Help with Lasix please

[wairoa36]

I have severe R LS. I take Methadone 10 mg Twice daily. It worked well but lately not at all. I had a heart attack, have a new pacemaker. I was put on Lasix 4mg 3 times weekly and remaining days 20 mg.

R L s has gone mad — starts at 10 am and goes on till 5 am. Please help.

Picol

[SueJohnson]

Lasix is a diuretic and unfortunately all diuretics make RLS worse. The only thing I can suggest is to switch to a different one that might affect RLS worse. or ask your doctor if you can take a smaller dose.

The only other thing you might do is add another drug that helps RLS. Gabapentin or pregabalin. I also mentioned dipyridamole to you before .

Beginning dose is usually 300 mg gabapentin (75 mg pregabalin) [Since you are over 65 if you susceptible to falls beginning dose is 100 mg (50 mg pregabalin).] It will take 3 weeks before it is fully effective. After that increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you.

Take it 1 to 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. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

If you take magnesium even in a multivitamin, don't take it within 3 hours of taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and don't take calcium nor calcium-rich foods within 2 hours for the same reason (not sure about pregabalin). 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 at Https://mayoclinicproceedings.org/a...

I'm so sorry you have this suffering.

[Joolsg]

bpac.org.nz/BPJ/2013/Novemb....

Apparently diuretics increase magnesium loss and this doctor uses spironolactone to minimise RLS.

So you could increase magnesium pills and ask for a review of your diuretic & possibly try spironolactone.