PLMD and RLS Update

[vikkitennis]

25 + years ago, I began experiencing symptoms with leg jerkiness during sleep, causing me to rise and stretch and sit up until the movement stopped. The GP prescribed gabapentin, which led me down the road until 2016 with a move to Phoenix, and to visit a neurologist. After testing, and his patient for 5+ years, he prescribed different RLS medications, and would switch to another one when either augmentation world occur. I explained I didn't have the creepy tingling-anxious to move my feet during the night feeling, but he and two more neurologists ignored my call-outs that I felt I had PLMD. A caring PA from Mayo assigned me to see a sleep specialist at Mayo recently, and after listening to me, studying the two sleep studies, lab workout, and her experience, she determined I didn't have RLS, and had PLMD. Thank you! Finally I consulted with a specialist who really listened to me, and is treating me correctly. I am set for a nerve test (dreaded: I had one is 2016) very soon, yet she took me away from the methadone and prescribed Tizanidine to combat the nighttime movement. I am very early into this stage, but I finally am able to have what I know is the disorder I knew that has rocked me for many years. I will relay to the forum with future results on testing and another sleep study (the last sleep study in 2023 was so inconclusive, they mentioned they didn't detect anything abnormal?)

I have been with the forum for close to year, and I had reported my experiences with RLS. I do have a question for the Viewers please: the sleep specialist at Mayo placed me on 1 mg tablet, buprenorphine/nalox, under the tongue for absorption. I am not sure if she prescribed this to substitute for the 5 mg methadone I am taking, and to gradually wean off the opiate. I have a 14 day supply, and will have a phone appointment/consultation with her on 7/5. I will also direct the question through the patient portal however, I am asking the viewers their knowledge for the prescription. I began the new medications two days ago, and at this time, it is too early to speculate how the treatment is.

[Joolsg]

Tizanidine is a muscle relaxant. Correct me if I'm wrong, but your doctor seems to have switched you from 5mg methadone to Buprenorphine. As you are in the USA, the lowest dose buprenorphine pill is 2mg.

You may only need a quarter or a half pill. Here in the UK we can get 0.2, 0.4, 0.8, 1mg pills.

The dose equivalence to your 5mg methadone once a day is more like 0.5mg buprenorphine.

You should NOT take methadone AND 2mg buprenorphine.

So stop the methadone. The buprenorphine at 2mg should cover your RLS and your PLMD. You can even try cutting it in half and just using 1mg buprenorphine.

I don't think you will need the tizanidine as well as buprenorphine.

[vikkitennis in reply to Joolsg]

you are correct, and the methadone was stopped the day I began the B-oprhine.

the dosage ingredients lists it as 2 mg/0.5 mg; she asked me to half it.

When reading the Caution, it mentions about dental exams, and scheduling dentist visits. I take it that the pill absorbed under the tongue is able to create dental decay, and it is advised to wait 30 minutes and brush teeth. Within the forum, what are the viewers insights or experiences by using this opiate and increase in dental decay?

[Joolsg in reply to vikkitennis]

The FDA issued an alert about dental decay. In my view, the reason given is incorrect. They say oral Buprenorphine causes acid in the mouth. As it's only in your mouth for around 2 minutes, there's no way it would cause tooth loss. Many using the Buprenorphine patch also report teeth problems.I know that it causes me to have a very dry mouth, especially at night, and THAT is the more likely reason for tooth decay.

I use products to increase saliva. Biotene mouth wash and spray and I chew gum.

So, buy saliva stimulating products.

I have been on Buprenorphine for 3 years with no teeth issues.

[vikkitennis in reply to Joolsg]

Wonderful! Thank you for your encouragement and advice.

[vikkitennis in reply to Joolsg]

I am aware Tizanidine is a muscle relaxant. When explaining about PLMD, she feels it is a muscle/nerve activity occurring. I am scheduled for a nerve test on Monday.

[Joolsg in reply to vikkitennis]

PLMD is treated exactly the same way as RLS. The Buprenorphine should cover both. Therefore the tizanidine should not be necessary.I would use just the Buprenorphine for a few weeks to see if it covers you 24/7. If not, you can then consider adding the tizanidine.

[vikkitennis in reply to Joolsg]

Thank you, I will discuss this with my doctor.

[vikkitennis in reply to Joolsg]

I believe the tizanidine is for my muscles to relax during the night, as I wake up suddenly 1.5 hours from retiring to an hour before I do rise in the AM.

[vikkitennis in reply to Joolsg]

Joolsg, I have a question when both are combined: the last three mornings, I am very groggy; do you feel the combination with both is causing it? I am wondering if it is too much.

[Joolsg in reply to vikkitennis]

Dizziness & drowsiness are listed as side effects of tizanidine. Drowsinesz can also occur on opioids.If I were you, I'd drop the tizanidine and just use Buprenorphine for 3 weeks to monitor your RLS and PLMD.

I have MS as well as RLS and have always refused medications for spasms as the side effects can be quite scary. I use medical cannabis for my MS spasms and it works well. I don't need to use it every night, just occasionally when the spasms play up.

[SueJohnson]

I agree with Joolsg. Also the Buprenorphine blocks other opioids from working so as she said stop the methadone.

[vikkitennis in reply to SueJohnson]

I did stop the methadone when beginning the Buprenorphine. I thank you both for your advice.

[jack101]

just to double check — buprenorphine or bupropion?

I ask bec just read this today, in Medscape and cd make sense if the latter.

//New drug combo for amphetamine disorder

naltrexone with bupropion

The study was published online on June 10 in Addiction

Methamphetamine use has increased worldwide, from 33 million users in 2010 to 34 million in 2020, with overdose deaths rising fivefold in the United States over the past decade, the authors wrote.

A previous open-label study of NTX + BUPN showed efficacy for treating severe methamphetamine use disorder, and NTX and BUPN have each shown efficacy separately for this indication. //

[vikkitennis in reply to jack101]

Jack101, the medication is Buprenorphine.

To the viewers, is the Buprenorphine cause GI stoppage ? (constipation) I am under care with a GI doctor for the like.

[ChickenTwisty in reply to vikkitennis]

If your asking if Buprenorphine can cause constipation, yes, quiet common, same with most opiods. Regular fibre helps me and I'll have a couple of senna if I get to three days.

[707twitcher]

Constipation is my worst side effect of buprenorphine. Finally after 4 months or so, it became a bit more managable. But anytime I have to increase dose (for break-through symptoms occasionally) I notice more constipation. Prunes work best for me (the chemical in them is what works, not the fiber content). Side effects are the reason we all try everything we can to minimize our dosage.