Hi, I have a friend taking 3 x 00.08mg pramiplexol, it's no longer working and she wants to come off it, as we know the GPs are completely useless when it comes to reducing this , please can you advise ?
I've just started 4:1 medicinal marajuana from a company called RELEAF ...4 cbd 1 thc, this is working .
Thankyou for your advice .
Substitute she for all my you in the following:
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 .088 tablet (ask for a prescription of these if needed) 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.
Dopamine agonists like ropinirole and pramipexole and the Neupro patch (Rotigotine)are no longer the first line treatment for RLS. Gabapentin or pregabalin are. (Pregabalin is more expensive than gabapentin in the US.) The beginning dose is usually 300 mg gabapentin (75 mg pregabalin) [If you are over 65 and susceptible to falls 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. 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 1-2 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)."
Have you had your ferritin checked? If so what was it? This is the first thing that should be done for RLS. Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not ask your doctor for a full iron panel. Stop taking any iron supplements including in a multivitamin 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. Have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. If your ferritin is less than 100 or your transferrin saturation is less than 20% ask for an iron infusion to quickly bring it up as this will help your withdrawal. If you can't get an infusion, let us know and we can advise you further.
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...
Thankyou as always sue .
I agree with SueJohnson.The tsunami of people experiencing augmentation on these poisonous drugs just doesn't stop.
UK doctors will keep prescribing them until we make them realise the damage they've caused so please tell your friend to file a report via Yellow Card Scheme.
We also advise people to sue their doctors if they experience Impulse Control Disorder. Hundreds have now done this successfully. Money talks louder than patient suffering.
bnf.nice.org.uk/medicines-g...
Withdrawal is really tough and most people think that taking gabapentin or pregabalin will cover all the RLS symptoms while they switch. Sadly they won't and you have to expect a few weeks of really intense RLS and little sleep.
Don't give up. Once through those few weeks, the RLS settles.
If gabapentin and pregabalin don't help after about 2 to 3 months, a low dose opioid may be needed.
Come back then for further info.
And, of course, raising serum ferritin above 200ųg/L will help reduce augmentation symptoms and RLS long-term for the vast majority.
Reducing Amiltriptyline 
Reducing pramipexole 
Is the doctor right?
