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[RLSbeegone]

I have had RLS for as long as I can remember. I am 66 now. About 4.5 years ago I was so miserable at night and even had daytime symptoms my GP put me on ropinerole 0.5 mg at night if I remember correctly. It was a wonder drug for me. At some point I had what was probably augmentation with more daytime symptoms and evening symptoms starting earlier. My GP added .5 mg in the morning, .5 mg in afternoon if needed then 1 mg closer to bedtime. The morning dose was enough and for quite a while (1.5-2 years) I have been on 0.5 am, 1 mg 5-6 pm then .5 when I go to bed. Last summer my GP must have heard of new guidelines because she wanted me to try Gabepentin instead of ropinerole but made no mention of tapering so as expected that did not go well. She sent me to a neurologist in December who explained tapering and was honest about how difficult it may be. I was going to be taking a driving vacation and also had foot surgery planned for February so we held off on this process. I had kept on the Gabepentin as both together were helpful and I read that it helps some people with osteoarthritis in knees.

In the meantime the neurologist ordered a sleep study at home which showed mild obstructive sleep apnea and I have since been fitted with an oral appliance which does seem to be improving my sleep so far. I had my foot surgery and continuing to heal.

When I saw the neurologist she outlined her plan. Her plan was to completely be off ropinerole then start the pramiprexol because it had a longer half life. She would have me take Gabepentin 300mg 3 times a day until off ropinerole. After reading on this site why would that be recommended?

I have an appointment this coming week to discuss again.

my last iron studies were July 2024 and ferritin was 108 and the transferritin saturation was not tested.

I have not attempted any changes. I am still on Gabepentin 400mg in am then 400mg with the 1 mg ropinerole at 5-6 pm. I still take ropinerole .5 mg in the am and at bedtime. I take magnesium oxide 400 mg at bedtime away from the Gabepentin. Since things have been stable for so long I don’t think I am in augmentation currently.

so, my main thoughts are why she would want to switch one dopamine agonists for another?

I plan to ask to retest Ferritin and see about getting it over 200 before making major changes. Also giving the sleep apnea treatment a little longer to see if that may make a difference.

Is there anything else I should be asking or any suggestions. She had mentioned possible need for opioids. I am in Iowa USA, on original Medicare with a supplement. I am interested in hearing thoughts about the ToMAC nerve simulator. Is that covered by Medicare?

Thank you!