After over 20 years of Pramipexole, which worked quite well without increasing dosage, I finally hit a wall with the drug and decided to see if the alternatives would work. After consultation with my PCP, we decided to give Pregabalin a go. At the same time, of course, I began to reduce my intake of Pramipexole.
Although not without the up-and-downs of DA withdrawal, the process has gone relatively smoothly. I am now down to about .15 mg of Pram and 225 mg of Preg. I use a bit of cannabis (gummie form) when necessary, which is not that often. As expected, many of the side effects of the Pregabalin have worn off - I was initially sleeping a good 7-8 hours (which is well above average for me ever since I was a very young child) and waking up extremely drowsy, unsteady, etc. Those symptoms are 90%+ resolved and continue to improve.
The one issue that remains is weight gain. Over the month of taking Pregabalin, I have gained nearly ten pounds. With hard work, I have managed to stem the tide and even lose a pound or so. My question is for those who have experienced the same problem: Have you found a way to reverse the upward trajectory, and have you come to an understanding of why you have put on the pounds? There isn't much on the internet to help; people propose all kinds of theories from water retention (clearly not my problem), to increase of appetite (maybe a factor), and metabolic slowing (again, perhaps).
I am enjoying the better sleep, as is my wife; however, at 70 I am not happy with the unhealthy consequences of bad weight (my body fat % has increased from 14.5 to 17). In addition, I lost over 25 pounds about 7 or 8 years ago and am not going back!!
Any thoughts on the subject are much appreciated.
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Pregabalin is more likely to cause weight gain than gabapentin so you might want to try switching to gabapentin. Although they are basically the same drug except you need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. Multiply the pregabalin amount by 6 to get the correct dose. which in your case would be 1300 mg. Since you need more than 600 mg take another 600 mg 4 hours before bedtime as it is not as well absorbed above 600 mg. And since you need more than 1200 mg, take the extra 100 mg 6 hours before bedtime.
If you take magnesium, even in a multivitamin, don't take it within 3 hours of the gabapentin as it reduces the absorption of the gabapentin. If you take calcium don't take it within 2 hours for the same reason.
By the way the gabapentin won't help you much until you are off the Pramipexole. I certainly wouldn't increase it as normally you wouldn't even start taking it until you were 3 weeks from coming off Pramipexole and then you would only take 300 mg and stay on that until your withdrawal effects had settled down and then increase by 100 mg every couple of days.
According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin." If you are not familiar with it check it out at Https://mayoclinicproceedings.org/a...
Thanks for the prompt reply. I've read through your very useful posts over the past couple of years, and have learned quite a lot, especially through some of the links you provided.
I have been pretty aggressive in weaning from Pramipexole, and it seems to be working as far as reducing symptoms. I'm now down to ± .2 mg from .75, and the originally awful nights seem to be a thing of the past, as are most of the initial side effects of the Pregabalin.
I'll have to see if my PCP is open to making the change to Gapapentin - so far he has bee pretty cooperative; as with many doctors, he is in need of education, which I have provided over the past few years.
BTW, my last ferritin panel showed me to be slightly anemic (no surprise), so I'm on the supplement path - every other day with "gentle iron" and Vitamin C on an empty stomach. I'm due for another reading in a couple months.
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 when you see your doctor ask for a full iron panel. Stop taking any iron supplements including multivitamins that have iron in them 48 hours before the test, don't eat a heavy meat meal the night before, fast after midnight and 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. You want your transferrin saturation to be over 20% but less than 45% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice.
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. I have a list of more than 300 medicines and OTC supplements that make RLS worse and have safe alternatives for most of them.
Gaining 10 pounds in a month is a lot.There are no definitive reasons for the weight gain. Lots of speculation about increase in appetite / water retention. But keep a diary so you can see if you're eating more than normal.
You are already at above pregabalin average dose, so don't increase anymore until you're completely off Pramipexole. If you do swap to Gabapentin-
the equivalent dose is X 6 so 1300 - 1400mg. Gabapentin has to be taken in split 600mg doses 2 hours apart.
If you continue to gain weight - discuss fully with your Doctor & discuss whether opioids would be more suitable.
Yep, I'm keeping records of eating and exercising. I don't see any change, although I do notice some increase in appetite. I exercise every day, and am about as fit as a 70 year-old should be.
Perhaps my PCP will allow me to lower the Pregabalin dosage once I'm completely off the Pramipexole, which should be in a couple of weeks.
If you do lower the pregabalin dose you need to do so very slowly to avoid withdrawal effects. Reduce by 25 mg every 2 weeks. If you switch to gabapentin and want to lower the dose reduce by 100 to 200 mg every 2 weeks.
hello, sadly I put on around 20 pounds when I first started taking pregabalin in 2021 and I’ve not managed to loose any of it - by watching what I eat I’ve managed to stay the same for the following three years but now am obese plus have developed significant pain in my feet which restricts walking and exercise. I personally think that pregsbslin slows down my whole metabolism so it’s not surprising that I can essentially eat less than I could before.
You sound pretty fit and active so hopefully you will be able to pull things back - however I do think that weight gain is a major issue for many with this drug.
Yes, I’ve also gained 14lbs on pregabalin and despite dieting furiously last year wasn’t able to shift any weight. My daughter in law who is also on pregabalin for anxiety and has gained a lot of weight spoke to her doctor about dieting to which her doctor replied no chance of losing weight without coming off pregabalin. I’ve come to the conclusion that it slows the metabolism right down resulting in weight gain. I would love to shift this extra weight but am at a loss as to how to do so.
like you I have had to come off the Dopamine drugs to long to list here reasons etc. I have gone on to Gabapentin and sadly gained half a stone that I can not shift for love or money and for someone that does a huge amount of exercise, works in the sports injury this has been really debilitating. While I dont think Gabapentin is as bad as pregabilin when I mentioned it to my consultant he did say yes It will slow down your metabolism. So not only do I still not sleep that well I have a fat stomach and rather large other bits! ITs so frustrating as Ive battled with my weight all my life and I seem to be going only upwards despite counting calories etc. I am now moving to another consultant that someone one here recommended as I want to come off Gabapentin as its not great and I don't feel great and try and go to Buprenorphine but sadly it will have to be a private prescription as my GP is reluctant to prescribe anything! Good luck, its such a hard journey with these side effects let alone dealing with the RLS.
I’ve been on PreGablin for 12 weeks, initially 150mg but upped to 225mg a few weeks ago as had breakthrough symptoms in the (very) early morning (4:00 ish) I’m used to monitoring what I eat/calorie intake as putting on weight would have quite a cost in monetary terms as well as the usual negative effects (I’m a racing driver and racesuits are super expensive)
As I did put on weight without significant extra calorie intake I have concluded that Pregablin lowers your metabolism (at least in my own case). It’s slightly skewed by Xmas when naturally one tends to eat more, and more of high-calorie foods (mince pies are my weakness)
I put on around 5kgs (11lbs) and clothing was definitely feeling tighter.
I have cut my usual calorie intake by around 800 calories per day and am slowly losing a little of that extra weight (2-2.5 kgs in 4 wks) . It is a little tough but another month and I should be ‘there’ and can gradually increase my intake.
However, I have resigned myself to having to eat less calories than I did before the PreGablin going forward.
So, in my case at least it does appear to be a metabolic rate issue but interested to hear others’ experience?
Also if there are any online sources which discuss Pregablin and weight gain?
Similar experience here. Felt drugged up in the mornings for months. I have gained a couple of stone in the 2yrs I’ve been on Pregab. I am getting older, 59, so there might be metabolic changes, as you have mused. I have had to change from a physical job to basically a desk job and I work from home a lot which where the fridge and food cupboard is. I keep loosing and gaining weight. It’s a battle that gets harder and harder. I have no wisdom on the matter I’m afraid but stand with you!
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