Pregabalin 150mg x 3 . Do I take all at once

[Myteamo]

I have been prescribed Pregabalin 150mg tree times a day. Should I take it all at once at bedtime or as my doctor says 3 times a day. I’ve been taking 400mg at bedtimes but that didn’t hold off my symptoms. Also Taking 150 mg during the daytimes makes me very sleepy. Thank you in advance regards Maureen

[SueJohnson]

Unless you have symptoms during the day take it all at 1 time 1 to 2 hours before bedtime.

[Myteamo in reply to SueJohnson]

thank you Sue, I have had symptoms in my arms and legs during the day . I started taking 300 Pregabalin which didn’t help at all. Then 400 mg I still had strong symptoms at night, that’s why I have asked for the 450 dose. My doctor admitted she knows nothing about Restless legs, so she was guided by me and the Nice guide lines. I will try to reduce the dose soon, but until then, I’m going to enjoy the lovely nights sleep, hopefully.

[SueJohnson in reply to Myteamo]

Sounds like you are going to need a low dose opioid.

[funkyday in reply to SueJohnson]

Yes, I am thinking the same Sue. My RLS has been helped incredibly with 225 mg Pregabalin and 50 mg. Tramadol. As I have mentioned before on this site, I was lucky enough to find a neurologist who has RLS so he is very up to date on how to deal with it.

[ChrisColumbus]

Uk doctors are not taught about RLS, and they are possibly following NICE guidelines (such as they are!):

"Initial dose: 75 mg in people aged under 65 years and 50 mg in people aged over 65 years. Titration: maximum recommended daily dose for RLS is 450 mg. CKS did not identify any specific guidance on dose titration and the requirement for divided daily doses. However, for another indication (neuropathic pain), divided doses are advised"

Unfortunately, NICE/NHS are not up-to-date on RLS research and practice and Sue has advised the correct way to take for RLS.

I note that you have been off ropinirole for c. 5 months after augmentation: gabapentinoids do not always help sufficiently after augmentation, and you may need a low dose opioid.

However, another possibility is that you are taking other medications that trigger RLS. Have a read through this list from RLS-UK:

rls-uk.org/medications-avoid

And have you had a recent fasting full panel iron test? Download and read the following:

rls-uk.org/_files/ugd/b0a19...

Hope this helps!

[Myteamo in reply to ChrisColumbus]

Thank you Chris for your helpful comments. I have checked and I’m not taking another medication that I’m aware of that could trigger RLS but I will check again. I have titrated the Pregabalin up from 150gm to 450mg I was reluctant to take the higher dose but needs must as they say , a lower dose wasn’t working at all.

I havnt had a fasting full panel iron test but I do take an iron tablet every other day.

Ropinirole was a big mistake so happy to be finished with it it was a disaster

[ChrisColumbus in reply to Myteamo]

It's good that you are taking iron, but oral iron can be very slow to raise ferritin levels: it would be good to have a test as described in the iron therapy paper.

Some people do find that pregabalin/gabapentin fully controls their RLS - like Sue - whereas others, after DA augmentation - like Jools - find that they need a low dose opioid.

Do let us know how you get on, and whatever happens do not precipitately reduce or stop pregabalin before getting further advice here from people like Jools and Sue. Good luck!

[SueJohnson in reply to Myteamo]

I agree with Chris. It would be very helpful to know your ferritin. You may not be taking enough iron or you may need an iron infusion or you may just be wasting the iron as you don't need it. For example my ferritin is almost 600.

[Myteamo in reply to SueJohnson]

my serum Ferritin was 99ug/L in a normal range of 15 to 300. Is that the iron range we are taking about. Thank you for taking the time to reply

[SueJohnson in reply to Myteamo]

Yes. It is close to 100 but some believe it should be over 200 or even 300 so Take 325 mg of ferrous sulfate which contains 65 mg of elemental iron, the normal amount used to increase ones ferritin, or 50 mg to 75 mg (which is elemental iron) of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption. Also take Lactobacillus plantarum 299v as it also helps its absorption. Ferrous sulfate is fine for most people, but if you have problems with constipation, iron bisglycinate is better.

Take it every other day, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption.

If you take magnesium, calcium or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after. Don't take your iron tablets before or after exercise since inflammation peaks after a workout. Don't take turmeric as it can interfere with the absorption of iron or at least take it in the morning if you take your iron at night. If you take thyroid medicine don't take it within 4 hours. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months.

By the way you may think you are not taking any medicines that make RLS worse but 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.

[Joolsg]

I agree with SueJohnson and ChrisColumbus.Your GP doesn't understand RLS and has prescribed you the 'pain relief' dose.

And it should be started VERY slowly- especially when over 65!

Pregabalin takes 3 weeks to be effective.

So, try taking it at night ONLY for a month.

You can even split the dose and take 200mg 3 hours before bed and 250mg just before sleep.

Monitor results. If it works- you can slowly reduce the earlier dose by 25mg every week.

450mg is a high dose and a lower dose might cover your symptoms.

If 450mg doesn't cover your symptoms, ask to see a neurologist/sleep specialist.

As ChrisColumbus says- gabapentinoids often do not work after the patient has suffered augmentation on dopamine agonists. So you may need an opioid.

[Myteamo in reply to Joolsg]

Thank you Joolsg. I will take your advice concerning dosage and timing. I’m hoping to reduce to find my ideal lowest dose.

[Myteamo in reply to Joolsg]

my serum Ferritin was 99ug/L in a normal range of 15 to 300. Is that the iron range we are taking about. Thank you for taking the time to reply

[Joolsg in reply to Myteamo]

Serum ferritin of 99ųg/L would be regarded as very good for most people. However- if you took iron pills within 48 hours of the test, it would raise your serum ferritin levels falsely.So, keep taking the iron pills every other day. Some people on this forum need levels above 300ųg before their symptoms resolve.

[Myteamo in reply to Joolsg]

hello . Joolsg, I don’t think 450mg is working for me. This is my 3rd night of taking the it. And I’ve had dreadful nights sleep again, Realess Legs seems to start after taking the medication, could this be the case,? will it improve if icarryon taking or or should I stop taking it now before it gets any worse. I feel desperate , nothing is working for me. Sorry to put this on you would just like your opinion

[Joolsg in reply to Myteamo]

Your body is used to taking it 3 times a day. So switching the timing will cause a few hiccups.However, if RLS starts soon after you take the pills- then split the dose so you take 200mg around 4 hours before bed and 250mg as you fall asleep.

Try that for at least 2 to 3 weeks so your body adjusts.

If you still get RLS every day- then you have 2 possibilities.

Add a low dose opioid ( Dr Buchfuhrer often says that 2 meds at lower dose may work better than 1 med at higher dose). If you add a low dose opioid- you can slowly reduce pregabalin by 25mg every 2 weeks to the lowest effective dose.

OR ask your GP/Neurologist to prescribe a low dose, long half life opioid like Buprenorphine. And reduce pregabalin very slowly as above.

[SueJohnson]

If reducing do 25 mg every TWO weeks to avoid withdrawal symptoms.

[Myteamo]

thank you Sue , I will do.

[Oscarcat63]

I began my rls medication journey with 0.88 my of pramiprexole and 75 mg of pregabalin.Then after 10 months came off pramiprexole. Increased pregabalin to 1st 150 mg, then 300 mg nightly in one dose.

If I split the dose, I doubt it would do anything, tbh

I but it has worked for me, so far, in regards to rls, but I also have 200 micro grams of clonidine.

It has little effect on pain. Unfortunately.

Never was recommended for iron transfusion either (my ferritin was 63 ng/ l last time I checked )

[SueJohnson in reply to Oscarcat63]

The clonidine is known to help RLS so good you are taking it,

Are you taking iron as I suggested?

[Oscarcat63 in reply to SueJohnson]

I have been, but with the pregabalin it is making me dreadfully 'clogged up' and I don't want to see a plumber !It has been the 'gentle' iron as recommended on here, but they don't last long as I need to take 2 tablets to get the proper dose !

Advice on 'unclogging the pipes' 😬😂!!

[SueJohnson in reply to Oscarcat63]

My laugh for the day I don't want to see a plumber ! 🤣🤣🤣