m not familiar with what a healthy transferrin level is. Ferritin seems excellent. Ferritin has very little if anything to do with RLS. Try raising your nightly iron to closer to 50mg on an empty stomach about two hours before bed. The 20mg would likely be fine if you weren’t on the SSRI, but since you are, I think you’ll need more. You might also need a codeine chaser.

[Rangers52 in reply to DesertOasis]

Thank you I will try that

[SueJohnson in reply to Rangers52]

Your ferritin is just barely OK. Some experts think you need to raise it to over 200. Unless the iron at night as suggested by DesertOasis stops your RLS I would suggest you try to raise your ferritin more.

Take 50 mg to 75 mg of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption.

Take it every other day, as research has shown more is absorbed that way, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption.

If you take magnesium, calcium or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after.

Don't take your iron tablets before or after exercise since inflammation peaks after a workout. Don't take tumeric as it can interfere with the absorption of iron. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months.

Your transferrin is fine. Do you know what your transferrin saturation (TSAT) is?

[Rangers52 in reply to SueJohnson]

Thank you, how long will it take to notice if raising the iron has worked?

[SueJohnson in reply to Rangers52]

For DessertOasis's method which works for some but not most, it should stop the RLS that night, so you will know if it works after one night. For the normal method as I described it will take up to the 3 months.

[DesertOasis in reply to SueJohnson]

Well I think it works for most. Many more than infusions, would you not agree? Isn’t it downright miraculous just how often it does work?

[DesertOasis in reply to Rangers52]

The raised amount of ferrous bisglycinate should provide relief that very first night. If not come back on here and we’ll talk about codeine or switching out your SSRI.

[Rangers52 in reply to DesertOasis]

Ok thank you

[Rangers52 in reply to DesertOasis]

Definitely an improvement last night, not completely eliminated but it's a start

[DesertOasis in reply to Rangers52]

Try 60mg of iron and not going off but lowering the SSRI.

[Rangers52 in reply to DesertOasis]

I've halved the paroxetine today so now taking 10mg will see how I go

[Rangers52 in reply to SueJohnson]

No but I can ask what it was

[SueJohnson in reply to Rangers52]

You do need to wean off the Paroxetine as it is likely making your RLS worse which you don't need. What are you taking it for?

[Rangers52 in reply to SueJohnson]

Depression

[SueJohnson in reply to Rangers52]

I gave you a recommendation for either Wellbutrin or trazodone which won't make your RLS worse. Was there a reason you don't want to switch?

[Rangers52 in reply to SueJohnson]

My doctor wouldn't switch it

[SueJohnson in reply to Rangers52]

Show him this article. Bupropion mentioned in the article is another name for Wellbutrin. jabfm.org/content/24/4/422. Paroxetine is specifically mentioned as well as SSRIs which is what it is.

[Rangers52 in reply to SueJohnson]

Ok I will thank you