Methadone pramipexole sleep disturbance

[tagaxel]

Next week I’m going to go on methadone in order to get off pramipexole. One of the side effects of pramipexole (I’m taking a higher dose than 0.5 because the withdrawal symptoms required me to increase the dose to diminish the withdrawal symptoms) is “sleep disturbance”. I just read that methadone also causes sleep disturbance. Is anyone else having a sleep disturbance now that they’re on methadone? I haven't had a solid night sleep in three years.

[Birdland]

I have tried every opioid available. Methadone is the only one that didn’t cause insomnia for me, but everyone seems to have their own experience. Some don’t experience insomnia at all from opioids.

[SleeplessinNC]

I have been off Pramipexole for a few years after augmenting and then a long scary withdrawal. I tried many things for RLS PLMD and insomnia. I have had the best results from methadone, slowly titrated up to 15 mg over a few months. My sleep quality has also improved during that time. No disturbances and I am prone to sleep walking and hearing noises on many RLS and sleep meds. Any new meds for you? Unusual life stressors? Sometimes I miss something “else” and blame my RLS. We are all on a slightly different journey :/. Best of luck.

[TheDoDahMan]

I'm 79 and a white male in the US who has been taking 10mg/day of methadone for the last 5 years. I've slept soundly for over 8 hours every night of these 5 years. Previous to being prescribed the methadone, I was thinking about how I should word my suicide note. Enough said?

[Moretravel1]

I’ve used pramipexole before for many years and got off of it. Now I take pregabalin.

[RLSLearner]

Expect it to be a battle to get off, every time you reduce the dose. Go slow , follow the advice here. But as the comments above show it can all be worth it in the end. Keep coming back here to talk about it when it gets tough.

[pdpurdy54]

I am still on 1 little pill of pramipexole. I have fought so many battles with this RLS, I'm not gonna do it again. I am going for an iron infusion next week as my anemia has worsened. My RLS is off the charts! Always.. I was put on blood thinners a couple of months ago and ever since then its insane. Sleepless nights often! I donno. I take 600 mg of gabapentin. Help me!

[SueJohnson in reply to pdpurdy54]

Since you are suffering now I suggest you add half of a .125 tablet of pramipexole and wait until your symptoms settle. However don't be tempted to stay on it as you will augment quickly again.

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 .125 tablet 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. If that is still too much to reduce you can get an inexpensive jewelry scale on Amazon ($11 in the US) that measures down to .01 gram and shave off a bit of the tablet and measure it. Then reduce by that amount every 2 weeks.

As you are aware ropinirole and pramipexole are no longer the first-line treatment for RLS, gabapentin or pregabalin are. They used to be the first-line treatment which is why so many doctors prescribed but they are not up-to-date on the current treatment recommendations. Also don't let your doctor switch you to Neupro (rotigotine). S/he may tell you that it is less likely to lead to augmentation but that has been disproved.

The beginning dose is usually 300 mg gabapentin but you are already on 600 mg. Normally you would start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks and your symptoms have settled. After you are off pramipexole for several weeks increase it by 100 mg 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.

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 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 According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin."

Have you had your ferritin checked? If so what was it? That is the first thing a doctor should have done. You want your ferritin to be over 100 as improving it to that helps 60% of people with RLS and in some cases completely eliminates their RLS and you want your transferrin saturation to be between 20 and 45.

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...

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, artificial sweeteners, carbs, foods high in sodium, foods that cause inflammation, foods high in glutamate, ice cream, eating late at night, oestrogen (estrogen) including HRT, dehydration, electrolyte imbalance, melatonin, Monosodium Glutamate (MSG), collagen supplements, eating late at night, stress and vigorous exercise.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennell, low oxalate diet, a low-inflammatory diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak (epsom salts), vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, playing and listening to music, creative hobbies, meditation and yoga.

Many medicines and OTC supplements can make RLS worse. If you are taking any I may be able to provide a safe alternative.