Pramipexole

[Maymount]

I had reduced prami very slowly from 5 x.088 down to two at night. After hols I decided to go cold turkey and stop. I take 2 tramadol x 50mg at 7oc. Quit alcahol as twas a trigger. I stay up as long as I can and about an hr before bedtime take 1mg Noctamid n sleep right thru. I don't want to become dependent on Noctamid. I also have a prescription fot pregabalin50mg. Im wondering when n how can i introduce it. My ferritin is 126ng/mL

Trans Sat 28%

B12 is ok too

Appreciate your valuable advice

Eithne

[Joolsg]

Well done for getting off Pramipexole.You seem to be doing very well on 2 x 50mg tramadol.

My only concern is noctamid. It is aan extremely potent benzodiazepene. The problem with benzos is that they do not work long term and you develop tolerance.

So, you could use them once or twice a week at most and see what your RLS is like.

If the 2 x 50mg are controlling the RLS, then you can stay on them.

The benzo is allowing you to sleep as it is a strong sedative.

So try a few nights without the noctamid.

If you can't sleep because RLS is waking you, then start pregabalin.

You start with 50mg and then increase every few nights by 25mg. Average effective dose is 150-200mg.

Your serum ferritin is good, but you want to maintain levels. So taking ferrous bisglycinate every other night will help that.

I do hope you continue to sleep well.

[Maymount in reply to Joolsg]

Thanks Jools. Could I take 2 more tramadol during the night if I wake with rls. Ideally if I could stay on one medication only, it would be my preferenceEithne

[LotteM in reply to Maymount]

Yes, you can. But try to get by at an as low dose as possible. There have been a few experiences of augmentation in people longterm on high doses (400mg). Once you have been off the pramipexole a bit longer, your RLS may settle a bit more and less tramadol is needed.

[Joolsg in reply to Maymount]

I agree with Lotte. Try to keep the dose as low as possible to avoid the small risk of augmentation. Tramadol was reported to cause worsening RLS in one small study.And it takes weeks/months for Pramipexole withdrawals to settle fully.

[Maymount in reply to Maymount]

Thanks for reply. The most of tramadol I plan to take is 200mg in any 24 hrs. I'm praying this will work. If not plan B is pregabalin 50mg to start off with n experiment from there. Appreciate your v helpful responses not only to me but to everyone.Eithne

[SueJohnson]

On the pregabalin Beginning dose is usually 75 mg [Since you are over 65 if you are susceptible to falls beginning dose is 50 mg pregabalin.] It will take 3 weeks before it is fully effective. After that increase it by 25 mg 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.

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 200 to 300 mg pregabalin."

[Maymount in reply to SueJohnson]

Thanks Sue.