Need Advice

[Busunsc713]

I need some advice. To make a long story short, a friend went through augmentation on dopamine agonists, tapered off and Gabapentin was prescribed 600mg at 4 hrs and 2 hours before bedtime (total dose 1200mg). Additionally, hydrocodone was prescribed to relieve severe RLS and PLMD. Hydrocodone 10 mg ER was first prescribed but it didn’t work (not sure if the dose was high enough). Immediate release hydrocodone was then prescribed 10mg at bed time and one tablet 4hrs later if necessary. It worked beautifully for awhile. The hydrocodone produced somnolence which allowed my friend to sleep through some minor periodic limb movements. Now he stays awake, the periodic limb movements are more pronounced and he feels pain in his arms and legs. I’m accompanying him on his physician visits because of the lack of sleep, etc ….. he’s not thinking clearly. I’m wondering if he needs to get off the hydrocodone, switch to methadone or Buprenorphine (longer acting) and add something to help him get some sleep? Is Lunesta appropriate for RLS patients? His primary care physician is very helpful…. Uses the Mayo guidelines. Currently, more pronounced periodic leg movements, pain and lack of sleep are his issues. Are there any thought s about the Gabapentin regimen?

[Joolsg]

Gabapentinoids often do not work after years on dopaminergic meds. That happened to me.Hydrocodone has a short half life and doesn't work as well as the longer half life opioids - methadone and Buprenorphine.

As your friend has a knowledgeable doctor, hopefully Buprenorphine will be prescribed.

Start low. In the USA the pills start at 2mg. In Europe and the UK, they start at 0.2mg.

I have zero RLS on 0.4mg. The average dose on this forum seems to be around 0.6mg.

You can get buccal film in the USA which is easier to cut into small strips.

You can switch overnight from Hydrocodone to Buprenorphine.

Gabapentin can then be reduced very slowly.

[Busunsc713 in reply to Joolsg]

Thank you.

[SueJohnson]

Lunesta is fine. I take it.

You say he is not thinking clearly. Did that start after he started gabapentin or after he increased it to 1200 mg. If so it could be a side effect of gabapentin. To avoid withdrawal effects he should reduce by 100 mg every 2 weeks.

[Busunsc713 in reply to SueJohnson]

Regarding not thinking clearly,…. It’s a result of gabapentin side effects, depression from the recent passing of his mother, effects of little sleep and having to work each day, effect of CPAP machine trials and sleep apnea. He just needs someone who helps keeps him focused. All of this is new…. Starting with the augmentation he experienced.

[AquaBluetoo]

For what it’s worth, here is my experience with many of these medications. I suffer from severe RLS. I was methadone for a few months after having tried gabapentin and Lyrica after having survived a 3 month long withdrawal from Pramipexole which I had been on for almost 30 years. I also tried hydrocodone after the methadone. None of these worked that well and left me with a lot of side effects, eg dizziness, sluggish fog brain, etc.

But once I transitioned to buprenorphine, my condition became livable. A dose of 50 mg of Lyrica at 4pm and 1mg of buprenorhine at 8pm works very well with relatively no side effects. Though it took awhile to fully acclimate and get through the dizzy light headed feeling. Buprenorphine was a life saver.

[Busunsc713 in reply to AquaBluetoo]

Thanks. Encouraging. Which form of burprenorphine did you use? Did you use plain buprenorphine or the buprenorphine/naloxone combination?

[AquaBluetoo in reply to Busunsc713]

I use the buprenorphine/naloxone combination. Hope this is helpful.

[Busunsc713]

Thanks