How to Taper off Dopamine Agonists for Restless Legs Syndrome (RLS)

@andyberkowskimd of ReLACS Health summarizes the process for tapering off dopamine agonist medications for patients and their healthcare providers. Dopamine agonist medications--three of which are FDA approved for the treatment of restless legs syndrome (RLS)--have been shown over the past two decades to worsen the condition gradually, a process called augmentation. Augmentation is at least partially reversible by completely tapering off the medication. However, due to a strong chemical dependence of the brain's dopamine system that develops with long-term use of these drugs, the process is very challenging and must be done under the guidance of an experienced physician or advanced practitioner.

For additional information on why dopamine agonists are bad for RLS, read this blog post:

[brianoverstreet]

Thanks for this whole series of RLS videos. I currently take pramapexole, methadone, and pregabalin. Unfortunately I accidentally mixed up my old .5 mg pramapexole with my new .125 mg. I've been talking 1.5 mg and had psychological side effects and terrible augmentation. I haven't had more than 3 hrs sleep per night for the last week. Thanks for the information about the blood thinner medication. I'll ask my neurologist about it.

[kimchamberlain]

I tapered off the Neupro Patch over a period of about 6 months. I used Buprenorphine to help ease off the dopamine agonist. It was the best thing I ever did.

[jameshallmark]

How can I start Gavapentin while weaning off of Ropinirole?

[liamporter]

Thanks for sharing. I can't stop Gabapentin now as the night is so torturing when I try to skip it. Worrisome.

[fritzb]

What about augmentation with tramadol - much riskier, since tramadol is an opioid. Second, what is the replacement for dopamine agonists??

[barbarab]

Hello Dr Berkowski, I have severe RLS and have been on Ropinirole for 10 years. I have had augmentation for a few years now and am getting to the top of my dosage level. I want to taper off of Ropinirole as my augmentation symptoms are almost unbearable. You mentioned other drugs that can help with the withdrawal symptoms... what meds are they? Also, after leaving ropinirole, what is there to take for RLS??? I'm 57 yrs old and have had RLS since I was 17. I know that I will need some form of medication for RLS Right now my symptoms are all day long and I cannot sit to rest without my legs going crazy and I cannot take more Ropinirole. I've had iron infusions with no result and take a lot of vitamins/calcium daily due to prior gastric bypass so my levels are good. Opinion? Please...

[grant]

I am suffering Dopamine Agonist Withdrawal post tapering off 18 months ago. Are there any known treatments?

[chrisj]

I took requip for about 9 months (0.5 am, 1.25 pm) and am tapering 0.25 pm, adjusting, and then 0.25 am. The pm wasn't too bad and am now working through the am. Reason i took it was because effexor caused rls, which I've tapered off. I've increased my klonopin to help with sleep and anxiety. The rls has returned during the early morning since cutting 0.25 am. Also having gi issues, including diahrrea. Go slow with this drug, lack of dopamine is no joke.

[jona]

I take 1.5mg of Ropinirole all in one go at night before bed. If I forget to take it I get confusion and sleepwalking which often results in me having a fall. I've suffered numerous sprains and even a broken ankle from forgetting to take it on time.

[mynights]

my baseline is over 200 involuntary movements per hour while asleep, and so bad while awake that i have to keep moving.... why the hell would i ever want to stop these drugs?

[rosemeade]

My RLS is severe and I’ve been taking Gabapentin for a year. I took 300 mgs for ten months and the last two months I’ve got down to 100mgs at bedtime. If I don’t take it my RLS COMES BACK.. WHY WOULD I want to get off of it? I can’t tolerate theRLs. What would be a better drug to take? I also have insomnia! 😢 any suggestions?