Rotigotine taper

[Laineypl]

Can anyone please advise on best way to taper off rotigotine completely

[SueJohnson]

You can do the reduction in one of 2 ways. Using a 1 mg Neupro patch cut it into sixths. The easiest way is to draw lines on it. This will equal the .25 mg reduction that is advised since 1 mg of Neupro = 1.5 mg ropinirole. Or you can switch to ropinirole. Multiply the dose of Neupro you are taking by 1.5 to get the correct amount. Since you can get ropinirole in .25 tablets this is the easier way to reduce. Then reduce by this amount every 2 weeks. 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.

[Laineypl in reply to SueJohnson]

Thank you

[Joolsg]

rls-uk.org/useful-resources

Scroll down under Useful Resources and there is a withdrawal schedule for each dopamine agonist.

Also report that you are experiencing increased severity in symptoms via Yellow Card Scheme. Neurologists in the UK keep prescribing the Rotigitone patch in the mistaken belief it causes fewer cases of augmentation. Not true.

The more people who report it, the more likely doctors will soon stop prescribing it.

bnf.nice.org.uk/medicines-g....

[Laineypl in reply to Joolsg]

Thanks Joolsg, it's my husband who suffers rls. Has appt in couple weeks to see Chris Murphy neurologist, hoping he'll prescribe buprenorphine. He's already tried pramipexole, n pregabalin. His ferratin is 72, however he takes blood thinners so not sure if he should recommence iron meds. Seeing GP tomorrow for advice about this and considering asking for gabapentin to see if this helps (even tho the pregabalin didn't). He just needs some respite and sleep n is pinning his hopes on getting help from Chris Murphy.

[Joolsg in reply to Laineypl]

Sadly, Chris Murphy still prescribes dopamine agonists and Rotigitone. Like nearly every other UK neurologist, he mistakenly believes Rotigitone doesn't cause augmentation, or doesn't cause it as frequently as Pramipexole/Ropinirole.That is not correct. The top experts in the USA know Rotigitone actually masks augmentation symptoms and when they break through they are even worse than on Pramipexole.

RLS-UK is trying to get dopamine agonists relegated to end of life scenarios, like the new guidance from the American Academy of Sleep Medicine.

So, when your husband sees Dr Murphy be absolutely resolute in refusing ALL dopamine agonists and any increase in the dose of Rotigitone.

Show Dr Murphy the guidance from ths American Academy of Sleep and Dr Berkowski's Buprenorphine study.

Dr Murphy has prescribed Buprenorphine to others and it can then be used to get off Rotigitone. But it will work straight away and your husband might be tempted to stay on Rotigitone.

He still has to get off Rotigitone completely.

Withdrawals should be less severe and he should be able to reduce more quickly than normal.

Once off Rotigitone and on Buprenorphine, your husband's RLS will be vastly reduced & he'll be able to sleep.

aasm.org/aasm-invites-publi...

neurologyadvisor.com/report...

[Laineypl in reply to Joolsg]

Thank you