Pramipexole

[Dreamaforever]

I have been on Pramipexole 0.125 for almost 7 yrs. Lately one pill hasn’t been working. What else is there. I am 44 yr old female, stroke survivor. I’m on sertraline, pantoprazole, Eliquis, Roustatin and pramipexole. Any advice would help. RLS is the worse.

[SueJohnson]

You are suffering from augmentation. The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen. This means you need to get off it. Luckily you are on a small dose.

First off check if you are on the slow release pramipexole. The slow release ones usually have ER or XL after their name. If so you need to switch to the regular pramipexole because the slow releases ones can't be cut.

To come off pramipexole reduce by half of a .125 tablet 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 but they are not up-to-date on the current treatment recommendations. (Pregabalin is more expensive than gabapentin in the US.) Also don't let your doctor switch you to Neupro (rotigotine). S/he may tell you that it is less likely to lead to augmentation but that has been disproved.

The beginning dose is usually 300 mg gabapentin (75 mg pregabalin) [If you are over 65 and susceptible to falls the beginning dose is 100 mg (50 mg pregabalin.)] Start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks and your symptoms have settled. After you are off pramipexole for several weeks increase it by 100 mg (25 mg pregabalin) 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. (You don't need to split the doses with pregabalin)

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 or magnesium-rich foods, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and if you take calcium don't take it nor calcium-rich foods within 2 hours for the same reason (not sure about pregabalin). According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

Did you ever find out what your ferritin was?

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 up-to-date on it as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

[DesertOasis]

Hi Dream, how long have you been on Sertraline?

[Dreamaforever in reply to DesertOasis]

About 6 years

[DesertOasis in reply to Dreamaforever]

Any SSRI before that? Bottom line, it’s possible that your worsened RLS symptoms are being caused by one or more of your medications? Can you switch them out for RLS friendly ones and report back to us?

[Dreamaforever in reply to DesertOasis]

My intentions are to taper off sertraline and see if that stops the rls. Now that I have been reading all the information I realize that my rls didn’t start till I started sertraline. Thank you all!

[DesertOasis in reply to Dreamaforever]

On another positive note, SSRIs only worsen the symptoms of RLS, they do not make our lousy dopamine transport system (which is essentially what RLS is) any more lousy, the way the DAs do. The Sertraline MAY actually have done just the opposite - meaning up-regulated your dopamine receptors, albeit temporarily. No pain, no gain. Yes, you suffered, but now your RLS may go very silent.

[DesertOasis in reply to Dreamaforever]

Dream, may I ask you if you have antiphospholipid syndrome? Or did you have Covid shortly before your stroke? Lastly, as you draw down on the Sertraline, and then the DA, you may want to try 28 to 56mg of ferrous bisglycinate about two hours before bed on an empty stomach. You should notice a very nice improvement in symptoms in about one hour. If not, stop the iron until you get your doctor’s permission to undertake a regimen of it. And if it were me, I would only undertake a regimen if my ferritin is below 40. I think you will find this member’s story interesting. She had a stroke at a young age due to APS. AND she has to be on RLS symptom provoking drugs, but manages by doing the iron at night trick.

healthunlocked.com/rlsuk/po...

[SueJohnson]

Sertraline is a SSRI antidepressant and makes RLS worse for some. Wellbutrin and trazodone are safe antidepressants.

[Joolsg]

Most meds you are taking trigger/worsen RLS.First get off Pramipexole.

Then join rls.org and you get access to free magazines/webcasts/local US help groups. And an alert card listing all trigger meds and safe alternatives.

Once off Pramipexole, you can ask your doctor to review and safely replace all the trigger meds.

[Dreamaforever in reply to Joolsg]

Thank you