pregabalin and alcohol

[Woodla63]

I have been on Pregabalin for approximately 6 weeks a 50mg dose per day along with the neupro patch. (3 mg)I have a new neurologist and she has been trying different things . My question is we are going on vacation and I would like to have a few drinks . I called my neurologist and they said I would be fine with one to two drinks a day . Has anyone had experience with the Pregabalin and alcohol? I’m worried if I have more than a couple drinks a day if I’ll have a problem .

[_quantum]

Pregabalin/gabapentin enhances the effects (and side effects also) of alcohol.

I drank a bottle of wine yesterday and then took gabapentin 300mg (equals pregabalin 50mg). I keep an interval of 3-5 hours between them. But ideally it is better not to drink at all

[skelley35 in reply to _quantum]

I have and experienced only a very small enhancement of effects.

[Woodla63 in reply to skelley35]

Thank you!

[Joolsg]

I do hope the new neurologist has advised you to get off the Neupro patch. Many doctors put patients on this after Ropinirole or Pramipexole when the patient has drug-induced worsening (augmentation).The patch quickly causes WORSE augmentation.

No point starting you on pregabalin until you are about a month off dropping the last dose of Neupro.

Pregabalin does NOT stop augmentation and doesn't reduce severity of RLS during Neupro reduction or withdrawal.

All dopamine agonists are now 'last resort' meds.

The Mayo Clinic Algorithm and the new AASM guidance sets out correct treatment.

A low dose opioid will help during reduction of Neupro.

Dr Andy Berkowski in Ohio is a top RLS expert and this webcast explains why Neupro is the worst dopamine agonist.

If your new neurologist has not arranged blood tests/iron infusions and has not given you a safe withdrawal schedule for Neupro- let us know where you are.

We can direct you to an RLS specialist.

So I would not take the pregabalin just yet if I were you. It's too early during the withdrawal process.

RLS-UK sets out a Neupro withdrawal schedule on the website under -'useful resources'

rls-uk.org/useful-resources

youtu.be/Tz7g9sxS0_I?si=yf8...(Not working as expected?)

[Woodla63 in reply to Joolsg]

Actually my new neurologist put me on the neupro patch. I had been taking the mirapex for several years and had become ineffective. Her suggestion was to try the patch . After several weeks I contacted her and told her it wasn’t working . She bumped the dosage from 2 to 3 mg. At my next appointment I told her that still wasn’t cutting it. Also told her that it had $100 copay and I would be retiring at the end of the year and marketplace insurance would not cover it . Asked to try something else . She then added the Pregabalin and said to try that and eventually ween of of the patch . My next appointment isn’t until June and this doesn’t always work either . With the addition of the Pregabalin I am tired all day and up half the night . Not a fan . I’ve had rls for 30 years and the doses she has me on seem very low.

[Joolsg in reply to Woodla63]

She clearly knows very little about RLS.To put you on Neupro once augmentation has hit is a very bad idea. And then to increase the dose is negligent.

You need to see a good doctor asap.

And it's a waste of time and money to start pregabalin now.

There are lots of really good RLS doctors in the USA.

Join rls.org and they have a list of good doctors, a great newlsetter and magazine and help groups throughout the USA.

You'll never be free of severe RLS until you're off ALL dopamine agonists.

[Woodla63 in reply to Joolsg]

Can I quit taking the Pregabalin on my own ? I will look into rls.org to see if there are any good doctors near me . We live in a rural area so probably doubtful 😞

[Joolsg in reply to Woodla63]

Yes. If you've only been on it for a short time. But always best to go slowly. So ask for 25mg pills and cut open with scissors- spread powder on card and drop 12.5mg a week. You should avoid any withdrawals.

[Woodla63 in reply to Joolsg]

Thank you for your advice, I appreciate your help!

[ADP17 in reply to Woodla63]

Your. Should only be taking pregabalin in the evening for RLS, which is when you need it! Taking it in the morning simply wastes it and makes you sleepy.

[Woodla63 in reply to ADP17]

Yes I only take it in the evening

[SueJohnson]

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

I agree with everything Joolsg has said but let me give you my usual advice which repeat some of the things she said but elaborate on some of them.

The fact that you had to keep increasing the dosage means you were suffering from augmentation. Dopamine agonists like ropinirole, mirapex (pramipexole) and Neupro are no longer the first line treatment. Gabapentin or pregabalin are.

You can do the reduction in one of 2 ways. Using a 1 mg Neupro patch cut it into sixths. Easiest way is to draw lines on it. This will equal the .25 mg reduction since 1 mg of Neupro = 1.5 mg ropinirole,. Or you can switch to ropinirole. Multiply the dose of Neupro you are taking by 1.5 to get the correct amount. Since you can get ropinirole in .25 tablets this is the easier way to reduce. Call your doctors office and ask for her to prescribe them.

Then to come off ropinirole reduce by .25 mg 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.

To come off pregabalin don't just stop or you may have withdrawal effects even after only being on it for 6 weeks as your body has already gotten used to it.. Reduce by 25 mg every 2 weeks.

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 ropinirole 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. In any case reply back and let us know what they are.

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...

What is the closest city you live near. I have a long list of doctors and may be able to give you the name of knowledgeable one. What is the name of the neurologist you are seeing now?

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 although it doesn't for all, 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.

[Woodla63 in reply to SueJohnson]

I did have my Ferritin levels checked and they were ok. My b12 was a little low so she has me on a supplement for that . I am in the upper peninsula of Michigan zip code 49854. I do take a magnesium supplement and then bergamont and berberine supplement for cholesterol.

[SueJohnson in reply to Woodla63]

What's normal or OK for other people is not normal for those of us with RLS. Call the doctor's office and ask what your ferritin and TSAT (transferrin saturation percentage) is and reply back here.

You have me stumped on doctors except for Dr Joseph "Andy" Berkowski who is excellent and a world renowned expert but he does not take insurance and is expensive. His pricing is on his website relacshealth.com He does teleconference.

[Oscarcat63]

I am so sorry that you have been given a dopamine agonist (again) - Sue, Joolsg and Chris Columbus are incredibly knowledgeable and very helpful regarding rls - you will learn about the horror of augmentation on Neupro and its like.And they will tell you (and support you) if and when you want to stop it.

In regard to pregabalin, I am on 300 mg a night and have been for nearly 2 years. I started with 75 mg though and was on Pramipexole (I think that's what Mirapex is) at the same time.

I did notice that I was quite drowsy, and did put on some weight with that combination. I had little problem stopping the latter drug, but I had been on it at a low dose for a short period - even then I had to wean myself of it.

In regard to alcohol, speaking purely for myself, if I over indulge, then yes 1) I will be more sleepy than usual, and 2) I will be in for a bad night of rls. However, I am quite tolerant now of my dosage of pregabalin - meaning if I do have a few drinks (not before bed, mind), that it really makes no difference.

It's all about what works for you though.

[Woodla63 in reply to Oscarcat63]

Thank you I appreciate your advise.

[amrob123]

Any more than one glass of wine on 300mg pregabalin and I feel quite unwell. Also, when I took pramipexole, a dopamine agonist like Neupro, it seemed to treble the effects of alcohol. I most definitely wouldn't be keen on combining alcohol with pregabalin and Neupro.Then again, we all metabolise drugs, including alcohol differently. I'm slim and seem to have a fast metabolism.

[Woodla63 in reply to amrob123]

Thank you for your advise . Not a big drinker myself but we are going to Cancún to an all inclusive so I might have a couple of drinks . I will be careful for sure to see how one goes .

[Purpleyam in reply to Woodla63]

If I were you, I'd carefully drop the pregabalin and enjoy the heck out of my Cancun vacation! 🌴🌵🍹🍷 Then once you are back look at the schedule for weaning off Neupro. Will you be retired by then? You'll need lots of time to manage your sleeplessness and irritation from the weaning process. Best wishes to you. We are here for you, we understand the misery. Believe us it will get better. 🩷

[Woodla63 in reply to Purpleyam]

Thank you !

[Merny5]

I have an excellent neurologist. Would you be apposed to seeing someone once a year in Macomb county?

[Woodla63 in reply to Merny5]

I may be ok with that if I continue to have problems with mine . My daughter lives in Macomb county so we do visit there .