RLS .. 3am and cannot sleep

[YoghurtLover2]

I’m weaning off Pramipexole… on 1/4 of .250mg now and 300mg Gabapentin. I’m struggling again to sleep . I’m having an appointment with my doctor tomorrow and want to ask for opioid to help. I’m in Canada and not sure whether she’ll give it because of opioid crisis. Which one should I ask for? Apologies to Sue, Jools and others . I see now I could have saved all your advice. Unfortunately I don’t know where to find it now. 🥲I’m learning ! 😂 I’ll try saving it this time !

[SueJohnson]

Click on your profile. There you will see links to all your posts and replies and clicking on those you will see the replies to your posts or replies.

I would recommend buprenorphine or methadone as they are long lasting. Most of the others last only 4 to 6 hours and need to be taken that often or you will have mini withdrawals. If you are prescribed one of the others be sure you are given enough to take them that often.

[YoghurtLover2 in reply to SueJohnson]

Thanks Sue🙏 What dosage do you think and for how long? And would I be taking methadone with Gabapentin and the little Pramipexole I’m still on?

[SueJohnson in reply to YoghurtLover2]

Yes you can take it while on the others. For Methadone according to the Mayo algorithm the usual starting dose is 2.5-5 mg and the usual effective dose is 5-20 mg. For Buprenorphine according to the Mayo algorithm the usual starting dose is .5-1 mg and the usual effective dose is .5-6 mg.

I suspect you won't be able to get an opioid as they usually don't prescribe it except temporarily to get off a DA unless one has tried gabapentin or pregabalin and they haven't worked and since you are only on a starting dose of gabapentin and haven't completely weaned off pramipexole and several weeks haven't gone by after that and your symptoms have settled you don't know whether gabapentin will work. In any case if the doctor refuses you can ask if s/he will prescribe it if gabapentin doesn't work.

[SueJohnson]

In Canada a doctor needs a special license/permit and must take courses to be allowed to prescribe methadone. Buprenorphine does not so that might be a factor.

I would go armed with a printed copy of section of the Mayo Algorithm on opioids at Https://mayoclinicproceedings.org/a...

If you haven't joined the Restless Legs Foundation at rls.org I suggest you do. It costs $40 a month and has a monthly magazine, They have lots on information on line. They also have a publication you can download and print on the Member section called Causes, Diagnosis, and Treatment that has a section on opioids.