RLS Augmentation and Weaning off Mirapex

In case you haven't read my posts/questions before, I am a 60-year old female with severe RLS/PLMD and severe OSA. My AHI is now down to almost nothing and sleepiness better after CPAP therapy since November, the Mirapex prescribed by neurologist was a nightmare in terms of augmentation and not clearing the fog, but rather making me dizzy and tired and having "the budgies" even during the day. At the suggestion of this forum, had my PCP run blood work and sure enough, ferritins were below 50, Vitamin D was low, A1C borderline at 5.7. I started titrating down off the Mirapex a few weeks ago and am down to one .125 pill a day now but the RLS is crazy in the afternoons now and I have to take the Mirapex then to get through work to end of day. Once I fully wean off in about a week, will the augmentation continue? He wants to start gabapentin (sp.?) after I'm off Mirapex. I am currently supplementing with huge dose of Vitamin D once a week for a month and gentle iron/Vitamin C daily to get ferritin up. Thoughts?

Hi, myself and others on the forum have used gabapentin (Neurontin) to treat RLS/PLMD (I have PLMD but not RLS). It does seem to work, somewhat, for a few people, without negatively affecting sleep architecture as some of the other medications do. The major shortcoming of gabapentin seems to be dose tolerance (ever increasing dosage required to achieve the same result). Gabapentin seems fairly benign as far as side effects go. I obtained fairly good results using gabapentin in conjunction with nsaids, but I could not tolerate the nsaids (Tylenol + Ibuprofen) and the gabapentin became ineffectual without them. Gabapentin also appears to be useful in helping to withdraw from addictive drugs, such benzodiazepines. Horizant is a formulation of gabapentin which is supposed to overcome the dose tolerance of Neurontin, though I don't know if it does.
Overall, gabapentin seems relatively safe, effective for some, and worthy of a trial.

Hi. Were your other posts under the same user name? It's kinda hard to follow people's stories when not a forum member and prior posts are scattered. It's great that things are settling in with your CPAP treatment. Hopefully soon you'll be able to say the same about your RLS. I may have missed this info, but are you on any meds that could be causing your RLS, particularly anti-depressants? It's just hard to know what is going to help you till you try.

I think the most information on augmentation is over on the RLS board http://bb.rls.org/viewforum.php?f=17&si ... 21d301ad5a

I have had RLS I'm sure most of my life. My mother had it. We called it the budgies before there was a name for it. No, I'm not on any meds that would would affect except Mirapex and the augmentation. As I had mentioned, at your suggestion I had bloodwork done and my ferritin was under 50, so I am supplementing with iron/Vitamin C. I am also supplementing Vitamin D with 50,0000 megadose weekly because that was low. I am supposed to start gabapentin tonight. Will the RLS that I am now having in the AFTERNOON calm down after getting off Mirapex? The Mirapex did help me sleep through the night, it was the daytime that was a problem on it. Neurologist says I have to try all these drugs in a certain order for insurance to cover, so I'm just a guinea pig. Hopefully I won't lost my job and insurance before they find the right one.

If you start Gabapentin you WILL sleep at night

Ferritin follow up -- had blood work done, and it checked. Numbers are all good.

PLMD -- Polysomnography had me at 120 events per hour on last over night visit (on oxygen). Doc's recommendation was daily clonazepam (benzo) which I really want to avoid. Still working on finding my sweet spot of other medications.

kteague wrote:I think the most information on augmentation is over on the RLS board

Yes and here is a good thread to study -> Mirapex to gabapentin -> http://bb.rls.org/viewtopic.php?f=4&t=9 ... c21455f055