Restless Legs Syndrome and Related Disorders - Medications

Highlights	Complications	Resources
Introduction	Diagnosis	References
Causes	Treatment
Risk Factors	Medications

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Medications

The American Academy of Sleep Medicine recommends medications for RLS or periodic limb movement disorder (PLMD) only for persons who fulfill strict diagnostic criteria, and who experience excessive sleepiness that occurs as a result of these conditions. Little is known about the best way to treat RLS but some experts suggest the following:

Over-the-counter pain relievers and possibly mineral and vitamin supplements (particularly folic acid in people who might be deficient) should be tried first.
People with RLS should be tested for iron deficiency and, if they are, treated with oral iron supplements.
Dopaminergic agents (drugs that increase levels of dopamine) are the standard agents to date for treating severe RLS, PMLD, or both. These drugs include dopamine precursors such as levodopa (L-dopa) as well as dopamine receptor agonists such as pergolide, pramiprexole, and ropinirole. Some experts then recommend regular use of dopamine receptor agonists for RLS patients who experience nightly symptoms and fast-acting L-dopa combinations for those whose symptoms occur only occasionally.
If dopaminergic agents fail or for patients who have frequent--but not nightly--symptoms, other agents may be helpful. These include opiates (pain relievers), benzodiazepines (sedative hypnotic drugs), or anticonvulsants. However, benzodiazepines and opiates can become habit forming and addictive.

Tylenol and Non-Steroidal Anti-Inflammatories (NSAIDs)

Before taking stronger medications, people should try over-the-counter pain relievers, such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil, Motrin, Rufen), naproxen (Anaprox, Naprosyn, Aleve), and ketoprofen (Orudis KT, Aktron).

Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events and gastrointestinal bleeding.

Levodopa and Other Dopaminergic Agents

Dopaminergic agents increase the availability of the brain chemical dopamine and are the first-line treatment for severe RLS and PLMD. These drugs significantly reduce the number of limb movements per hour and improve the subjective quality of sleep. Patients with either condition who take these drugs have experienced up to 100% reduction in symptoms.However, these drugs, which are ordinarily used for Parkinson's disease, can have severe side effects. They do not appear to be as helpful for RLS related to hemodialysis as RLS from other causes. Dopaminergic agents include dopamine receptor agonists and dopamine precursors.