Augmentation and Levodopa

I had previously written about my concerns over augmentation. My restless legs syndrome (RLS) is very severe when I don’t have a medication to manage it. Even with alternative methods and lifestyle changes added in there.

My neurologist put me on levodopa as a way to manage my RLS. Since I really knew nothing about the treatment of RLS, I definitely had no alternatives to suggest. It is an effective medication for me; I’ll give it that. Levodopa is a dopamine precursor drug, and it turns into dopamine in the brain.

The potential for augmentation

Levodopa has a pretty fast rate of augmentation in some people. In about 2 months, in 60 percent of people, augmentation can occur. It seems to be a fairly common problem that levodopa treatment can cause rebounding morning or afternoon RLS symptoms.1

Augmentation and restless legs syndrome symptoms

Augmentation means RLS symptoms can worsen in the late afternoon or early evening, or medication is needed during the day as RLS symptoms become a problem in the daytime.

Some people begin to notice other areas of their bodies affected when they were never affected by RLS before (like the arms or torso).

Augmentation was first reported by Allen and Earley and found to occur in over 80 percent of RLS patients treated with levodopa, especially at a dosage exceeding 200 mg per night.2,3

That doesn’t necessarily mean someone on it will experience augmentation quickly, or at all. One thing I know about medications is that we all definitely respond to them differently.

My early days with Levodopa

Clearly, this medication was very effective for me. I didn’t augment on it quickly. My dosage was 1 to 2 pills per night at 100 mg. However, knowing about this medication made me reluctant to take that much.

I would try half a pill to one pill and see if that worked first. I also tried to do a lot of alternative treatments and removed all other medications that could be aggravating my RLS. I was just really trying to calm the RLS down so I needed less medication.

Finding some relief on Levodopa

All my efforts somewhat worked. My RLS was extremely severe, painful, and in my arms, legs, and occasionally my torso. I got the intensity down a bit, and I now usually just get it in the legs.

It is still usually painful, though. Nevertheless, making some lifestyle changes and changing some medications did put a dent in the situation. I just still needed medication to manage the symptoms.

Reaching the point of augmentation

I am clearly at the point of augmenting on levodopa now. I have some pretty obvious signs of it.

  1. The first indication there was a problem was the increase in daytime RLS. It was a rare thing. It got to be more common, and at this time, it is extremely common. If at any time I am at rest, RLS kicks in – hard.
  2. There was an earlier onset at nighttime as well. So before I went to bed. Then early evening. Then before dinner. Some seriously early onset of my RLS.
  3. Symptoms kick back in during sleep. So in the middle of the night, I wake up with symptoms and have to get up and take more medication. Or walk around for a bit. Or stay up for a bit.
  4. Some days, it seems like it just never actually goes away. When I wake up, it is still there – to a lesser extent, but there. And bothersome the whole day, especially if I dare to rest at all.
  5. No matter what, RLS does kick in a lot faster during the day than it used to for sure.

I am planning to change my medication

So I clued into what was going on, finally. I am dealing with some insane RLS symptoms as a result. And insane insomnia.

Due to the pandemic, I have not been able to contact my neurologist. So I have to wait for my next phone appointment with him to change my medication. Until then, I may pick up midnight tap dancing as a coping strategy.

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