augmentation

[GrainFarmer]

I was taken off of Mirapex two weeks ago. I have been on it for over 20 years. I started out .25 mg and through the years had increased it to 1 mg. I was started on 6 milligram neupro patch about one month ago, and I am having daytime and nighttime restless legs. I am wondering if anyone out there has went from Mirapex to Neupro and then back to Mirapex? I took a holiday from the Mirapex before i changed to the Neupro patch. Can or has anyone taken Neupro and went back to Mirapex without taking a vacation from Neupro?

[Madlegs1]

You are suffering Augmentation, and need to get off those meds.

Read up on Sue Johnson's replies to most any of the people in similar situations.

And get a new medical team.

Your current one knows zip all, and will end up killing you.

[SueJohnson]

Welcome to the forum. You will find lots of help, support and understanding here.

Your doctor did you a great disservice. You were on twice the maximum for mirapex and are on twice the maximum amount of Neupro. You are suffering from augmentation and need to come off it.

The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen.

Ropinirole, mirapex and Neupro 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 them but they are not uptodate on the current treatment recommendations.

I would suggest you switch back to you 1 mg mirapex. Since you can get mirapex in in .125 tablets this is the easier way to reduce. You do not need to take a holiday.

First off check if you are on the slow release ropinirole (pramipexole). The slow release ones usually have ER or XL after their name. If so you need to switch to the regular mirapex because the slow releases ones can't be cut if needed.

To come off mirapex, 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. 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.

Save or bookmark this because you won't need it for a long time: On the gabapentin or pregabalin, beginning dose is usually 300 mg gabapentin (75 mg pregabalin). (Pregabalin is more expensive than gabapentin in the US.) Start it 3 weeks before you are off mirapex although it won't be fully effective until you are off it for several weeks. After that increase it by 100 mg (25 mg pregabalin) 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. (You don't need to divide the doses on pregabalin) 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. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg of pregabalin)."

If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason (not sure about pregabalin).

Have you had your ferritin checked? If so what was it? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not ask your doctor for a full iron panel. Stop taking any iron supplements 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 uptodate on it as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium(salt), foods that cause inflammation, ice cream, eating late at night, estrogen including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, eating late at night, stress and vigorous exercise. It is a good idea to keep a food diary to see if any food make your RLS worse.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate 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, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, 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, listening to music, meditation and yoga.

Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[SueJohnson]

You really need a new doctor. If you can tell me what city and state you live in I may be able to provide you with a knowledgeable one.

[Joolsg]

Follow SueJohnson advice. Get a new doctor fast.You are suffering drug-induced worsening. Mirapex AND Neupro actually worsen the disease which is why the Mayo Clinic Algorithm relegates dopamine agonists and the new American Academy of Sleep Medicine Guidance relegates these dangerous drugs to end of life scenarios.

Get off them slowly.

Find a knowledgeable doctor.

[GrainFarmer]

My question was not completely answered. We are leaving in two days and will be driving to Florida. My doctor switched me to the Neupro patch which is not controlling my RLS. I need a quick fix for when I start driving my drive. I will address this when I get back home better. But for now, like I said, I want a quick fix. I have been on Neupro for one month. Question is can I go back to my .25 mg of Mirapex without taking a vacation from Neupro.