Question re Requip Modutab vs Requip quick release

[Insomniak]

I am reducing down my Requip intake. I have reduced from 2 x 2mg Requip slow release to 1 x 2mg per day. To go lower I have asked my neurologist to prescribe the quick release Requip which come in 0.25mg format. He has but he has put me on 0.75mg of quick release Requip per day. This seems like a very big drop from my 2mg of Requip slow release. Am I wrong to be comparing the strengths this way? Does the transition look ok? does anybody know?

[SueJohnson]

You want to reduce by .25 mg every 2 weeks so take two .75 which is 1.5 mg and divide one of your ,75 mg one into thirds. If this is too difficult to do you can get an inexpensive jewelry scale on Amazon ($11 in the US) that measures down to .01 gram and use that to shave off and measure 1/3. And when it is time to renew your prescription insist on a prescription for .25 mg.

[Insomniak in reply to SueJohnson]

Thanks Sue - unfortunately the neurologist has not prescribed enough to allow me to do that. I may go back into battle with him 🙁

[SueJohnson in reply to Insomniak]

Then do go back into battle with him or put off reducing any further until you have enough time left before you would renew your prescription so you can reduce at the rate mentioned. And if he won't then do the same thing again. It will be slower that way but will prevent unnecessary suffering.

You could also ask your pharmacist to prescribe three .25 mg pills for each .75 pills so you don't have to try and cut them or measure them.

[Joolsg]

2mg slow release is same strength as 2mg slow release but your doctor has dropped your dose instantly by 1.25mg.You'll get severe withdrawals.

So ask him for 2mg in 8 x 0.25mg.

Look at the withdrawal schedule under Useful Resources on the RLS-UK website.

You'll likely need a low dose opioid to settle the withdrawals and you need to raise serum ferritin above 100ųg, preferably 200ųg by pills or iron infusion.

And start replacement meds around 4 weeks before you drop the last 0.25mg.

[Insomniak in reply to Joolsg]

Hi Jools, I accessed the withdrawal schedule info on the RLS-UK website and it is very useful. I am using it now to organise full panel iron blood tests with my GP including checks on serum ferritin. They are pretty open to the idea of me bringing in research like this and going with it unlike my neurologist who tends towards the defensive and reminds me that it his job to decide on my treatment. The description in the withdrawal schedule document of what it will feel like going through the final phases of Ropinirole titration is chilling. I got none of this detail from my neurologist - at least now I have an idea of how to prepare myself. Fortunately I only work part time these days but even so I have organised with the company I work for to ramp even that down for the next few months to reduce the stress on my system. I applaud your efforts to educate the medical profession about RLS and hope that you are able to make some impact as it s badly needed. Thanks again!

[Joolsg in reply to Insomniak]

Getting off Ropinirole nearly killed me.My old GP knew absolutely zero.

RLS-UK is now anti dopamine agonist.

The AASM guidance is very clear. All DAs are NOT Recommended and relegated to 'end of life' where short term benefits outweigh long term complications.

Don't switch to requip or another DA.

Hopefully, you will get offRopinirole and onto a better med. Keep us updated.

[Insomniak]

Thanks Joolsg and Sue, I have gone back to him or as close as I can get i.e. his secretary, I have also enrolled the dispensing pharmacist who is going to use her access to him to query the big drop in medication. If that doesn’t work I am going to twist my GP’s arm to get dispensed more Requip. So stressful, I am so glad that this group is here to bounce stuff off.

[Insomniak]

Here is my update. My neurologist agreed not to reduce my Ropinirole so rapidly and altered my prescription. So, I have been able to continue my reduction from 4mg/ day stepping down from 2mg to 1.75mg at the start of October and a few days ago to 1.5mg/ day. I am simultaneously taking 400mg of Pregablin per day and find that I also need 30 - 45mg of codeine to manage some sleep during the night. Sleep is generally about 4-5 hours per night over 2-3 sessions and I often log 4-5k steps each night as I am up and walking around to get rid of sensation in my legs. This is a bit dry and factual but just wanted to record the numbers in case any use to anyone.