Tramadol/coldeine?

[Bowie4eva]

Hello all,

I am UK based, 65, with RLS from hell, night and often day, which I’m sure is familiar to most!

I’m currently on 300mg Pregabalin, which I take at night, but which is becoming less and less effective. Like many, I’ve put on masses of weight since taking it, so am not willing to raise the dose.

A specialist at my hospital has now agreed to Tramadol or Codeine (not Bupremorphine).

Should I go for this? I have MS and get up a few times a night to use the toilet! Will I risk a fall?

All views and advice (could be one for Joolz?) gratefully received. Thank you and best wishes to all.

[Joolsg]

Definitely try it. Tramadol and codeine are less likely to cause falls at night than pregabalin.Reduce pregabalin very, very slowly to avoid any withdrawal symptoms.

It's a shame the neurologist refused Buprenorphine. Bart's MS team use methadone. So many MS neurologists now realise the benefits of the long half life opioids.

Tramadol and codeine have short half lives so might cause mini opioid withdrawals during the day, and the main symptom of opioid withdrawals is RLS. It's why many heroin addicts fail to get off the stuff.

So try taking 100 mg Tramadol or 60mg codeine at night and keep asking for Buprenorphine or methadone.

[Bowie4eva in reply to Joolsg]

Hi Jools

I have codeine phosphate tablets in front of me!! Owing to “protocols”, i have to try these first, and upgrade to Tramadol, then Buorenorphine if no success. Why they can’t just give me Buprenorphine immediately I don’t know - but at least it’s progress!

My Pregabalin capsules are 50mg (currently on 300mg pd).

My clinical pharmacist has advised cutting down by 50mg pw and starting the codeine (in 30mg tablets) gradually (not sure when).

I thought I’d get down to about 150mg Pregabalin pd before taking a codeine tablet.

What do you think? My GP and pharmacist are nice, but your thoughts would be invaluable!

Thank you so much for your help.

[Joolsg in reply to Bowie4eva]

Pregabalin can produce nasty withdrawal symptoms, so I would advise much slower reduction.I reduced from 150mg to zero 5 years ago and I took around 9 months to do it.

I reduced ridiculously slowly.

Apparently, patients on pregabalin withdrawal groups suggest reducing by 10% every 2 weeks. So you'd need to swap to 25mg pills and reduce by 25mg for first 2 weeks and so on.

Codeine helps many, but I suspect you would need to take 30mg regularly through the day to get relief.

I agree that insisting you try codeine & then tramadol seems cruel.

However, if they work, great.

[Bowie4eva in reply to Joolsg]

Thank you, Jools, that is really helpful.

Onwards and downwards! (if you see what I mean ……).

[SueJohnson]

I've given you this advice before but it has been awhile so let me repeat it. If you decide to come off pregabalin and at the very least with tramadol or codeine you should be able to reduce it. you need to do so very slowly to avoid withdrawal effects. Reduce by 25 mg every 2 weeks. If you do so you will have very few or no withdrawal effects.

[Calm2]

Hi, this could have no relation to your problem but I was put on Pregabalin for pains in my leg after an accident in which I tore the calf muscle. After doing some research into Pregabalin and mainly reading the side effects I decided not to take it. The doctor then prescribed Amitriptyline 2 x 10mg each night. I have to say they work very well, the pain in my leg was much more bearable and I wasn’t moving my legs all night to get comfortable. Although not prescribed for RLS maybe it’s worth a shot?

[SueJohnson in reply to Calm2]

Unfortunately for many it makes RLS worse.

[Calm2 in reply to SueJohnson]

I’m not completely sure what RLS is Restless Leg Syndrome, would that be like a severe case of “The Fidgets” as we call it?

[SueJohnson in reply to Calm2]

RLS is Restless Leg Syndrome. All of the following must be true for a diagnosis of RLS: 1) The urge to move the legs and sometimes the arms 2) The onset or worsening of symptoms during periods of inactivity when lying down and sometimes when sitting 3) Symptoms occur or worsen in the evening or bedtime. They are usually dormant in the morning 4) Symptoms get better when walking or stretching as long as it is continued. 5) Can't be explained by another medical or behavioral condition.

PLMD (Periodic limb movement disorder) which is moving your legs while sleeping - and sometimes during the day but not consciously is treated the same way as RLS.

[Bowie4eva in reply to Calm2]

Thank you, Calm2, very interesting!

[wildlegs]

hi there, I’m 80 year old male from USA and I’ve had RLS for30+ years. I’ve taken Tramadol for 20+ years and it works if taken ln proper order. I take 100 mg a day. I take one tablet (50 mg) three hours before bed time and another 90 minutes before and no more walking the floors. Good luck

[Bowie4eva in reply to wildlegs]

Thank you, Wildlegs (great name!), very helpful!

[Purpleyam in reply to wildlegs]

Thank you for posting your treatment here. I'm now on Tramadol 50 mg before bed, but still taking Gabapentin in 2 doses of 400mg then 600 mg before bed. I still get breakthrough RLS around midnight and have trouble falling asleep. My sleep specialist doctor won't go higher than 50 mg Tramadol. I see a few people saying 100 mg seems to do the job. Any comment on that to help me out?

[SueJohnson in reply to Purpleyam]

Unless there is something I don't know you are taking the gabapentin wrong for maximum effectiveness. Take 600 mg 1 to 2 hours before bed, then 600 mg 2 hours before that and then 200 mg before that. It's possible you are taking it that way because when you were withdrawing from pramipexole you probably had symptoms during the day, but you shouldn't have them now.

[Purpleyam in reply to SueJohnson]

Hi Sue, I wasn't clear on my Gabapentin doses. I take 400 mg at 7pm, then 600mg at 9pm. I take 50mg tramadol at bedtime. I find that I wake during the night with some RLS fidgeting/buzzing.

[SueJohnson in reply to Purpleyam]

Ahh - I read it wrong. You might want to try increasing your gabapentin then by 100 mg every 2 days. You are still below the average effective dose of 1200 to 1800 mg.