Introducing Gabapentin to Pramipexole

[rls-ottawa]

Hi folks,When Introducing Gabapentin to Pramipexole do you take a Gabapentin dose simultaneously with a Pramipexole dose or you take it every other day?Thank you

[SueJohnson]

Last year you were taking gabapentin so you already know to take it every day and then I believe you switched to pregabalin. Are you now wanting to add pramipexole or are you already taking pramipexole.

You are familiar with the Mayo Algorithm so why in the world do you want to take a dopamine agonist like pramipexole?

That would be a big mistake!!!

[rls-ottawa in reply to SueJohnson]

Thank you Sue for prompt response.

Currently, I am taking pramipexol, I was not able to withdraw last year due to unbearable pain and no sleep and GP not prescribing opioids.

My GP laughed at me when i said pramipexole and other DAs are no longer first line drugs.

Also, recently she discovered in my blood test that kidney eGFR marker is getting down.

So first 2 weeks, she wants me now to take gabapentin by starting gabapentin 300 mg capsule every other day with pramipexole 0.25 mg. Than 2 weeks every second day (2 days gabapentin one pramipexole and then do 2 weeks gabapentin 1 capsule 3 times per day

Finally, if needed add 2-3 capsules 3 times per day

[SueJohnson in reply to rls-ottawa]

I am a little confused.

1st 2 weeks - why gabapentin every other day? And continue .25 pramipexole every day?

2nd 2 weeks - take gabapentin every 2nd day ie skip 2 days? And continue ,25 pramipexole every day?

3rd 2 weeks - take gabapentin 3 times a day every day?

If needed add 2 to 3 capsules of gabapentin 3 times a day every day? And continue .25 pramipexole?

And if your eGFR marker is going down, you don't want to take either of those drugs.

[rls-ottawa in reply to SueJohnson]

>>1st 2 weeks - why gabapentin every other day? And continue .25 pramipexole every >>day?

both gabapentin and pramipexole every other day

1st day gabapentin,

2nd day pramipexole

3rd day gabapentin,

4th day pramipexole

>>2nd 2 weeks - take gabapentin every 2nd day ie skip 2 days? And continue ,25 pramipexole every day?

1st day gabapentin

2nd day gabapentin

3rd day pramipexole

4th gabapentin

5th gabapentin

6th pramipexole

[SueJohnson in reply to rls-ottawa]

What is your goal? Are you trying to come off pramipexole?

This schedule won't work. On the day(s) you are off pramipexole you will have withdrawal symptoms. Then going back on pramipexole will relieve them and reset your body to want pramipexole. It will not help you reduce. You will get nowhere this way except to suffer. And you may even have withdrawal effects from gabapentin although that is less likely.

Also there is no point in taking gabapentin 3 times a day. Doctors will prescribe it that way as it's main used is for neuropathy which lasts all day. It is used off label for RLS.

A better way to reduce is to get an inexpensive jewelry scale on Amazon ($11 in the US) that measures down to .01 gram and shave off a bit of the tablet and measure it. Then reduce by that amount every 2 weeks.

Since gabapentin is not good for someone with low kidney function a better option for your RLS is methadone preferably or buprenorphine which has less effect on your kidneys than gabapentin. Both of these opioids are better for low kidney function than oxycodone, codeine and tramadol.

Your doctor may not have clearance to prescribe these or may refuse to prescribe them in which case you will need to change doctors. You would be wise in any case to change doctors for your RLS as it is obvious s/he is not that knowledgeable about RLS.

If you tell me what city you live in I may be able to give you the name of a doctor who is.

[rls-ottawa in reply to SueJohnson]

>What is your goal? Are you trying to come off pramipexole?

Yes, replace prama with gaba for now

>Your doctor may not have clearance to prescribe these or may refuse to prescribe them in which case you will need to change doctors.

That's the problem, in Canada/Ottawa it is impossible to change GP more over get an opioid drug

>Also there is no point in taking gabapentin 3 times a day.

I know, but that's just how she sees it, I can adjust it to use all around 8PM

[SueJohnson in reply to rls-ottawa]

It may be difficult to change doctors, but it is not impossible. And doctors in Ottawa can prescribe opioids for restless legs unless Ottawa is different than the other provinces as we have people on the forum from Canada that have been prescribed them. Unfortunately I don't have the name of a knowledgeable doctor nor even anyone else on the forum that lives in Ottawa.

I have names of doctors in British Columbia, Quebec, Ontario, Nova Scotia and Alberta who prescribe opioids.

At the least you should be able to get tramadol which is a weak opioid.

So your only option is to educate your doctor. Print out the appropriate sections from any or all of the following:

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

jcsm.aasm.org/doi/pdf/10.56...

rls.org - you will have to join but it is only $40 and they have lots on information and downloads at their website and a monthly magazine with lots of good information.

relacshealth.com/blog

massgeneral.org/rls-registry

[SueJohnson in reply to rls-ottawa]

Reminder take 600 mg 1 to 2 hours before bed and the other 300 mg 2 hours before that.

[rls-ottawa in reply to SueJohnson]

>Ontario

Ottawa is part of Ontario

[SueJohnson in reply to rls-ottawa]

Duh! Shows how much I know.

Kingston- Dr Garima Shukla is a neurologist at Queen's University. She is an officer of the IRLSSG (International Restless Legs Study Group).

Toronto- Dr. Mark Boulos neurologist at Sunnybrook Hospital. He is an Associate Professor, Department of Medicine, Division of Neurology, University of Toronto, Ontario. He spoke at the RLS foundation research virtual summit.

For support in Ontario if you join the Restless Legs Foundation you can call the RLS Support Contact in Toronto ON Armand Gilks 416-561-2710. He might be able to provide more information on opioid availability. He is a volunteer.

Neither are close but many doctors may only require you visit once if at all and will do telehealth after that.

[Purpleyam]

I am in Alberta and I've been on Tramadol with Gabapentin for nearly 2 years. Your gp is not good for you, it sounds like she speaks down to you and doesn't want to learn about RLS. I went to a Sleep Specialist here in Calgary who confirmed and even increased my Tramadol to 50mg nightly so that I'd get best coverage of my RLS. I'm also on 1200mg Gabapentin, taken in 2 doses of 600 mg only in the evening. I wish you luck in getting the proper health care that you need.