opioid alternative

[kirks2092]

hi for those of you on here that can’t get on with opioids due to side effects what do you take for rls?

i’ve heard good things about pregabalin but is it effective?

thanks

[ChrisColumbus]

Gabapentin or pregabalin can be very effective in controlling RLS, but is this for you or your mother? If for her I think that she was on pramipexole, switched to gabapentin and/or pregabalin and said that she couldn't tolerate them and went back on to pramipexole (before going on to buprenorphine). It's possible that she came off pramipexole too fast and/or couldn't give the gabapentin/pregabalin long enough to work through the initial side effects. On the other hand, gabapentin and pregabalin aren't always effective if someone has augmented on pramipexole, ropinirole or rotigotine...

[kirks2092 in reply to ChrisColumbus]

hi yes sorry for mum

yes she weaned off pramipexole, had a horrendous time and went on bupre in july.

before that i think she had the issue with gabapentin and lyrica i think it was called and she has tried pregabalin i think

Shes not sure now though if it was the pregabalin causing the issues, more the lyrica she thinks

So if she can not shift the nausea with lowering the dose and cutting into quarters we may have to try adding small dose of pregabalin but it doesn’t seem there’s any other non opioid alternatives for mum if she has to come of bupre

[ChrisColumbus in reply to kirks2092]

I'm afraid they're the same thing: pregabalin (generic name) = Lyrica (brand name). You'll recall that Joolsg used a small dose or pregabalin to counteract anxiety on buprenorphine and medical cannabis to stop nausea, and that her doctor also prescribed ondansetron (Zofran) for this. I guess you've tried this?

[kirks2092 in reply to ChrisColumbus]

yes tried them all unfortunately

thanks for pointing this out, it seems pregabalin may not be a good choice for mum

we keep trying with low dose and cutting into quarters every 6 hrs

it doesn’t help that shes unwell at the minute with colitis flare but i am hoping we will get there

thanks again

[ChrisColumbus]

SueJ or Joolsg may be along again shortly to offer their experiences on these drugs and better advice than I can give.

[Joolsg]

I only took pregabalin AFTER I started Oxycontin 5 years ago. Dr Buchfuhrer recommended it to counter opioid panic attacks.I went up to 150mg pregabalin with 25 mg Oxycontin.

But my RLS was very severe. 38/40. Up every single night with it.

Chaudhuri refused an Iron infusion saying it might kill me and there was NOTHING else he could do. I was told that 4 hour's broken sleep was the best I could expect.

Luckily, I eventually pushed for Buprenorphine.

So for me- Oxycontin and pregabalin just didn't cover my very severe RLS. Same for claire-lc.

BUT gabapentin and pregabalin do work for some people. SueJohnson uses gabapentin and it covers her RLS.

So it might be a possibility.

[kirks2092 in reply to Joolsg]

thank you Joolsg

[SueJohnson]

Gabapentin is less likely to cause nausea as a side effect than pregabalin but it isn't very common on either. If so it will show up early. And then try taking it with food.

Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). It will take 3 weeks to be fully effective. After that she should increase it by 100 mg (25 mg pregabalin)every couple of days until she finds the dose that works for her. She should take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. If she needs more than 600 mg, she should take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If she needs more than 1200 mg, she should take the extra 6 hours before bedtime. (She doesn'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 pregabalin)."

If she takes magnesium she shouldn't take it within 3 hours of taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and she shouldn't take calcium nor antacids within 2 hours for the same reason (not sure about pregabalin).