Restless Legs Syndrome and Related Disorders - Medications

Dopamine Receptor Agonists. Agents known as dopamine receptor agonists (also called dopamine agonists) are increasingly being used as alternatives to L-dopa. Because they have fewer side effects than L-dopa, including rebound effect, and augmentation, these drugs may be used on a daily basis. They have been shown to relieve symptoms in up to 70 to 90 percent of patients. Dopamine agonists can be categorized as ergot-derived (such aspergolide, cabergoline) or non-ergot derived (such as pramipexole, ropinirole). The newer non-ergotamine derivatives may induce fewer side effects than ergot-derived agents. Studies on these medications report the following:

Ropinirole (Requip) is a non-ergotamine dopamine agonist. It is the first and only drug approved specifically forthose who have more than 15 RLS episodes a month. The FDA approved ropinirole for RLS in May 2005. Side effects are generally mild, but can include nausea, drowsiness, and dizziness. (Ropinirole is sometimes used to treat Parkinson's disease.)
Pergolide (Procalamine) is as effective as carbidopa-levodopa and has fewer side effects, though nausea, dizziness, and nasal stuffiness are common. It also seems to produce fewer of the rebound and augmentation effects of levodopa, particularly at higher doses.Benefits persist for at least a year.
Pramipexole (Mirapex) is the most potent drug yet used for RLS and has resulted in dramatic improvement in symptoms. It seems to be very effective in improving sleep and may also reduce periodic limb movement. A long-term, follow up study showed the drug continued to be effective for RLS, even after seven months of use. Pramipexole also appears to have antidepressant properties. The drug is used at much lower doses than when used for Parkinson's disease, so severe long-term side effects are rare. However, studies have shown that tolerance (need for higher doses) and augmentation may occur in around a third of patients.
Cabergoline (Dostinex) is also showing promise. In one study, cabergoline was used for RLS after levodopa had either failed or resulted in increased symptoms. Patients in the study reported relief or freedom from symptoms after four weeks of use.

Other Dopamine Agonists. Rotigotine is a unique dopamine agonist that is being developed in patch form for RLS and Parkinson's disease. Other dopamine agonists that have shown some promise in small studies include alpha-dihydroergocryptine, or DHEC (Almirid), and piribedil (Trivastal), although these are not currently available in the U.S.