Hello again. My name is Dr Ronald Popper and I am a board certified, sleep medicine specialist
and the Medical Director of the Southern California Pulmonary and Sleep Disorders Medical Center
in Thousand Oaks, CA
In our last video session we talked about Restless Limb Syndrome. Today I'd like to
talk to you about some of the treatment options for this syndrome. The primary treatment class
of medications for this are known as dopamine agonists. This is a class of medication used
primarily for the treatment of Parkinson's Disease. When using these medications for
the treatment of Restless Limb Syndrome we use them in a much smaller dose than we would
use for Parkinson's Disease and therefore the potential side-effects are much less
The most common drugs within this classification are Mirapex or pramipexole and ropinirole
or Requip. The most common side-effects that occur when using these medications include
headache or nausea, increased sleepiness or fatigue, and some patients feel drugged or
have difficulties upon rising the next morning. There's a black box warning that talks about
a very uncommon side-effect which is sudden uncontrollable sleep attacks. This is almost
never seen in patients with Restless Limb Syndrome and has primarily occurred in patients
with Parkinson's Disease who are taking vastly larger doses of this medication than
patients with Restless Limb Syndrome would ever take.
In addition, there's a small incidence of an increase in compulsive behaviors; compulsive
gambling, compulsive shopping, compulsive lying, compulsive sexual activity, any compulsive
behavior can occur within this class of medication.
When using these drugs, we are always striving to use the lowest effective dose, so we titrate,
or gradually increase the dosage until we find that it's effective with the least amount
of side-effects or, hopefully, no side-effects.
The next class of medications that we use to treat restless limbs are a class of medications
called anti-convulsives or neuroleptics. These drugs were initially used, as the name implies,
for treating epilepsy. And just like with the dopamine agonists, if we compare it to
aspirin and Tylenol, which are both used to treat fever and pain, we've found that these
medications are often useful in treating other disorders, in this case, Restless Limb Syndrome.
The drugs most commonly used in this class of medications include Neurontin, or gabapentin,
and Lyrica, or pregabalin. More recently there has been a long acting version of gabapentin
known as Horizant.
The third class of medication common in the use of Restless Limb Syndrome is a classification
known as benzodiazapines. The most commonly used within this group is a medication known
as Klonapin, or Clonazepam. This medication is also useful as a sleeping aid and as a
treatment for anxiety. Patients with restless limbs often have insomnia and are anxious
about their insomnia, and Clonazepam can be used as a supplement in the treatment of this
disorder.
Another class of medication which can be useful are analgesics, in particular, opioids or
narcotic medications. Many patients, and physicians as well, are reluctant to use these medications
in the treatment of restless limb but they can be very effective if the dopamine agonists
or neuroleptics are either not tolerated or were found to be ineffective. Sometimes we
have to use multiple medications to adequately treat restless limbs including all classes
that we've previously discussed.
Some patients prefer to use over-the-counter medications. While these are not always proven
to be as effective, some patients will respond to simple measures such as over-the-counter
analgesics like tylenol or advil. Sometimes supplements such as calcium or magnesium are
also helpful and especially if we find that your blood iron levels are low or, in particular
if your ferritin levels are low, the use of supplemental iron can be very effective in
the treatment of restless limbs.
I hope this brief overview on the treatment of Restless Limb Syndrome has been helpful.
For more information please visit my website and always remember, sleep well tonight for
a better day tomorrow.