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Taking Ropinirole For RLS/WED Condition. Recommend?
Question: Hi Doc.........currently taking 11mg of ropinirole per night after dinner for 35yr old severe RLS/WED condition. Over the years we have tried many heavy hitter pharmas and I was just wondering if you have had any luck lately with this condition or if you had any recommendations?....My pcp suggested a trip to Mayo in Fla., but after that the disease {constantly morphing} started responding to the requip so Now at least I can sleep all night only after suffering severe attacks for 30 to 45 minutes after taking the requip.{augmentation probable}. Truly at a hopeless stage. I will pay for your input out of sheer desperation. The Neuro Docs here are really lacking in knowledge and understanding on this "non-lethal" disease and seem rather apathetic frankly. If you know of a Dr. that is cutting edge on this subject I would owe you big time or maybe you are my miracle......... XXXXXXX
Brief Answer:
Try adding gabapentin to ropinirole.
Detailed Answer:
Hi XXXXXXX
Welcome to Healthcare Magic!
I agree that recommended blood tests and other investigations that have presumably come as normal, I shall move to the treatment part. I have the following suggestions for you.
1) Discuss with your doctor regarding a hike in the dose of ropinirole, since you are on 11 mg/day at present and it is feasible to hike it further. However, if your doctor is suspecting augmentation, this may not be advisable.
2) I guess that in addition to ropinirole, you might also have tried pramipexole, rotigotine and levodopa, which are similar acting agents. If you have not tried pramipexole, it is a good option for you particularly if you wish to hike up ropinirole and cannot, because of side effects. It is of similar efficacy to ropinirole but has lesser side effects.
3) I do not know if you have tried gabapentin or not. I have found it to be efficacious in quite a few of my patients. In your case, since ropinirole has already benefited you, I suggest that you discuss with your doctor regarding combining ropinirole with gabapentin. Both agents have different mechanisms of action and will act synergistically to bring you greater relief. Also, the problem of augmentation is not so common with gabapentin as with ropinirole.
4) Some of my patients have reported benefit in RLS symptoms with practicing Jacobson's progressive muscular relaxation technique, which I had taught them for other indications like comorbid anxiety. You can try this or any other relaxation exercises before going to bed every night and see if it helps you. Even if it doesn't help in RLS symptoms, it will certainly improve the quality of your sleep and as well as daytime well being. Best of all is that it costs no money.
5) Although you must be aware of this, I still wish to emphasize that please ensure that your doctor has ruled out presence of any venous disease like varicose veins and any thyroid disorders, because both of these are commonly associated with RLS. You have already mentioned that iron deficency has been ruled out.
I hope some of this is of benefit to you. Please feel free to ask if you want any clarifications. I shall try to answer to the best of my capability.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Try adding gabapentin to ropinirole.
Detailed Answer:
Hi XXXXXXX
Welcome to Healthcare Magic!
I agree that recommended blood tests and other investigations that have presumably come as normal, I shall move to the treatment part. I have the following suggestions for you.
1) Discuss with your doctor regarding a hike in the dose of ropinirole, since you are on 11 mg/day at present and it is feasible to hike it further. However, if your doctor is suspecting augmentation, this may not be advisable.
2) I guess that in addition to ropinirole, you might also have tried pramipexole, rotigotine and levodopa, which are similar acting agents. If you have not tried pramipexole, it is a good option for you particularly if you wish to hike up ropinirole and cannot, because of side effects. It is of similar efficacy to ropinirole but has lesser side effects.
3) I do not know if you have tried gabapentin or not. I have found it to be efficacious in quite a few of my patients. In your case, since ropinirole has already benefited you, I suggest that you discuss with your doctor regarding combining ropinirole with gabapentin. Both agents have different mechanisms of action and will act synergistically to bring you greater relief. Also, the problem of augmentation is not so common with gabapentin as with ropinirole.
4) Some of my patients have reported benefit in RLS symptoms with practicing Jacobson's progressive muscular relaxation technique, which I had taught them for other indications like comorbid anxiety. You can try this or any other relaxation exercises before going to bed every night and see if it helps you. Even if it doesn't help in RLS symptoms, it will certainly improve the quality of your sleep and as well as daytime well being. Best of all is that it costs no money.
5) Although you must be aware of this, I still wish to emphasize that please ensure that your doctor has ruled out presence of any venous disease like varicose veins and any thyroid disorders, because both of these are commonly associated with RLS. You have already mentioned that iron deficency has been ruled out.
I hope some of this is of benefit to you. Please feel free to ask if you want any clarifications. I shall try to answer to the best of my capability.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for your input. Tried gabapentin in the distant past and it seemed to make it worse.I have seen more side effects from "mirapex" than requip., so that's out. Thyroid and vascular checks were made and a two hour MRI {with RLS active} was torture.This disease goes through so many changes......Sleep quality is good now, but the RLS episodes before are hell. I'll look at the exercises that you mentioned. The sensations seem to stem from the spine base and then to one leg or the other. Very difficult to describe. The rotigotine patch and levadopa have not been tried and I'll continue to explore.I've learned to stay away from "Benzos" and the last heavy hitter prescribed was Trazadone. {bad stuff but ended sleep deprivation}.I could go on, but it is really useless. I truly suspect that WED is a nutrition based disease. It is worldwide and getting worse. Thanks for input!
Brief Answer:
Thanks for sharing your experience with me.
Detailed Answer:
Hi,
Thanks for sharing your experience with me.
You may be right in saying that RLS/WED may have a nutritional basis. There have been many reports of improvement with vitamin supplementation. Maybe in the next few years, we will know much more about this disease than we do now.
I am glad that you avoid benzodiazepines. That is a really sensible decision. People have tried even opioids for relief, and then they get into even worse problems than RLS.
Hope that you get better with time.
Best wishes.
Dr Preeti Parakh,
MD Psychiatry
Thanks for sharing your experience with me.
Detailed Answer:
Hi,
Thanks for sharing your experience with me.
You may be right in saying that RLS/WED may have a nutritional basis. There have been many reports of improvement with vitamin supplementation. Maybe in the next few years, we will know much more about this disease than we do now.
I am glad that you avoid benzodiazepines. That is a really sensible decision. People have tried even opioids for relief, and then they get into even worse problems than RLS.
Hope that you get better with time.
Best wishes.
Dr Preeti Parakh,
MD Psychiatry
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Above answer was peer-reviewed by :
Dr. Raju A.T
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