Medical Treatments

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Dopaminergic agents
Opiates
Benzodiazepines
Anticonvulsants
Beware of some medications
General information about medications
 

Remember that before taking any medication it is imperative that you consult with doctor/ pharmacist to make sure that you are on the right treatment. Some treatments that work for some people may not work for you.

Dopaminergic agents

Dopamine precursors

Carbidopa/levodopa, are drugs which add dopamine to the body's system and have been used the longest. Unfortunately, the high rate of "augmentation" of symptoms, around 85%, is a major disadvantage.

Augmentation means you may have a better night's sleep, but paradoxically, the symptoms can worsen, developing at an earlier time in the day, often intensifying! A higher dose will only exacerbate RLS. The standard formulation has an effective life of only two to three hours. Consequently, many doctors now only recommend Sinemet and Madopar to those with mild symptoms, where low doses can be effective. Other side effects may include insomnia, sleepiness, gastrointestinal problems and in some cases the effect of the drug may be reduced when eating foods high in protein.

Dopamine agonists

Ropinirole, pramipexole, pergolide and cabergoline are newer drugs and some of them may not yet be available in Australia. It appears that these drugs are less likely to cause augmentation than dopamine precursors such as levodopa.

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Opiates
If dopaminergic agents are contraindicated or unable to control the symptoms opiates such as codeine, oxycodone and tramadol can be used for relieving severe pain sometimes associated with RLS. Side effects include dizziness, sedation, nausea, vomiting, constipation, hallucinations and headache. The sedative qualities can impair alertness, while narcotic addiction is a concern, although physicians have reported that this is not such a problem at very low doses. Those that try this classification of drugs are usually people who have already tried the other drug groups without success.

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Benzodiazepines
Benzodiazepines, notably clonazepam, have been widely used to treat RLS in the past, and are now reserved as second-line therapy. Their effectiveness is uncertain, because most studies of benzodiazepines in RLS have involved only small numbers of patients. Drawbacks to the use of these medications include the potential for daytime drowsiness or confusion, especially in older patients. Beware of impaired ability to operate machinery or drive. It is best policy to avoid alcohol. Benzodiazepines may result in unwanted psychological or physical addiction, so medical consultation is essential.

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Anticonvulsants
Some anticonvulsants – carbamazepine and gabapentin – can improve RLS symptoms. Not much is known about how they work in RLS, but they may be helpful in individuals in whom RLS is painful, or in patients in whom dopaminergic drugs or opiates have not been effective or are contraindicated. Side effects may include dizziness, sleepiness, fatigue, increased appetite and unsteadiness. As with other drugs, the sedative properties may cause mental impairment.

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Beware of some medications
It seems that the use of some medications will worsen RLS symptoms. Included in these drugs are the calcium-channel blockers (used to treat high blood pressure and heart conditions),most antinausea medications, some of the cold and allergy medications, major tranquilisers (including haloperidol and phenothiazines), and phenytoin (antiseizure).

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General information about medications
All drugs should be started at low doses, increasing slowly if needed, in order to decrease potential side effects. Careful trials are typically necessary, to find the best medication and dosage for each individual. Some patients report that a combination of medications is needed for effective treatment. Others find their drug loses its efficacy after a time and they need to change to another.

It is vital for you to find an understanding and informed doctor, often a Neurologist, who will help guide you towards successful treatment. Remember ... you don't have to put up with those relentless sensations that drive you crazy! You don't have to drag yourself around exhausted from night after night of poor sleep. Some may have to work harder than others to find the right medication or combination for them ... but don't give up. What a relief to be able to declare "RLS had taken over my life, but now I'm back in control."

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