My RLS Medication Mix

There are 4 FDA-approved drugs for those of us with restless legs syndrome (RLS). They are gabapentin enacarbil (Horizant), pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro). I have experience with several of these drugs.

When I was diagnosed with RLS, the first medication my doctor prescribed was gabapentin (substituted for Neurontin). It helped with my symptoms but did not control them completely. We worked with the dosage and dosing schedule. You can read about my experience with gabapentin in more detail.

Adding Requip to my mix

Unfortunately, my symptoms continued to be problematic. I had been on gabapentin for more than a year when my doctor added Requip. I started with a small dose, and as I recall, I took it twice a day (it’s been a long time, so that detail is a little fuzzy in my mind).

Happily, I had no side effects. Over time we tweaked the dose and dosing schedule. Eventually, I ended up with a somewhat larger dose that aligned with the same schedule as my gabapentin regime.

My 3 biggest RLS triggers

I have always been susceptible to certain RLS triggers. Being sedentary, the weather, and stress are the big 3 for me. I described how lack of movement affects my symptoms when I told about my diagnosis experience. At that time, I didn’t know heat also triggered my symptoms. I live in Florida, the Sunshine State. It’s summer here most of the year. In fact, we have 2 growing seasons. How ironic is that?

I think it was the second summer after I was diagnosed that I went running to my doctor in a panic because I crawled constantly. No matter what I did, I couldn’t find relief. Since I know sitting is a trigger for me, I started walking more. I would walk 3 or 4 times a day. Outside. In the heat. Poor foolish me; I had no idea I was making my symptoms worse.

Once again, my doctor tweaked my prescriptions and re-educated me on known RLS triggers with emphasis on the ones that seem to be most relevant to me. I must have corn in my ears. Florida. Heat. How did I miss that?!

My introduction to the Neupro patch

I was on gabapentin and Requip for a number of years with moderate success. Aside from the typical nighttime symptoms, I am prone to daytime crawling as well. Even with the two medications and lifestyle changes my symptoms continued to slowly escalate over time.

I have a tendency to put up with discomfort because I don’t want to feel like I’m complaining. I would go from each regularly scheduled appointment to the next 3-month appointment without calling for help even if I was miserable. Don’t do that. If you’re uncomfortable, call your doctor for help. In fact, the nurse said almost those exact words to me once.

At one of my regularly scheduled appointments, my doctor suddenly looked up from reviewing my chart and asked, “Have we tried the patch with you?” Patch? What patch? I don’t know anything about a patch. Wait. Let me search my memory because I tend to forget things. Nope. Never had a patch.

He explained how the patch works and started me off with samples. He also said there was a small possibility the patch would work well enough that I may, at some point in the future, be able to stop the other meds. I was so excited; anyone who saw me leave the office that day must have thought I’d won the lottery.

Where am I now?

As of this writing, I’ve been wearing the Neupro patch for almost 3 years. The only side effect I’ve experienced is itching when I remove a patch. For me, that has been easily fixed by whatever antihistamine cream I have handy or even some soothing hand lotion.

My dosage has been as low as 2 mg and as high as 8mg. The larger the dose, the larger the patch. I don’t know why, but that surprised me. I haven’t been able to decrease the gabapentin or the Requip as we had hoped.

Even so, I feel that my experience with the Neupro patch has been successful. During those times, especially in the summer, when I need more pharmaceutical intervention to find comfort, the patch has provided me with another avenue of relief.