RLS and pregabalin

[DonkeyRose]

Hiya. I personally have found almost all of my medications like pregabalin given for GAD, sertraline for bipolar and many others increased my symptoms of RLS. I had my 4th breakdown in Nov 24 through severe stress and over the last 2 years I have been weaning myself off from all medications because of the side effects which I had been prescribed over 26 years. I now will only take paracetamol for pain only if necessary as my headaches became severe hemiplegic migraines 3 a week in fact. I have another referral back to neurologist soon as I was advised to take propranolol x 2 at night and I am still getting episodes that feel like a type of epilepsy and flashing lights set a migraine off. In my family history many of the symptoms are genetic related and chronic gastritis flareups several times a week too from stress. I have now been diagnosed with fibromyalgia since Jan this year though brought on by many traumas and continuous stress since early childhood. I am still weaning myself off from my medications also causing side effects even now after 2 years. I take various vitamins like vit D, magnesium, seven seas with codliver oil for joints and mobility etc.

I would like to point out though to anybody reading or taking an interest in this post. Most medications doctors prescribe you with have many knock on side effects and are very addictive. I have basically detoxed over 2 years + and still continuing to do so. GPs, do not always have the time and knowledge about reducing addictive meds a lot more slowly and gradually, cutting them in halves etc. So you don't suffer any side effects. I appreciate certain drugs like for cancer etc. Are in the hands of certain experts but any medications given to you I would advise strongly please do your research on your own conditions if possible and whether any new drugs given will cause any adverse effects on what meds you are currently taking.

The Internet can be a minefield so just use it correctly and sensibly.

[ChrisColumbus]

To be clear, are you saying that pregabalin made your RLS symptoms worse?

Yes sertraline (Zoloft), estradiol, atorvastatin, lansoprazole are all known to make RLS worse for many - but not pregabalin, which is usually effective in *treating* RLS symptoms in doses in the range of 150 to 450 mg daily.

Pregabalin, like all drugs, does of course have side effects...

[rlswarrior in reply to ChrisColumbus]

Pregabalin is considered a first-line treatment for Restless Leg Syndrome (RLS). However, like the low-dose opioids sometimes prescribed for RLS, it carries a risk of dependency. It’s possible that Zoloft contributed to an increase in your RLS symptoms, or that you might benefit from a higher dose of pregabalin.

For example, my husband takes gabapentin—a similar alpha-2 delta calcium channel ligand—and he had to increase his dose when he started a tricyclic antidepressant for chronic daily headaches (most tricyclics make RLS worse). You might consider talking to your doctor about trying pregabalin alone again to assess its effect. If that is not for you, that’s fine too, as it’s your body. However, I would hate for you to go without sleep if your RLS gets really bad.

While there is a risk of dependency with these medications, it is important to distinguish between dependency and addiction. I take a low-dose opioid, and my doctor compared its necessity to insulin for people with certain forms of diabetes: just as insulin is essential for their health, these medications can be essential for managing severe RLS. For many with severe RLS, these medications are critical for sleep and daily functioning. Although it would be ideal to avoid them, sometimes they are necessary for maintaining quality of life.

Wishing you the best.

[ChrisColumbus]

I note from your post 12 days ago on another forum that at that time you were only taking 25mg of pregabalin.

The effective dose for RLS is 150-450mg a day "usually administered as once- or twice-daily doses in the late afternoon or evening or before sleep. It is recommended to start treatment 1 to 2 hours before usual onset of symptoms" - Mayo Algorithm.

According to the British National Formulary the pregabalin dose for General Anxiety Disorder is "Adult: Initially 150 mg daily in 2–3 divided doses, then increased in steps of 150 mg daily if required, dose to be increased at 7 day intervals, increased if necessary up to 600 mg daily in 2–3 divided doses."

I believe - according to that other post - that you were/are taking the small pregabalin dose to supplement 50mg of sertraline for GAD, and the sertraline was/is almost certainly triggering your RLS.

As to coming off sertraline, the BNF advice is "The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment)."

I wish you all the best with controlling your stress, anxiety, RLS and any other conditions that you are suffering - but hope that you don't come off ANY medications too quickly.

[Greenseagirl]

You’re quite right about the need for very slow tapering of any dependence forming medications. The Maudsley Deprescribing Guidelines published last year now give patients and clinicians specific information on how to do this as safely as possible, though no taper is ever completely risk free. Good luck with the rest of your reduction journey.