Doctor about turn!!

[Jukebox55]

having got down to 1 1/2 pramipexole, i was back to my old insomnia… waking constantly, legs going mad. So time to see Gp. My regular doc had refused to give me gabapentin due to addiction issues. So talked to a different GP. I explained i was no longer sleeping well and she offered me sleeping tablets!!! Unable to prescribe gabapentin for insomnia… she said the uk did not follow the Mayo clinic recommendations. So I said, forget about the insomnia. Can you prescribe it for coming off pramipexole for restless legs? Yes, she said!!!! So i got there in the end! She prescribed 75mg x 2 daily. Started taking them 2 days ago at 4.00 and 8.30. BINGO! 8 hours uninterrupted sleep! Not had that since i had a general anaesthetic!! Thinking i could cut it down to 50mg? I am 68 but my liver function is fine so doc didn’t think i needed to take less (as advised in algorithm). Any thoughts anyone? Love the help i get on this site. The help, especially from Sue and Jools has been both inspirational and transformational. Deeply grateful. I wouldn’t have got to this point without you.

[Joolsg]

I think she has prescribed pregabalin 75mg, rather than a sleeping tablet. Can you confirm?

It's great that you slept so well, but that may not continue as you reduce the Pramipexole further. If I were you, I'd take just 75mg pregabalin at night until you're ready to drop the last dose of Pramipexole. The RLS symptoms will ramp up and you can then increase pregabalin back up to 150mg, taking only at night. As RLS follows the dopamine cycle, you only need to take it in the evening.

If the Pregabalin doesn't cover all the withdrawal, you can ask your GP for a short term opioid, like tramadol, codeine or oxycodone for the 4 to 5 weeks after the last dose of Pramipexole.

Fingers crossed your withdrawal continues smoothly.

Keep track of your serum ferritin levels, as keeping them above 100 MAY help reduce severity of withdrawal.

[Jukebox55 in reply to Joolsg]

sorry if I wasn’t clear. She has prescribed 75mg of pregabalin ( i asked her for gabapentin). I will keep taking pramipexole, now down to one tablet for a month then a half for a month and then stop. Thanks so much for your advice.

[LotteM]

Good to hear, and I hope it lasts. Just something to clarify: 2x 75mg is a atrangely low dose for gabapentin, that usually starts with 100mg or 300mg doses. Maybe your doctor prescribed pregabalin? Pregabalin is also available in 50mg and 25mg pills.

Also, as for RLS usually one mainly needs medication in the evening and at night, consider playing around with the timing of the doses. Maybe even only the evening dose suffices.

[Jukebox55 in reply to LotteM]

thanks for your reply. The doc prescribed pregabalin 75mg x 2 daily. Yes, will play with the timing… maybe one dose at night will be enough. Thank you

[SueJohnson]

It's great that you finally found a doctor that can help although discouraging that she said the UK did not follow the Mayo clinic recommendations. As others have said, take your pregabalin only in the evening. You can try just 75 mg but I see nothing wrong with increasing it up to 150 mg if needed. I gather since you said you were thinking of reducing it to 50 mg that you have 25 mg pills so if 75 mg is not enough you could try 100 mg and if that is not enough 125 mg rather than going straight to 150 mg. 150 mg is still a low dose although I certainly wouldn't increase it more until you are off pramipexole and your symptoms from that have settled.

[Tanker1]

As a side note: Pregablin (and gabapentin) does not undergo any metabolism in the liver and does not induce or inhibit any liver enzymes.

[Jukebox55]

The Mayo algorithm suggests the over 65s should reduce their pregabalin to 50 from 75. Due to liver issues. Apparently…. Thanks for your input.

[SueJohnson in reply to Jukebox55]

No - they say the starting dose of pregabalin should be 50 mg rather than 75 mg. "Treatment should commence at . . . 75 mg of pregabalin daily (50 mg in patients older than 65 years)"