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A drug that may work at a particular dose will work for years. Occasionally we need to escalate the dose with time. We can develop a tolerance, but it's very rare that we reach the top of the level of that particular medication. So it may be once a year, once every couple of years I have to increase the dose a little bit, but the patient will let me know and we will build to make adjustments.
A drug that may work at a particular dose will work for years. Occasionally we need to escalate the dose with time. We can develop a tolerance, but it's very rare that we reach the top of the level of that particular medication. So it may be once a year, once every couple of years I have to increase the dose a little bit, but the patient will let me know and we will build to make adjustments.
There's not too many home remedies for treating restless leg syndrome other than iron, if that's what we need. But there's probably some utility in people, especially who are deficient to get some calcium or magnesium. We can get this certainly fruits and vegetables supplements, but one way to do it is to get it through an Epsom salt bath before bed. So if you ever read the ingredients of Epson salts, it's just magnesium crystals. And those crystals can absorb through the water, into the skin and into the muscles and relax them. Some patients say that this works well, certainly it's cheap and it might be relaxing before bed. It won't be harmful. And magnesium does have known relaxing effects, which is why milk of magnesia, a laxative, relaxes the bowels. And it also may help promote sleep.
The usual drugs for restless leg syndrome are not overly expensive and tend to be generic. And cost-effective, so this is not something that's going to be a very expensive treatment. It will make a huge impact on the person's quality of life, but it's not going to bankrupt them. Insurance companies typically pay for almost all of these medications that are prescribed for restless leg syndrome. They're tried. They're true. They've been around for a long time and they're usually covered in formulary. There's an occasional new medication that has come out. That's more expensive that may be hard to get, but the usual drugs are well paid for.
Once a prescription has been given to a patient, they can get started right away, even on the day of the same office visit. Some people are lucky enough to get away with the smallest dose and the first medication, and they will find relief. It's interesting. Those dopamine agonists that I mentioned earlier are commonly prescribed they're generic, but they are given in a very unique way. What I say is take the pill one hour before the symptoms occur. So if the patient knows that they have symptoms every night at nine o'clock, we can ask them to take the pill at eight, it takes about an hour for the drug to take effect. And if that is the right dose and the right drug, which often it is sensations will greatly diminish or even go away. If that's not the right dose, I asked the patient to take that every night for two or three, four nights, and then take another. We gradually titrate the dose for the symptoms. So sometimes I get lucky on the very first night, the first dose, the first drug symptoms go away. Sometimes we need to escalate that dose a bit and sometimes we have to change medications. But the beauty of this disease is it's very responsive and it's very interactive. As in the patient tells me and I tell them and we work back and forth together until symptoms are resolved. We can find relief very quickly. And for some people, this just gives them back their lives.
"We can use medications certainly to help restless leg syndrome. There's a variety of classes that work in a little bit different ways. Sometimes they need to be combined. Not everybody responds to everything. And sometimes a combination of more than one drug at a time is actually synergistic and works better. The first thing I always look at is iron because treatment with iron supplementation is easy and cheap and very effective. If somebody's iron is low, but if we're going to use pharmaceutical agents, the biggest group we use are called dopamine agonists and they include drugs like Paramapaxil, Ropinirole, and Neupro, which is actually a patch that lasts for people 24 hours. If they have symptoms that last that long, these drugs can be titrated, very small doses up to the dose the patient needs to control their symptoms. Actually, they tell me, I don't tell them because it's about their symptomatology. They feel better? We've found the right dose. That whole class of drugs can have a few annoying side effects like nausea, easy to overcome with a little snack at the time they take their medicine. Sometimes they're sedated, but not a problem cause most restless legs patients have their symptoms at night. So if they take their medicine before bed and it helps them sleep, that's a bonus. Occasionally they may develop a strange reaction like they can to any drug. That whole class of drugs, dopamine agonists have one really weird and interesting side effect. It happens rarely, but it can exacerbate addictive behaviors. So if a person is already a compulsive gambler or a sex addict or eater, not the drug to use for them, but these drugs have been around for a long time. Most of them are generic and they're very effective. They work well. That's our first class of drugs. We also use Gabapentin, which is a failed seizure medication, but it's used for peripheral neuropathy pain and other things, but it relaxes the nervous system and it also treats restless leg syndrome. It can be sedating, also not a bad thing before bed. Sometimes it's a little fattening. So I have to warn my patients. If they're gaining weight, that they have to be careful about their food intake, but it's an old drug it's been around for a long time. It's cheap. And it works for a lot of people. Sometimes in combination with a dopamine agonist, sometimes by itself. We've also got benzodiazepines. Those drugs we've heard of, they've been around for a really long time, made popular in the 1960s, like Valium, also Ativan, Lorazepam, Klonopin, Xanax. But what we tend to use if we needed to use a benzodiazepine is a longer-acting one that helps us sleep through the night in very small doses. It can be synergistic, not my first choice. I don't want anybody to be sedated, but it works. Finally, last thing that we'd ever do is actually use opioids. That class of drugs are narcotics and they're usually used for pain, but interestingly, they have this peculiar side effect of helping restless leg syndrome. And sometimes people find this out. Incidentally, they have pain because they've had surgery or a back injury. And they find that when they take their Vicodin or oxycodone or other narcotic, but the restless legs actually improves. That is always my last choice, but it does work and for really hard to treat cases, I've done it and done it safely."
Sometimes when people look up on the internet, the medications that are commonly used for restless leg syndrome, such as the dopaminergic agonists like Pramapaxil and Ropinirole, they may see that these same medications are used for a very serious neurologic disorder called Parkinson's disease. And they can get really frightened and wonder if they are on their own way to Parkinson's disease. And the truth is it's on a spectrum and people with restless leg syndrome never have to develop Parkinson's disease. Although many patients with Parkinson's disease do develop restless leg syndrome. It can be a disease that's just on its own and nothing worse has to happen. So I want to give people comfort knowing that just because this medication is also prescribed Parkinson's disease does not mean that they're going to get it. And just because they have restless leg syndrome and it's considered a movement disorder doesn't mean anything's going to get worse. So one should feel relieved, not worried. It's restless leg syndrome. It doesn't have to get worse. It doesn't mean bad things are coming. It's usually very well-treated and once we've got the right diagnosis and treatment, life gets a lot better.
Treatment for restless leg syndrome depends on what causes it in the first place. Sometimes we literally just give back iron because the patient is iron deficient. Sometimes we give back magnesium potassium, even vitamin D. We make sure that thyroid hormone and kidney functions optimal, but sometimes we use medications and other times exercise and control of lifestyle like caffeine and alcohol, which can sometimes exacerbate restless leg syndrome. Getting too much exercise can make it worse and getting not enough can also make it worse. At times we also know certain medications, exacerbate, restless leg syndrome, such as anti-histamines and anti-psychotic medications, even anti-nausea medications. So sometimes we take away those medications and that will treat restless leg syndrome.
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine