Only clonazepam is effective

[MrCrow]

I have tried pramipexole at 0.25mg and it didnt help. Also tried pregabalin at 75mg and wasn’t very effective. I know what average recommended dose of pregabalin is 150-300mg for RLS, but i would expect it to be at least partially effective.

Clonazepam at 0.5mg and 0.25mg knocks me out, restores sleep and keeps the symptoms to a minimal. i take it for about a week when symptoms flare up and then stop to avoid dependence. However they return some weeks later whenever there is a stressful event.

Come to think about it, my RLS started when i tapered off trazodone (which i was prescribed for sleep) and went away completely when i was put on clonzepam 0.25 + escitalopram 10mg for 3 months. It reappeared with a vengeance when I stopped the clonazepam cold turkey (lowest dose available).

What does this say about my RLS? And further treatment options?

[amrob123]

In my experience, pregabalin just isn't effective at a "partial dose". I currently take 250mg. If I take any less, even 25mg less, it's not at all effective. I find clonazepam helpful for sleep, however my main problem is PLMD, with only mild RLS. I find the daytime sedation from it considerable even at a very low dose (eg 0.25mg).

Benzodiazepines (incl. clonazepam) aren't recommended for long term use. They affect memory and cognition in the long term, but some may say, so do gabapentinoids.

It's really about finding the medication that is most effective with the least side effects (short and long term).

If you decide you're not prepared to take benzodiazepines long term, then why not try pregabalin again at a higher dose.

[amrob123 in reply to amrob123]

Also, taking clonazepam on and off isn't ideal. Psychotropic medications are best taken at a consistent and regular dose. If you're only experiencing RLS when stressed, maybe you could look to improve stress management as opposed to focusing on RLS.

[MrCrow in reply to amrob123]

I developed this weird issue where I’d feel breathless when about to fall asleep. I started snoring a lot more also while on it. I not a 100 percent sure if it’s from the pregaba alone or not but ever since stopping it it’s better.

[amrob123 in reply to MrCrow]

That's something to discuss with your doctor.

[SueJohnson]

I've never really felt you have RLS as .25 pramipexole which is not even a low dose but half of the maximum should have stopped your RLS. cold.

You said you have no urge to move and that your symptoms are worse when first get up then go to low level for rest of day.

Also escitalopram should make your RLS worse and as I've mentioned before the efficiency of clonazepam has not been established and it should not be used to treat RLS symptoms according to NightWalkers Fall 2021 which is the magazine of the Restless Legs foundation.

[MrCrow in reply to SueJohnson]

The symptoms are worse in the morning and evening. They get worse when I’m lying down relaxed. I am still not clear on what an “urge to move” is. Movement or massage makes better. Staying still makes it worse. Feels painful and like things are crawling inside my muscles.

It got that way a week back. I started taking clonazepam 0.5 since the last 3 days. Slept well and it has mostly gone away for now.

I also took 1 dose of pram 0.25 4 days ago before starting clonazepam just to see if it would control things. Didn’t even scratch it.

[snoemata in reply to MrCrow]

"I am still not clear on what an 'urge to move' is" : WED/RLS sufferers should know this, otherwise they are not suffering from WED/RLS, but from something else, like peripheral neuropathy, et cetera.

[SueJohnson]

Urge to move is when you feel an irresistible need to move your legs. You can't resist it. You just have to do it.

The symptoms should not feel worse in the mornings.

If the clonazepam works for you I would continue it. Yes you will become dependent on it, but we are all dependent on medicines that work. And if for some reason in the future you want to stop it, you can wean off it. I took it for many years and weaned off it.

As Amrob said you should take it regularly, not just every few days or when you feel you need it.