pregabalin

[Frenchmen]

How effective is it to control RLS?

[Joolsg]

It depends.It works well for many people.

However it often does not work for pat who have been prescribed dopamine agonists first.

Average effective dose is between 150- 200mg.

[SueJohnson]

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

To clarify Joolsg's answer. For most people it works very well even after being on dopamine agonists. For some especially if they have been on DAs for a long time and/or have augmented, the dopamine receptors may have been damaged and it doesn't work.

You list pramipexole on your profile. Are you taking it? I am going to assume you are and answer accordingly.

You need to come off it as up to 70% of people will eventually suffer augmentation according to the Mayo Clinic Updated Algorithm on RLS which believe me you don't want because it can be hell to come off it and the longer you are on it, the harder it will be to come off it and the more likely your dopamine receptors will be damaged so that the now first line treatment for RLS gabapentin and pregabalin won't work nor might iron and it has been found that suffering from augmentation can lead to painful RLS which you don't want. And some experts believes everyone will eventually suffer augmentation.

Ropinirole, pramipexole (Mirapex) and the Neupro (rotigotine) patch are no longer the first-line treatment for RLS, gabapentin or pregabalin are. They used to be the first-line treatment which is why so many doctors prescribed them but they are not uptodate on the current treatment recommendations.

First off check if you are on the slow release pramipexole. The slow release ones usually have ER or XL after their name. If so you need to switch to the regular pramipexole because the slow releases ones can't be cut if needed.

To come off pramipexole, reduce by half of a .088[.125] tablet every 2 weeks or so. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it.

On the gabapentin or pregabalin, the beginning dose is usually 300 mg gabapentin (75 mg pregabalin). (Pregabalin is more expensive than gabapentin in the US.) Start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks and your withdrawal symptoms have settled. 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 1-2 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 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 of pregabalin)."

If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and if you take calcium or antacids don't take it within 2 hours for the same reason (not sure about pregabalin).

Have you had your ferritin checked? If so what was it? This is the first thing a doctor should do for RLS. Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not ask your doctor 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. If your ferritin is less than 100 or your transferrin saturation is less than 20 ask for an iron infusion to quickly bring it up as this will help your withdrawal. If you can't get an infusion, let us know and we can advise you further.

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 as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

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.

[Frenchmen in reply to SueJohnson]

Thanks so much for the information. I will read it carefully, take notes and respond. I also have begun using a CPAP device for sleep apnea. Thus the problem: a lack of sleep makes rls worse, but rls makes using the device difficult, at times impossible.

[Frenchmen in reply to SueJohnson]

My prescription is pregabalin cap 50 MG, and my doctor instructed me to begin with one capsule before symptom onset or at bedtime. The maximum is nine capsules per night. I am using two pramipexole tablets daily (.125) this week, down to one daily the following week, and then off completely. Do you have a suggestion on the best time to take the pregabalin? Again, thank you so much.

[SueJohnson in reply to Frenchmen]

Take it 1 to 2 hours before bedtime.

You are reducing the pramipexole too quickly. It's fine if your withdrawal effects are not bad but if they are slow down and use my withdrawal schedule above.

The pregabalin won't help much until you are off the pramipexole and your symptoms have settled and you have been on it for at least 3 weeks. I wouldn't take more than 150 mg pregabalin or 3 capsules until then. After that you can raise it by 1 capsules every couple of days until you find the dose that controls your symptoms. Once you do that however I would suggest you either ask for 25 mg capsules from your doctor or get an inexpensive jewelry scale that measures down to .01 gram from Amazon ($11 in the US) and open up the capsule and measure half of it. Then try taking 25 mg less than what worked and see if that will control your symptoms since you don't want to take more than you need.

[nick-the-turk]

I've been on pregabalin for many years now along with codeine phosphate with little relief but what it does for me is stops me climbing walls during the night could be the codeine I know if they could or would change pregabalin for better then I'd jump at the chance but having little success doing so

[Frenchmen in reply to nick-the-turk]

Thank you ever so much for the information. What is the pregabalin dosage, and when do you take it?

[nick-the-turk in reply to Frenchmen]

150mg at 4 in afternoon and 300mg at an hour before bed along with codeine phosphate 100mg