Augmentation on low dose pramipexole?

[Catscratchman]

Hi folks, is it possible to get augmentation if I am only taking 88 to 176mcg per day of pramipexole and have only been doing so for about 3 months. It worked well initially but now I'm getting symptoms during the day as well as at night. Have messaged neuro but he is strangely silent and am wondering what the next step is. Many thanks.

[Nanpat]

Sorry can’t answer your question but am having a similar problem with Targin, worked initially but now I swear it’s bringing on my rls….even though this seems impossible. Frustrating

[Elffindoe]

I'm afraid that it's documented that even a small dose of a dopamine agonist such as pramipexole can cause augmentation. It appears you have been very unlucky.

Unlucky because

a) It usually takes a higher dose

b) It usually takes longer

c) Your doctor has prescribed soemthing which is no longer recommended for the first treatment of RLS.

There may be another factor however, i.e. I note you say you take 1 to 2 tablets a day. If this means that one day you might take 2 and the following only 1, this is not really a good idea.

It may be because of this that, rather than having augmentation, you are suffering "rebound" which occurs when the drug wears off.

Notwithstanding, if pramipexole is the first drug you'be been prescribed for RLS then according to the latest recommendations you should not have been prescribed it.

Additionally,if you are suffering augmentation then it's recommended that you stop the pramipexole and start taking an alternative.

The drugs now recommended for the first drug treatment of RLS and the alternatives to a dopamine agonist are called alpha 2 delta ligands,either gabapentin or pregabalin.

In additon your doctor should haver discussed iron therapy with you. This is the first treatment for RLS as iron deficiency is the main cause of RLS. Drugs really are a last resort.

Secondly, if you're taking may other mecdications for any other health condition, then they are possibly making your RLS worse. There is quite a list if these.

I think your options are either

a) take the same number of tabkets evert day. Never take mnoire than two. If that doesn't work after a few days then OR

b) ask your doctor for gabapenbtin or pregabalin, start taking it and THEN reduce and stop the pramipexole.

NOTE ; after taking the pramipexole for 3 months you will have developed a dependency which means

1) Do not stop it suddenly, this is dangerous.

2) Reduce the dose in steps of half or even a quarter of a tablet (44to 22 mcg) and no more often than once every 10 to 14 days.

When you do reduce it, you may get wthdrawal effects within 24 hours, a worsening of symptoms and insomnia which should diminish in days.

The starting dies for gabapentin/prgabalin are 300mg/75mg.

The minimum effective doses are around 900mg/150mg so you well need to raise the dose until it becomes effective.

Thye maximum doses are 2700/450mg.

]

It often takes 3 - 4 weeks for these to work.

I appreciate that your doctor may not be aware of any of what I've written so you can refer him/her to the following links which they (and you) should find very informative.

mayoclinicproceedings.org/a...

cks.nice.org.uk/topics/rest...

cks.nice.org.uk/topics/rest...

sciencedirect.com/science/a...

pubmed.ncbi.nlm.nih.gov/274...

If you've just been diagnosed with RLS, then you need to educate yourself about the condition and its management, you cannotrely on doctors for this.

Read about other people's experience and the pinned posts on this site.

If you have further questions, please ask. Somebody is awlays willing to respond.

[Catscratchman in reply to Elffindoe]

Thank you so much Elffindoe. That's just the advice I was looking for.