After months of avoiding the DA class, I finally gave in and tried a TINY Requip dose (1/8th of a 0.5mg pill, so like 0.0625mg) and I’d say it helped me sleep a good amount.
HOWEVER, when I woke up in the morning, my RLS was severe, and I have muscle fasciculations/twitches ping-ponging all over my whole body. The twitches are constantly moving around my body and frequently the twitch causes a full spasm/movement of my fingers/toes/abdomen. The strength of the twitches has increased as the hours have gone by.
Has anyone had these types of twitches after a DA? And is it concerning?
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LongswordChampion
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Welcome to the forum. You will find lots of help, support and understanding here.
For gosh sakes DO NOT take requip as believe me you will regret it! Sooner or later you will suffer augmentation and it can be hell to come off it. Some say as worse than heroin.
Have you had your ferritin checked? If so what was it? If not this is the first thing that should be done for RLS. When you see your doctor ask 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. You want your ferritin to be over 100 as improving it to that helps 60% of people with RLS and in some cases completely eliminates their RLS and you want your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice.
Above all don't let your doctor prescribe a dopamine agonist like ropinirole (requip), pramipexole (mirapex)or Neupro (rotigotine). They used to be the first line treatment for RLS, but no longer are because of the danger of augmentation. Instead ask your doctor to prescribe gabapentin or pregabalin. (Pregabalin is more expensive than gabapentin in the US.) Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). It will take 3 weeks before it is fully effective. 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 to 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 split the doses with 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 pregabalin)."
If you take magnesium even in a multivitamin, don't take it within 3 hours of taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and don't take calcium nor antacids within 2 hours for the same reason (not sure about pregabalin).
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 at
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, 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.
I greatly appreciate the information. My story of RLS is very different from the average. I only tried the Requip because both my PCP and neurologist were adamant that I tried it. I’ve also tried many other remedies
I did get my iron and ferritin checked. Ferritin is 128 and Iron saturation is 50.
All of my symptoms began with a possible episode of Serotonin Syndrome in Sept 2024. I was sick with some virus so I took NyQuil and had a horrible reaction with mild hallucinations, hot flashes, ocular flutter, nausea, etc for about 24 hours. I monitored my vitals at home, and they were stable so I decided not to go to the ER. I thought I’d be fine. Over the next 48 hours, my jaw had some involuntary clenching and tremor, along with a tongue tremor. To this day, the tremor hasn’t gone away. I’ve had constant internal tremors since as well. This has caused a lot of anxiety as my body just doesn’t feel like my own with the constant internal (and now external) shakes. Over a couple months, the internal tremor became visible with action, primarily in my fingers and wrists. My hands feel weak and uncoordinated, also worsening my anxiety. This anxiety made me sleep horribly in addition to nightshift work for about a month. In December of 2024, I started having muscle spasms in my fingers as I tried to sleep. My fingers would twitch strongly right as I doze off, which would wake me up. My anxiety and lack of sleep got so bad, I was vomiting and had to go to the ER for IV electrolyte replacement. (I also became sick at this time with 2 more viruses of some sort). I slept horrible for a couple more months as these twitches spread to my entire body, including my face and chest and legs. These twitches only occur as I doze off to sleep. My PCP thinks it is anxiety and essential tremor, so he intermittently tried Ativan and Klonopin, with Klonopin providing the most relief. (And yes I have lots of anxiety from the shakes and not getting enough sleep. (This is new for me, I’m never anxious.) The twitches have been so severe that there have been many nights when I literally do not sleep at all). I’ve had lots of full body hypnic jerks too. Eventually, when the twitches spread to my legs, and an irresistible urge to move. If I resist the urge for too long, my legs twitch and move involuntarily. I have also woken up a couple times raising my arms and kicking my legs due to my dreams, making me think it is Periodic Limb Movement Disorder. I finally got in to see a neurologist (waited 2.5 months for appt), and she thinks it is NOT neurological…she thinks it is endocrine related. We did some lab work, and my ANA is positive for 1:320 and speckled; indicating likely something autoimmune (possibly triggered by all the viral infections?). My vitamin E (only gamma Tocopherol is low, not alpha Tocopherol is not low). I have not gotten to talk to the dr about the results of this yet as they will not return my calls. I am scheduled for a brain MRI and EMG. I did a sleep study but results are pending. I have an endocrinologist appt in a few months.
Medications I have tried:
400mg magnesium Glycine (ever night no matter what)
Propranolol 5mg every 8 hours (for the hand tremors and high heart rate from the stress. I weaned off this for a time but the night twitches persisted)
4mg zanaflex (attempted for a couple weeks for my jaw clenching/ tremor. Didn’t help)
Gabapentin (only 200mg, but that same night when I tried it is when I had the worst restless legs of my life so I’ve been hesitant to try again)
GABA Supplement (250mg)
Klonopin 0.5mg
Ativan 0.5mg
Melatonin up to 5mg (been taking it for years, but I’ve been minimizing usage lately)
CBD/CBG/CBN (up to 300mg)
THC Delta 9 (this made my tongue tremor much worse)
phosphatidylserine (300mg nightly to help reduce cortisol and stress)
Ashwaganda (didn’t see any changes)
L-theanine (200mg)
Requip (0.0625mg. Had decent sleep and minimal twitches, but the following morning has caused fasciculations)
WOW - you have certainly have a lot going on. You obviously have hereditary RLS as your parents have it and it was just waiting to have something start it. I think it was just a coincidence you had bad RLS when you tried gabapentin as that is not a possible side effect. Definitely don't take iron as your iron saturation is borderline high. Internal tremors are a pain. I have them. For anxiety buspar is safe for RLS.
You definitely have RLS and PLMD which is treated the same way as RLS. Unless you are taking a medicine not listed I don't think you have drug induced Parkinson's .I don't think you have ALS nor MS as you don't have most of the early symptoms.
Thank you again so much. And good idea I’ll have to try gabapentin again. Perhaps Lyrica if it doesn’t seem to work for me.
I’m sorry to hear you have internal tremors as well. They’re very stressful. Do you know what caused them for you?
I’ve considered buspar, but I heard it can worsen myoclonus/Tardive dyskinesia (my jaw/tongue tremor?) potentially. And I’m scared of more potential serotonin syndrome since I appear to be susceptible.
I’ve also considered clonidine, Primidone, and/or Keppra. Do you know how they interact with RLS/PLMD?
Are you still taking it every night?Your doctor should FIRST have reviewed and replaced all trigger meds. (Anti depressants, sedating anti histamines etc) and raised your serum ferritin above 200ųg ideally.
Only then should you consider meds.
And NOT dopamine agonists.
Gabapentinoids are first line meds.
Follow SueJohnson advice.
And yes- requip can cause spasms & twitches . I had them when I suffered augmentation on Requip. They disappeared once I stopped the med.
I only had the twitches after 9 years on Requip. In your case- if you have only taken requip for one night- then it's either a severe reaction to the drug OR something else completely.
Dopamine works in a similar way to serotonin. Both can cause strange reactions/behaviours.
You can experiment.
Try not taking requip for a week to see if the twitches stop.
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