No single medication controls RLS for everyone. However, one of these RLS treatment options could be right for you.
When exercise and lifestyle changes are not enough to ease your restless legs syndrome (RLS) symptoms, it may be time to talk with your doctor about certain medications that could help control your condition. Although no single medication effectively manages RLS for everyone, several drugs could help alleviate the urge to move and the burning, tingling, creeping, or crawling sensations in your legs.
When to Consider Medication for RLS Treatment
If your RLS symptoms occur more than twice a week, interfere with your sleep and normal daily routine, and don’t respond to lifestyle changes like limiting alcohol and exercising regularly, your doctor may prescribe medication to help manage your condition.
“RLS treatment is based on a person’s medical conditions as well as their lifestyle and behavior,” says Nabeela Nasir, MD, a neurologist at Loyola University Chicago’s Stritch School of Medicine. “You have to look at all those aspects and also really look at quality of life. The other thing to consider is whether or not symptoms are associated with an underlying medical condition.”
RLS symptoms are often related to issues such as iron deficiency or diabetic neuropathy, Dr. Nasir points out. “You have to keep all this in mind and then decide if the person qualifies for a pharmacological treatment,” she adds.
Medications Used to Treat RLS
Most of the drugs used to treat RLS were actually developed for other diseases, such as Parkinson’s and epilepsy.
However, the fact that such drugs may be effective for your RLS doesn’t mean you’re at any greater risk for developing Parkinson’s or another disease than someone without RLS, assures Nasir. “Parkinson’s patients tend to have more RLS and their medications take care of it, but just because you have RLS doesn’t mean you are going to develop Parkinson’s or any other problems,” she says.
There are four categories of prescription medication available to reduce RLS symptoms: dopaminergic agents, calcium channel alpha-2-delta ligands, benzodiazepines, and opioids. Here’s what you need to know about each one.
Dopaminergic Agents. These drugs increase levels of dopamine, a brain chemical. Nasir says these drugs, usually taken at bedtime, are often the first line of treatment for restless legs syndrome.
The U.S. Food and Drug Administration (FDA) has approved three dopaminergic agents for the treatment of RLS:
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· Pramipexole (Mirapex)
· Ropinirole (Requip)
· Rotigotine patch (Neupro)
Levodopa has also been used in the past to treat RLS, Nasir says.
Side effects include a very wide range of possibilities. Among the physical side effects are nausea, dizziness, and sudden sleepiness. “When I prescribe these drugs to my patients I always tell them not to drive after taking the medication,” says Nasir. Although rare, leg edema, or swelling, may also occur.
Another uncommon but troubling side effect of dopaminergic agents is compulsive behavior. “About 10 percent of patients develop some degree of impulsivity,” says Ihtsham Haq, MD, a neurologist and assistant professor of neurology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “They may take up gambling, be more likely to speed, or develop a sudden love for scratch lotto tickets.”
Although gambling is one type of impulsive behavior that could result, studies have suggested that compulsive shopping and eating may be more common. A study to determine the frequency of impulse control disorders in patients treated with dopaminergic agents, including with 100 people with RLS who were treated with the drugs, revealed that 10 percent of those in the RLS treatment group engaged in compulsive shopping and 7 percent were involved in pathologic gambling. Compulsive eating was reported in 23 percent, and hypersexuality was documented in 8 percent.
Nasir notes that compulsive behavior typically occurs about nine months after the medication is started and will disappear once the patient stops taking it.
Because compulsive behavior stemming from dopaminergic agents could worsen an underlying psychological disorder, Nasir cautions that anyone with a history of compulsive behavior should be watched and warned about this potential side effect or avoid taking this drug entirely.
Another important side effect associated with dopaminergic agents is known as augmentation. “Symptoms start to occur earlier and earlier in the day,” explains Nasir. “In someone who is having symptoms at 9 p.m., after a while with treatment they may start to complain of symptoms at 4 p.m. or 5 p.m. They may also start to notice involvement of other parts of the body. Their arms or even their trunk develops this same restless feeling.” In these cases, Nasir says, the medication must be either adjusted or tapered off.
Calcium Channel Alpha-2-Delta Ligands. These anticonvulsants, commonly used to treat epilepsy, can reduce the pain, burning, tingling, and creepy-crawly sensations associated with RLS. Nasir says that if you can’t tolerate dopaminergic agents or have an underlying neuropathy, the following medications may be prescribed:
- Gabapentin (Neurontin, Horizant)
- Pregabalin (Lyrica)
Side effects of these medications include sleepiness, fatigue, and dizziness.
“The good news is that, as an RLS treatment, this drug is taken in the evening, so even if you get a bit sleepy, it is time to go to bed anyway,” says Nasir. She notes that since the medications can cause dizziness, it’s important to use a night-light to prevent falls in case you need to get up during the night.
Benzodiazepines. These drugs are generally usually used to treat anxiety, muscle spasms, and insomnia. The following benzodiazepines are also used as RLS treatments:
- Clonazepam (Klonopin)
- Diazepam (Valium)
Side effects can include sleepiness and unsteadiness. These drugs can also cause tolerance and dependence. “These medications should not be abruptly withdrawn,” says Nasir. “People on these drugs need to be monitored by a physician.”
Benzodiazepines may trigger or worsen sleep apnea and shouldn’t be prescribed if you have this common sleep disorder.
Opioids. The following drugs may be prescribed at night to ease pain and reduce anxiety if you have more severe RLS symptoms:
- Codeine sulfate
- Oxycodone (OxyContin)
“These drugs tend to be reserved for people that are resistant to first- or second-line treatments,” says Nasir.
Side effects associated with opioids include sedation, constipation, unsteadiness, and cognitive problems. “Sometimes if given at heavy dosages, patients may also develop sleep apnea,” notes Nasir. “If someone has underlying sleep apnea, that condition needs to be treated before you would commit to these medications.”
She cautions that opioids also carry the risk for dependence, abuse, and withdrawal. If you take them, you need to be closely monitored by your doctor.
It’s important to be patient when you’re considering drugs for RLS treatment. You may need to try a few before finding one that works for you.
By Mary Elizabeth Dallas
FEB