Oxycodone

[Cook359]

I am taking Oxycodone 5mg twice daily for RLS. it is effective but it makes me very tired, sleepy and dizzy. Is there an alternative (not dopimines) which I could try instead?

[SueJohnson]

Welcome to the forum. You will find lots of help, support and understanding here.

Have you tried gabapentin or pregabalin? they are the first line treatment for RLS.

Have you had your ferritin checked? If so, what was it? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. This is the first thing a doctor should do. If not when you see your doctor ask for a full iron panel. Stop taking any iron supplements including multivitamins that have iron in them 48 hours before the test, don't eat a heavy meat meal the night before, fast after midnight and 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 transferrin saturation to be over 20% but less than 45% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice.

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, estrogen without progesterone and sometimes even with it, 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.

[Cook359 in reply to SueJohnson]

Sue thanks for your prompt reply.

After weening off pramipexole, then Rotigotine patches I tried both gabapentin and pregabalin for a short time with no marked improvement, but I don know if I was still suffering augmentation. Should I revisit this medication?

My Ferritin was 85.4 ugl, I couldn’t find any TSAT result.

Medication

Levothyroxine

Amlodipine

Atorvastatin

Tamsulosin

Vitamins

cranberry extract

Vitamin B12

Cod Liver Oil

Folic Acid

Vitamin D

Feroglobin

[SueJohnson in reply to Cook359]

If you were still suffering from withdrawal from the Rotigotine patch they wouldn't have helped. Also it takes 3 weeks for them to reach full effectiveness. And you may not have taken gabapentin in 600 mg doses divided by 2 hours, or you may not have taken enough. the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg of pregabalin)."

They probably didn't test your TSAT. Next time ask for a full iron panel.

The Feroglobin is a slow release type of iron which bypasses where it is best absorbed. Instead 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. Since 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.

Time your medicines so that you take your thyroid medicine at least 4 hours from any medicines that contain aluminum, calcium (or calcium rich foods), iron and magnesium (or magnesium rich foods). DAs like pramipexole inhibit TSH secretion so brings down thyroid hormones. Conditions associated with hypothyroidism can make RLS worse so want to bring it up. People with hypothyroidism may have prolonged and exaggerated responses to opioids

Amlodipine bothers some but not all. Some medicines that are safe for high blood pressure are propranolol (Inderal, Hemangeol, InnoPran) a beta blocker that may help RLS, Isosorbide Mononitrate (Monoket, Imdur) which is not a beta blocker nor calcium channel blocker. Other possibilities are: Clonidine (Catapres) an Alpha-2-Agonist used to treat high blood pressure which may help RLS and which also treats insomnia, tenex (Guanfacine, Intuniv), prazosin (Minipress) an alpha-adrenergic blocker that is also useful in managing sleep-related problems caused by PTSD and Tadalafil a vasodilator that in one study completely eliminated RLS. Clonidine can actually help RLS. Discuss these with your doctor. And then there is reducing salt by 1 teaspoon a day nih.gov/news-events/nih-res....

All statins make RLS worse. Nexlizet (Nustendi (UK) is a cholesterol lowering drug that is not a statin, but I don’t know if it exacerbates RLS symptoms. Ezetimibe (Zetia) - reduces cholesterol although It doesn't reduce cholesterol as fast as the statins, but according to Chris Columbus it didn't trigger his RLS, however don't take it if you have diabetes and then there is Bezafibrate (Bezalip) and Triglide which seems safe. Berberine may help if it is mildly elevated. . You might want to discuss these with your doctor. A more difficult way to reduce cholesterol is to go vegan. My husband lowered his cholesterol from 221 to 131 this way.

[Cook359 in reply to SueJohnson]

Thanks so much Sue, I a m going to print that off and work a timetable for my medication and I shall make appointment with Doctor to discuss Gabapentin. I’ll take the print out with me re the Statin question. Thank you

[SueJohnson in reply to Cook359]

Here is the information on gabapentin:

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.

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 Https://mayoclinicproceedings.org/a...

[Cook359 in reply to SueJohnson]

Sue, I have digested your last.

I have found my stock of Pregabalin 25mg tablets, what dosage (how many tablets) do I need to take?

Can I just stop my Oxycodone 5mg x2 which is making me depressed?

I will take my Thyroxine 4hours after my morning tablets.

I will pause my statins and monitor my cholesterol.

How does that sound?

[SueJohnson in reply to Cook359]

You need to wean off the oxycodone and also the statins. Discuss this with your doctor.

See my reply above about the pregabalin.

[bumblebee_tuna in reply to Cook359]

Just a note - I switched from short-acting Oxycodone to PERCOCET with a lot of success and almost no side effects.

[Cook359 in reply to bumblebee_tuna]

Thanks

[Bieler]

Tramadol. Many sufferers on here, including me, have found relief.

[Cook359 in reply to Bieler]

Thanks

[Maymount in reply to Bieler]

Yes Tramadol has been my saviour too!

[LotteM]

How long have you been taking it? If not long yet, these side effects may settle. I would say, within 2-4 weeks (no substantiation for that time frame, just gut feeling). And talk to your doctor and/or pharmacist for ways to deal with it or alternatives.

[Cook359 in reply to LotteM]

Thanks 👍

[Cook359 in reply to LotteM]

Thanks

[BettyRae]

I also take ocycodone. I’m taking the same amount you do. My other RLS meds, which I take at 5 pm, seem to start wearing off around around 3pm. I become very irritable and agitated. I take 5 mg then. The other one I take around 1am, which I hope will help me get more sleep.

[Cook359 in reply to BettyRae]

Thank you