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Restless Leg Syndrome – Medications

January 14, 2021
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Transcript

"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."