Methadone pramipexole Horizant side effects

[tagaxel]

As you know when you’re on a higher dose of pramipexole the side effects are “sleep disturbance” and “fatigue”. So I am always tired and exhausted. The main side effect of Horizant is “drowsiness”. Now I’ve been taking 2.5 mg of methadone for the last four days and its major side effects are drowsiness and restlessness so now I pretty much feel like a zombie. Any idea how long it takes for the side effects to go away?

[SueJohnson]

Get off the Horizant. That will eliminate one source of drowsiness.

It can take awhile for the side effects from methadone to go away if they do. It is very individual. If they don't you can ask for adderal or ritalin for daytime sleepiness. Take in the morning and it will wear off by the time you go to bed.

[tagaxel in reply to SueJohnson]

The Horizant is controlling my RLS. He will take me off Horizant after I get off pramipexole but I can’t get off pramipexole until I reach a high enough dose of methadone to block the DAWS. If all goes well I could be off pramipexole in a year and then I can get off Horizant. The high dose of pramipexole is causing sleep disturbance and fatigue so I want to get off that. I was just hoping that the side effects of methadone will subside.

[SueJohnson in reply to tagaxel]

The Horizant isn't controlling your RLS. It doesn't have much effect until you are off the pramipexole. Since you are drowsy I suggest you switch to pregabalin since that is only taken 1 to 2 hours before bed. And increase the methadone. 2.5 mg is half of the starting dose. Why are you waiting. The normal effective dose is 5 to 20 mg according to the Mayo Algorithm. It is ridiculous to wait for a year to get off pramipexole. If you increase the methadone enough you won't need to microdose reducing the pramipexole and can reduce it one-half of .125 mg every 2 weeks which should take you about 8 to 10 weeks.

[SueJohnson in reply to tagaxel]

You may need a new doctor who is more knowledgeable. If you tell me what city and state you live in I may be able to give you the name of one.

[tagaxel in reply to SueJohnson]

My neurologist studied under Winkleman. I took him on a few months ago because the other "sleep doctor" didn't know anything. The RLS was out of control when I was on pramipexole but when I was given Horizant by yet another doctor, the Horizant controlled the RLS. My current doctor wants me to get off pramipexole first and then Horizant. But right now the Horizant actually is controlling my RLS.

[SueJohnson in reply to tagaxel]

OK - understood. You are unusual in that the Horizant controls your RLS. But everybody is different. After you are off the pramipexole you may find that the Horizant is enough. But there is no reason to take so long to increase your methadone and start reducing your pramipexole.

By the way I goofed when I said reduce by .125. It should have been 1/2 of a .125 tablet. I will correct my reply.

[tagaxel in reply to SueJohnson]

Because I have a kindled central nervous system I cannot reduce the same way that most people do but I will be able to increase the rate of my micro taper once I'm sure that methadone prevents DAWS. Then, when I'm off pramipexole I can get off Horizant and that way methadone will treat the RLS and prevent the emergence of DAWS.

[Munroist]

I can understand the desire to avoid withdrawal symptoms but it does feel like you are taking too many drugs. If you are augmenting on the pramipexole then the other drugs will struggle to fight against that and while you are on all three your body has to contend with all the side effects together, but probably doesn’t get the benefits. I’d agree with Sue that now is the time to start reducing Pramipexole and you may find that your symptoms reduce and you don’t need increase the other drugs. If you are right that horizant is controlling your RLS then coming off pramipexole (carefully and slowly) will mean that it has less work to do and your body will have fewer drugs to contend with. If you do get some breakthrough symptoms from withdrawal then you could raise methadone to the starting dose. You have support from a doctor who is prepared to give you the medication you need but based on other people’s experiences I feel that a totally symptom free withdrawal may not be achievable. On the other hand every day longer on pramipexole prolongs the current situation. All the best.

[UsableThought]

tagaxel -

I too am taking all three of these drugs. I have winnowed down the pramipexole to roughly 0.09 mg (less than half of the 0.25 tabs), and hope at some point to get it to even less.

I don’t know how long you have been taking the Horizant, but my understanding from reading the literature on this drug is that for most people, the drowsiness lessens markedly after the first few weeks. If you have been taking it for longer than a month or two and you are sure that it is still causing significant drowsiness, then it might be that it’s never going to go away. You could talk to your specialist about that.

I don’t like the methadone or any opioid for the simple reason that all opioids reduce the amount of deep sleep we get. This is a side effect that never goes away and contributes to tiredness to some degree. But all of these drugs have side effects of one kind or another so that’s life. As far as excess tiredness from the methadone that isn’t related to the deep sleep issue, as Sue said, it will take time to go away. A dose of 2.5 mg is tiny - I take 8.75 mg daily, for example. So personally I would suggest that you just hang in there. When we are taking multiple drugs, and have some anxiety, etc., things can seem very fraught.

I do disagree with a few of the comments made so far, wherein you are being encouraged to drop the Horizant because it can’t possibly be effective while you are still on pramipexole. First of all, I don’t believe that statement can be entirely true, for the simple reason that I too benefit from the Horizant despite still being in the prolonged middle of tapering the pramipexole. Moreover, I don’t recall any of the studies & “best practices” white papers that I have read saying that Horizant absolutely shouldn’t be taken while someone is still on a pramipexole taper. And finally, those of us commenting here are not medical authorities! Even though we may know more about RLS than many general practitioners, and alas, more than some specialists who ought to know better.

I think that as a generality, it might be better stated that “in some cases, it seems like people do better with Horizant if they can first get off pramipexole“, etc. This seems a more useful way of stating what some people (not myself) have gleaned from their experience and their reading and discussion.

Really, it sounds like you trust your specialist pretty much. Plus you also trust your personal experience. I think those are two good things to have going for you, so I wouldn’t want to dissuade you. You’ll find out for yourself what seems to work for you.

- Randy