Increasing the Dose: My First Augmentation Experience

Don’t worry if you have never heard of augmentation before — neither did I, until recently. Augmentation is the worsening of RLS symptoms that happens with dopaminergic drug treatment. The medication may work at first, but over time the body develops a tolerance and symptoms may be worse than they were before starting treatment. This may lead to a need to increase the dose of the medication.¹

In a way, I am glad that I am not the only one who experienced this with pramipexole. Between 50 and 70 percent of people who take these drugs eventually experience augmentation within 10 years.²

Not my first experience with building up a tolerance to medication

While this may be my first augmentation experience, I am definitely used to my body building up a tolerance to other medications.

I first experienced this when I was 17 and was prescribed glucosamine for my mysterious joint issues. I think I was okay for about 6 months, maybe a little bit more, before glucosamine was no longer helping me. My GP decided not to increase the dose. I ended up finding a natural medicine that helped me and I didn’t build up a tolerance.

A history of tolerance issues and switching medications

Building up a tolerance has mainly been a pain for me with my endometriosis. In the beginning days, I would be okay with a birth control for about a year before my body would build up a tolerance and I would need to change to a different brand of birth control. Eventually, we gave up on birth control and switched to Visanne.

I am sure that if I had better experiences with medications I would have experienced more tolerance issues, but most medications I've tried don't work for me. That being said, with medical marijuana, you can build up a tolerance.

It’s normally suggested to take a tolerance break, but because I don’t have anything to help with my constant pain and nausea, I avoid tolerance issues by consuming different strains. Otherwise, I would have to consume more within the doses that I currently take.

Deciding I needed to increase the dose of my RLS medication

I wasn't sure if I was experiencing augmentation at first because sometimes my RLS will act up, like a tiny little flareup, and that can last anywhere from a couple of days to a week. This can be due to stress, not sleeping properly, not walking enough, or a combination of all of the above.

My RLS was starting to act up in the middle of the day when I would go take a nap, and I wouldn't be able to fall asleep because of it. When a month passed with no change, I figured that I was suffering from augmentation and needed to increase my dose.

Increasing my dose of pramipexole helped calm my RLS symptoms again

I increased my dose of pramipexole by 0.25mg, and about a week and a half later I noticed my RLS had calmed back down. I talked with my GP about everything I was experiencing and she agreed to increase my dosage. I think, if this happens again, I will try increasing the magnesium dose first.

Are you someone who has experienced augmentation on your RLS journey? If so, what was it like? Do you have any advice for those of us who are new to augmentation or who haven’t experienced it yet?