Restless Legs Syndrome and Related Disorders - Medications

Using the lowest dose possible can minimize these effects.

Withdrawal Symptoms. Patients who withdraw from these agents typically experience very severe RLS symptoms for the first two days after stopping. RLS eventually returns to pre-treatment levels after about a week. The longer the drugs have been taken, the worse the withdrawal symptoms.

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Benzodiazepines

Benzodiazepines, such as clonazepam (Klonopin), are commonly called sedative hypnotics and are used for insomnia and anxiety. They may be helpful for some patients with RLS that disrupts sleep. Clonazepam may be particularly helpful for children with both periodic limb movement disorder and symptoms of attention-deficit hyperactivity disorder. It also appears to be helpful for RLS patients who are undergoing hemodialysis.

Side Effects. Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people and should not take long-acting forms. Side effects may differ depending on whether the benzodiazepine is long- or short-acting.

The drugs may increase depression, a common co-condition in any case in many people with insomnia.
Breathing problems may occur with overuse or with people with pre-existing respiratory illness.
Long-acting agents have a very high rate of residual daytime drowsiness compared to others. They have been associated with a significantly increased risk for automobile accidents and falls in the elderly particularly in the first week after taking them. Shorter-acting benzodiazepines do not appear to pose as high a risk.
Memory loss (so-called traveler's amnesia), sleepwalking, and odd mood states have been reported after taking triazolam (Halcion) and other short-acting benzodiazepines. These effects are rare and probably enhanced by alcohol.
Because these drugs cross the placenta and enter breast milk, pregnant nursing women should not use them. An association was reported between the use of benzodiazepines in the first trimester of pregnancy and the development of cleft lip in newborns.
In rare cases, overdoses have been fatal.

Interactions. Benzodiazepines are potentially dangerous when used in combination with alcohol. Some drugs such as the ulcer medication cimetidine can slow the breakdown of the benzodiazepine.

Withdrawal Symptoms. Withdrawal symptoms usually occur after prolonged use and indicate dependence. They can last one to three weeks after stopping the drug and may include the following:

Gastrointestinal distress.
Sweating.
Disturbed heart rhythm.
In severe cases, patients might hallucinate or experience seizures, even a week or more after the drug has been stopped.