Restless Abdomen

[Joolsg]

medauth2.mdedge.com/topics/...

An interesting case of Restless Abdomen from Tokyo.

The 85 year old patient initially responded to oral iron when her serum ferritin increased to 100ųg/L.

However, rather than prescribe an IV iron infusion when her Restless abdomen symptoms returned- to raise serum ferritin levels further, or to prescribe gabapentinoids, the team prescribed 0.25mg of Pramipexole.

Of course her symptoms resolved, confirming the diagnosis.

However, I have huge concerns about an 85 year old woman being prescribed Pramipexole. Japanese women usually live longer than women in Europe and she will probably suffer augmentation within 5 years and struggle to get through withdrawal when she is in her 90s.

I know that opioids are strictly controlled in Japan and are allowed only for cancer patients. I suspect gabapentinoids are similarly restricted.

[Kakally]

unusual presentation but the diagnosis sounds pretty clear from what you say .

Daft , criminal and sounds rather stupid not to have given an iron infusion before any other drugs… and please NO to a DA….! 😔😔😔😔

[Joolsg in reply to Kakally]

Japan is SO strict about 'addictive' medications. They totally fail to realise that most experts now regard dopamine agonists as having 'addictive' characteristics. The need to increase- the total dependence on the medication- horrendous withdrawals.

[WideBody]

It's down right scary. I would hate to have to deal with augmentation at 85 years of age.

[SueJohnson]

I have notes on a doctor in Japan who was one of the authors of a 2016 article saying alpha2-delta ligands can be 1st line treatment, if DA keep low to avoid augmentation, or switch to Neupro or if severe opioid - and one of authors of a 2017 article saying DAs, levodopa, oxycodone/naloxone, alpha2-delta ligands all OK but augmentation more likely with DAs than with pregabalin.

So apparently opioids and are alpha2-delta ligands are allowed for RLS.

[Joolsg in reply to SueJohnson]

Interesting. However we had a poster around 18 months ago who wanted to visit Japan for 2 weeks and take his Buprenorphine. He applied for dispensation to take Buprenorphine INTO Japan. He was denied. Technically you should be able to get dispensation- but in reality the authorities won't let you take Buprenorphine into Japan unless it's prescribed for cancer.