He is amazed that such symptoms do not awaken me at night!!! I am not a huge coffee drinker, don't drink alcohol but I am a smoker. Please do not blame the smoking for this, I have been smoking for 30 years! I work in a seniors nursing home and am on the "go" for 7. Lots and lots of walking and physical activity involved in the job. I was wondering if being under stress, taking the antidepressant and being in such a demanding physical active job is this causing my RLS and trunk twitching at night???
I am also going thru the change of life as a woman and am 52 yrs old?? Another thing to put down to menopause??? What other sleep aids would help. I don't waken feeling tired or anything like that. What about natural herbs and or remedies for this. Should I be concerned re my sleeping habits??? Stopping these medications would help your RLS and PLM that most likely do not bother you but do bother your boyfriend.
Wellbutrin is an antidepressant that does not worsen RLS, so if it works you should be better. Smoking may have a small effect on RLS hard to say but alcohol and caffeine certainly do. Wednesday, May 23, My husband suffers terribly with RLS. He is a diabetic type1 , has had several heart attacks, by-pass surgery and has now been on dialysis for the past 5 years He is up all night and now he is suffering from this terrible condition all day too.
He cannot sit for longer than a few minutes and he's exhausted. I am afraid that soon he will just give up. He has tried quite a few of the RLS medications, including Mirapex which created a gambling problem. He is now on Requip, but it's not helping. He sometimes takes Benadryl or Gravol at night hoping this will help him sleep.. He is getting worse every day and his health is deteriorating because he cannot rest. His neurologist doesn't seem to know what to do.
Does acupuncture or reflexology work? Are pain killers the answer? Typically, Mirapex and Requip are the most effective medications in this group however that does not seem the answer for you husband. Other choices include gabapentin and painkillers. However, doses have to be adjusted carefully as these drugs can easily accumulate and cause side effects in dialysis patients.
Friday, May 25, I am like a zombie as a result of the lack of sleep I am able to get. The longer I lay in bed, the worse the pain gets and the more anxious I become. My worse symptoms are pain and cramping in both of my calf muscles. Is this much pain and cramping really a RLS symptom? I am concerned that there may be something other than RLS going on but I've been going to my family Dr.
I don't like the idea of taking Requip because of its side effects. I've tried Benadryl, but it makes me more anxious. Tylenol helps but I'm not sure how safe it is to take it every night. Benadryl makes RLS worse so that may be why you get anxious when taking it. Tylenol should not help RLS but may help unrelated pain problems. Cramping is not a part of RLS. However, some RLS patients do have painful symptoms in their legs.
If the Requip relieves the painful symptoms then they are definitely RLS. That drug may still be your best choice for RLS symptoms. For painful symptoms, drugs such as gabapentin may work well. Friday, May 25, 7: Requip helps peripheral neuropathy? I have Peripheral Neuropathy. The symptoms are similar to Restless Leg Syndrome. I have been using heavy duty pain relievers for years and still found it difficult to find relief, especially, sleeping at night.
After seeing the Requip commercials on TV, I asked my doctor if it would be worth a try? She prescribed Requip for me, and now I sleep like a baby at night, with "0" pain all night! It's the best thing that has happened to me since I was diagnosed with Peripheral Neuropathy. There is no real knowledge as to what if anything Requip should do for neuropathy pain. From the lack of response of most RLS patients who also suffer from neuropathy, it appears that it does not generally help their pain.
Why or how it seems to have helped your problem is somewhat of a mystery. Saturday, May 26, 1: The Requip does not help the pain, but it does relax my legs and feet, enabling me to sleep at night. I still have to take all the pain meds, but I still swear by Requip for nighttime relief. During the day, while being active, it does not work at all. I can only assume that it works like a relaxer on me, calming my legs and feet. This typically occurs more commonly in those who develop RLS after age If you have an urge to move your legs that is relieved by movement and Requip and gets worse with rest, you likely have RLS.
Sunday, May 27, 8: I am 71 years old female and have chronic restless legs. I am on Requip low dosage of. Helps some, but still have restless legs and only sleep about 4 hour a night. I have starting having hot flashes terrible dreams and I have talked to other people that take Requip and they say it may them sleepy. I does not make me sleepy and also just had blood work done and now have high liver count. Would like to know if Requip has cause all this.
I just hope there can be more research of restless legs. It is very miserable. I have been thinking of switching to Mirapex. You are on a low dose of Requip most need mg so it may be reasonable to increase the dose a little and see if it helps you especially as you do not seem to have side effects. Your elevated liver tests likely have nothing to do with Requip. If after you increase the dose of Requip, you are still not better and not sleeping through the night, then perhaps a change to Mirapex should then be considered.
Monday, May 28, 6: Worsening of RLS with Requip? I am a 54 year old female who has been using Requip for about 6 months. The symptoms used to begin about 7: I have been told to take Requip about two hours before onset of symptoms. This is becoming impossible, because once I take. This has destroyed the quality of my life. I have an appt. I have been trying to research on the internet.
On my recent lab work my ferritin level was 18 but she thought that was okay. Would I be less lethargic with an anticonvulsant? Should I get a referral to a neurologist? I am desperate for help because the symptoms have become maddening!!!! When you stop the Requip, have your doctor prescribe an opioid such as Vicodin or oxycodone for the weeks to treat the worsening of RLS that occurs with stopping Requip. Most likely, your RLS will then return to once or so weekly and you can use a painkiller opioid or tramadol or Sinemet only when necessary to treat the RLS symptoms.
Also, we find that treating with iron until your ferritin level is over 50 may help your RLS. Any doctor who can follow these instructions should be able to help you although typically, neurologists and sleep specialists are the ones who are most knowledgeable about RLS. Wednesday, May 30, I tried a whole bunch of meds but side effects seemed to outweigh any benefits. I have been on Celexa for about 3 years and I think that has been helping in addition to treating depression.
Over the last 6 months my sleep has become even more disturbed and this apparently would go hand in hand with my depression worsening. I switched to Cipralex a couple of weeks ago and my sleep has deteriorated. I am wondering if this daytime fatigue and easily disturbed night-time sleeping is related to RLS or is it part of breaking in a new med? It is certainly possible that the new drug may cause worsening of your sleep while the old one did not but the drugs are very similar. Cipralex Lexapro is supposed to be more effective than Celexa and have fewer side effects.
Thank you for your information. I have since gone off Lexapro and am not dozing off in the morning. Sunday, June 03, 3: Question about mattresses and RLS. Can a different mattress lessen the RLS symptoms? After taking my prescribed medication I go to another bedroom where the mattress is softer and I seem to quiet down in a short period of time.
Last night I tried not taking the medication and I again was able to go back to sleep shortly. Many different things can affect RLS symptoms and that often varies considerably from one person to the next. Some like their legs wrapped tightly while other can't stand to have the bed covers touch them. In your case, a softer mattress seems to help. One explanation may be that by being more comfortable on the softer mattress, you can relax and decrease your anxiety levels that may indirectly calm your legs.
Sunday, June 03, 5: Refractory RLS I have emailed you twice before in and again, Thank You very much for listening to and replying to my concerns. Since , I have been allowed to stay on Provigil and 8 Vicoprofen a day. My concern is the fact that either my RLS is getting worse age 46 or I've just been on Vicoprofen too long now all total nearly a decade - at 8 a day almost 3 years.
Also I know this treatment is causing a great deal of havoc with my memory - and I find myself increasingly concerned about what life could be like in the next 10 years at this pace. I am always listening for alternate treatments for RLS - particularly ones that work as a narcotic has for me - which has me wondering about Suboxone? Of what I can see, it is for the purpose of quitting narcotics without experiencing the dreaded side effects - one's I'm all to familiar with when I've voluntarily taken breaks - one of which I know is RLS - or some form of it.
Is Suboxone a lesser form of a methadone type of drug? It seems to initiate less of a response among doctors here than methadone does. Are you aware of it being a successful treatment for RLS? There is really no data on the use of Suboxone for RLS. However, it contains a partial opioid drug Buprenorphine and naloxone which is an opioid agonist and thus runs the risk of worsening RLS.
Smaller amounts of methadone should be much safer than the large amounts of Vicoprofen not to mention the ibuprofen that it contains which does not help RLS so can only cause problems without benefits. Tuesday, June 05, I have been on re-quip for 3 months now for RLS. I take 2 mg each night before bedtime. But, I often wake up in the wee hours of the morning, sometimes, every hour on the hour.
Does re-quip cause fluid retention? I have not noticed it as a side effect. Requip may cause problems with insomnia although others sometimes complain of sleepiness. Fluid retention with swelling of ankles and feet hands are less common does occur with the drug although it is not the most common side effect. Tuesday, June 05, 1: We have been on all different types of medications for ADHD and insomnia. We just had a Polysomnographic done and he was found to have RLS as well as obstructive sleep apnea.
We will be getting tonsils and adenoids removed. I want another opinion on what would work best for him and not make him addicted or having further problems. Please help me with this! Concerned Mother, April R. RLS is not diagnosed from a sleep study. It is a clinical diagnosis that only occurs while awake similar to back pain which only occurs while patients are awake to experience the pain.
Sleep studies do find PLMS leg kicks while sleeping which is often associated with RLS but most often occur by themselves or with other conditions sleep apnea, narcolepsy, etc. You are correct to have concerns about the treatment of your son's PLMS or RLS as no drugs are approved to treat kids with these conditions and these disorders often require many years or indefinite of treatment. Furthermore, it is very controversial whether anyone adults or kids need to be treated for PLMS.
Getting a second opinion would be very valuable in this case. Thursday, June 07, 6: RLS worse with blood pressure medication? I have just been put on quinapril Accupril for hypertension, Do you know if it's possible for this to cause my RLS to go whacko? I took one pill last night as I picked them up late from the pharmacy and woke up at 4: I took one this morning around 5: Is this just a crazy coincidence?
I can hardly sit long enough to type this and I never have RLS in the mornings! It is most likely that something else has worsened your RLS or you have some very unusual reaction to this drug. Thursday, June 07, 7: Muscle cramps from Requip? I have had RLS for years. I was on Permax ,but is no longer on the market. I have tried Requip and it gave me horrible muscle cramps. Can I take another pill if I wake up in the middle of the night.
Have others complained of muscle cramping and what do they take for it. I can not take quinine. Muscle cramps are unusual with Requip and other then quinine, there are no other remedies for leg cramps. You may want to consider trying gabapentin or other anticonvulsants or painkillers. Friday, June 08, RLS better with Lamictal? Have you heard of Lamictal being prescribed for RLS?
It can happen if I take this drug on an empty stomach or -- at random. The side effects of this drug are more difficult to treat. Usually they get better after a few weeks but after a few years, you are likely stuck with them. Changing to or adding another type of drug Requip or Mirapex may be helpful. Saturday, June 09, RLS affecting the genitals?
Do you have any information or patients with RLS affecting the genital area? Requip helps, but the problem seems to be getting worse. RLS extending to virtually every body part has been reported. I have several cases of RLS affecting the genitals on our website. Saturday, June 09, 4: It is the worst, absolute worst, when I go to lay down at night. It starts up as soon as I lay down.
If you can imagine, I dread nighttime. I've gotten so frustrated, and out of exhaustion and pain, just hit my arms and legs over and over. This past month, I have NOT had hardly any sleep. The most sleep I've gotten has been 4 hours and that's a period of sleep all together throughout the whole day and night! I haven't been able to sleep any more then that. I mean really really really exhausted!
Tonight was the worst, and is spilling over into the day. It has not left, even now I can feeling it and I keep shaking myself while I write this. I have taken everything under the sun to try to get it to leave and nothing works. I don't have insurance to get any prescription drugs and I am currently unemployed. Is there anything, anything at all, that I can do in the meantime to help alleviate RLS so I can get 8 hours of REM sleep without constantly being woken up by this???
Please, any suggestions at all will be appreciated! As your RLS symptoms extend to the arms you must have fairly severe and advanced symptoms. Most with your level of RLS cannot control the symptoms without medication. You have already exhausted most all of the non-drug treatment of the disease. At this point you must somehow seek out medical treatment as there is not much else of any significant benefit out there to help you. Requip may cause nasal problems and then possibly lead to more sinus problems.
If you developed nasal stuffiness and dripping before your sinus problem then perhaps the Requip is indirectly responsible. Generally sinus surgery is a last resort and you might want to get a second opinion from an ENT specialist. It is less likely that stopping the Requip will help but you never know. If you do stop it for a while, make sure that you have other medication such as painkillers to treat your RLS during that period. Saturday, June 09, 9: I started Effexor today and am concerned that it will aggravate my RLS condition.
My legs have been better lately, and I don't want to upset that. Is Effexor one of the antidepressants that worsens RLS. Wellbutrin is a better choice as it does not bother RLS and often works as well as the other antidepressants. Jun 13, 9: I have suffered from nocturnal myoclonus for nearly forty years. During most of that time I have been taking Klonopin to control the night time jerky legs. Now that drug has very little effect and some side effects that I do not like. I am now trying 0.
At the same time, I gradually reduced the amount of Klonopin I have been taking and have not used any Klonopin for the last four or five days. The night time leg jerking is almost totally gone, but I am still wide awake through much of the night. Of course, that means major daytime fatigue. I have some questions: Thank you very much for you help with these questions. Klonopin is a benzodiazepine that works like most of the sleeping pills.
Likely, going off of it has created most of your insomnia. I would not recommend going back on this drug as you seem to already be somewhat tolerant to it and it is a drug that can cause dependence you may also be having some withdrawal from this drug that may last several days to weeks. Although Klonopin can be taken with Requip, a better choice may be one of the non-benzodiazepine drugs like Ambien or Lunesta that rarely cause tolerance or dependence. Although Requip can cause insomnia in some people, it is more likely that withdrawal from Klonopin is the major problem with your insomnia.
Jun 13, 4: I have been taking Celexa 20 mg for awhile now. Was taking l0 mg previously. My physician just gave me the starter kit yesterday for Requip. Yesterday I forgot to take my Celexa medication. I had the best day that I can remember. Could not taking the Celexa just one day make a difference? I understand Celexa can interfere with some meds and make the RLS worse.
Should I approach my physician on this? Celexa and all the other SSRI antidepressant medications tend to make RLS worse they do not act on other medications but do this directly. Stopping it even for one day can be helpful for your RLS. Requip is a much better choice for treating RLS. Friday, June 15, 8: I have had RLS all my life. Through the support group, I have learned what I can eat, and the time of day I can eat certain things, and I can control the RLS pretty good.
I am 77 years old. I am in good health. But lately I have developed a burning sensation in the front of my legs, from the ankles to about midway up my legs. I went to my doctor yesterday, He was unable to give me an answer, except that it could be neuropathy. All my lab tests were normal, including glucose. My blood pressure is normal. He said he did not think this was related to the RLS. It does sound like you may be suffering from neuropathy.
It might be related to your RLS but that would not change the treatment. Neurontin or Lyrica may be helpful for this problem. Saturday, June 16, 4: I'm taking 2 medications for my high blood pressure. I read an E-mail that said certain high blood pressure medications can make RLS worse. Do you happen to know them? Blood pressure pills do not have any effect on RLS.
There were a few reports that propranolol an older blood pressure pill might help RLS but that has never been confirmed. Saturday, June 16, 9: Anxiety meds and RLS I'm a 50 year old male. I've suffered from RLS and had difficulty falling asleep for most of my adult life. About four years ago I approached a GP with the problem. She tried several different dopamine agonists first, all of which caused vivid dreams and prevented restful sleep.
I ended up taking. Over the following years, due to tolerance, the dose was increased to 2mg. Although it did relieve my RLS symptoms, I would wake up after about 5 hours of sleep, feeling like I had not gotten a restful sleep. I was constantly tired and groggy. I decided it was better to deal with the RLS than the results of Klonopin addiction. Against advice from others, I tried to quit the Klonopin "cold turkey".
I went for 5 nights with almost no sleep at all. I also experienced very severe anxiety and depression. Eventually it got to the point where I felt I could actually die from sleep deprivation. It worked to the point that I got off the Klonopin, and now only take 5mg of Valium before bedtime. However, the anxiety and depression never went away which I never experienced before this episode , and I still wake up after 4 to 5 hours of sleep.
I have also developed an irregular heartbeat skipped beats , which I have had checked out, and my heart is fine. I found this to be very true. Again, I couldn't sleep. I have read your advice that Remeron and Wellbutrin are the only antidepressants that don't affect RLS. Considering I am also under a lot of tress from work and home issues, what would be your suggestion for a course of action?
I'm at wits end. I need to do something before I end up in a psych ward somewhere. Bupropion is the generic name for Wellbutrin. Serzone may cause severe liver damage quite uncommonly so it is not worth the risk of using it for RLS. Trazodone is RLS friendly but not a great antidepressant or anti-anxiety drug. Saturday, June 16, 3: Anxiety meds and RLS Thanks for the quick response. So, I guess what I'm looking for is the most effective antidepressant, with the least likelihood of increasing my RLS.
My RLS has been behaving itself pretty well lately, as long as I don't take some medication which exacerbates it. If the only serious side-effect of Serzone is a very remote chance of liver damage, I might tend toward that. I'm otherwise a pretty healthy individual. I just need to get rid of this damn anxiety that was brought on by my week without sleep.
I expect the need for the antidepressant to be relatively short-term. We can usually work around the increase in RLS symptoms by treating them separately especially if the mood problems are short-lived. Some psychiatrists do use Serzone and think that it works very well despite the small but serious risk of liver damage. Saturday, June 16, 1: I had my ferritin level tested about 8 weeks ago, and it was at I had already been on approximate mg elemental iron, in the form of ferrous sulfate, then later ferrous bis-glycinate a month before my test, so I was probably much lower.
I have continued the iron until now. A few days ago, I was retested, at a different lab because I was in a different area and it came back ! I told them that was impossible because everything I know mostly from your website says what a very long and difficult process it is to raise levels to even above They actually retested it and it still came back Is it possible to raise 80 points in less than 8 weeks?
Or was my first lab wrong? I think I will retest it there again. I just don't think it was wrong, because I had been donating blood too often, for over a year. My RLS is much better for now, for whatever reason, so I'm grateful for that. Your dose of mg of elemental iron per day is quite reasonable and certainly could raise your serum ferritin level within 2 months. It usually does take longer often up to 6 months but there is a lot of variation in this process. Also, the fact that your RLS has improved supports this improvement in ferritin levels.
Friday, June 22, 5: I just came from my first appointment with my psychiatrist and she has started me on Wellbutrin, Restoril, and Requip. The Requip is 1 mg at bedtime.. I asked her if I should start at 1 mg, and she said yes. Does this sound like too much of a starting dose to you, or should I just trust her judgment? I'm scared to take it. I could split it, but it has a bump in the middle and doesn't split well.
What is your opinion? Typically, we start Requip at. There is a Requip starter kit that starts at. You may do fine starting with 1 mg but the odds are good that you may have side effects starting at a relatively high dose and since it comes in lower doses there is no reason to take a chance by starting a higher dose. Furthermore, many patients only need. Despite the bump in the middle put there to make this drug easier to manipulate by Parkinson's disease patients , it can be cut in half.
There is no coating, so don't worry about splitting for that reason. You may want to go back to your doctor and ask her to give you a Requip starter kit. Sunday, June 17, 4: Mirapex Ruining Our Lives? My husband has RLS. My husband changed psychiatrists approximately three years ago. With this change, came a whole new prescription regimen. When he began going to this new doc, the new prescriptions were Effexor mgs , Ambien, Mirapex and finally Provigil to combat the sleepiness in the day brought on by his sleep meds.
I remember mentioning to his doc once when they asked me to come to one of his first appointments that it seemed like my husband had improved greatly.. Sometime throughout this time the Effexor was increased, along with the Mirapex. I believe it was at approximately the six month mark that he started on all of these meds that he all of a sudden began going to the bar every night. Since this time it has gone down hill. My husband continues to frequent the bar every night.
He spends in my opinion large amounts of money at the bar, so that he CAN drink. He maintains that he cannot focus, nor can he stay on task. Since husband has been on his new medication regimen, we have refinanced twice. Now he is advocating we do that again. We have a beautiful home on quite a few acres. I find that trying to talk to husband about this is totally futile.
It is just one huge argument after another. My husband and I have been married for 28 years. His doctor told me to write him a confidential letter, explaining to him what has been going on. I am hoping that this doctor.. Considering the above situation, do you have any suggestions as to questions I could ask his doctor.. It is possible that the compulsive drinking may be due to Mirapex.
It is much less common to get this behavior with the lower doses used for RLS you did not state his dose but it certainly can happen. If that is the case, then the behavior will reverse quickly with stopping the medication sometimes even with a reduction in the dose. His RLS may be managed with Neurontin or Lyrica in place of Mirapex although they may increase daytime sleepiness problems. My husband is on 1mg Mirapex nightly. He does already have daytime sleepiness that he has to take Provigil for.
The sleepiness is, I presume, caused by the Mirapex. Should changing to Neurontin Or Lyrica be anymore of a problem than what the Mirapex already is doing to him daytime sleepiness wise? Your husband's dose of Mirapex 1 mg is actually very high for RLS but not too high for Parkinson's disease which is likely what your pharmacist was thinking of when he answered your question.
The only way to know whether the Mirapex is responsible for the daytime sleepiness is to stop the medication and see what happens although this is quite likely. Neurontin may work well but again, the only way to tell if your husband will tolerate this medication and do better with it is to try it. Effexor should not cause compulsive behavior but Mirapex may be cause it, especially at 1 mg. I was diagnosed with RLS about 7 years ago but this condition had gone on for years before the diagnosis.
I can remember as a child when my legs would ache told they were growing pains and nothing seemed to help As I got older, I can remember moving my legs around in bed and the coldness of the sheets seemed to ease it up some but then when the sheet would warm where my legs were, it would start again. Flexing my feet to tighten the muscles, etc.
After reading thru your site and some of the emails you had received, I couldn't believe that some medicines that help you to even function could be the cause of it. I have been on anti depressants off and on over 20 years. I now take Zoloft mg a day and was told 4 yrs ago that I would have to stay on an anti depressant for the rest of my life and at that time I was put on Effexor and Xanax but have changed to the Zoloft. Now I find out that possibly my anti depressant is causing this RLS to be worse.
Recently I have had the RLS flare up when I was sitting watching tv or trying to read, crochet or sew. I've also noticed that sometimes my arms feel like my legs do at night. Can RLS also be in the arms? Is it all tied into the nervous system somehow? I can't remember anyone in my family ever having RLS but I do know my younger sister has mentioned it to me before and my oldest son has it and is diabetic.
When first diagnosed, I was given Klonopin. I was reluctant to take it due to knowing that they sometimes give this to people who have seizures and I didn't know what it would do. Eventually I took it and slept all night. Then they put me on Neurontin and I find its an anti seizure medication. I've only taken it a few times when it gets so bad I can't go to sleep.
I guess my main concern is if this RLS can be somehow felt all over the body? Mine feels like electrical surges or tingling going up and down my legs. Creepy, crawly sensations, an urge to continue to tighten or strain the muscles. I am 62 years. Many medications can worsen RLS and you should download our free medical alert card to show to your doctors it contains all of the RLS worsening drugs and alternatives.
Wellbutrin in your case may work better to not bother your RLS if it works as well for your depression. RLS typically occurs in the legs but can spread to other body parts. Requip or Mirapex are the drugs of choice for RLS and you may do better on one of those. Monday, June 18, 4: I am also on medication for high blood pressure, which worked well for some years, but the last few years I have seen my blood pressure go up. Does more than 30 PLM's per sleeping hour mean the same as more than 30 PLM's per waking hour for blood pressure to go up?
It has been found that PLM are associated with transient increases in blood pressure and some acceleration of heart beat when they occur during sleep. The actual clinical ramification of these transient increases in blood pressure are not fully known although some researchers have speculated that it might lead to premature heart disease or strokes.
We clearly need more research on this topic. However, as to your question about PLMW PLM while awake , it is even less likely that they are of any clinical significance other than the annoyance they cause those who experience them. It is very doubtful that they have any important effect on blood pressure compared to the many other daily events that also raise blood pressure. Monday, June 18, 8: Does Mirapex lose it's effectiveness?
I have had RLS since I was 26 years old and have probably tried every possible drug or action to no avail. I am now When I finally found Mirapex, I truly believed it to be a miracle drug. I have been on 0. Lately that percentage has dropped considerably. It is now 9: Staying on the computer helps me as well as walking. Should I assume that my body has adjusted to Mirapex and It is time to try Requip or another med.
I previously lived in NYC and even there up until about 10 years ago, it was hard to be taken seriously, Now I'm in a very small community in Missouri and I generally research my own meds and tell the doctor what to prescribe. My country doctor told me this would lead to Parkinson's disease. I asked where he got his data and he couldn't tell me, so hence, I do my own research. I tried going into a research drug trial in Memphis about two years ago but was told I had to stay off the meds for two weeks, I couldn't even make it through the night.
So I had to abandon my hopes of being a trial subject. After 9 years, it is more likely that your disease is slowly getting worse or perhaps something else like other medications may be worsening your RLS rather than you becoming tolerant to the medication. As such, increasing the Mirapex a bit to. These symptoms were mild until age 56 when they worsened and disturbed her sleep. The patient reported a positive family history of RLS with her father, brother, and 2 sons being affected. Because of her chronic low back pain, an MRI of the lumbosacral spine was performed and showed moderate spinal stenosis at the L2 to L4 levels.
Her neurological examination was unremarkable and surgery for spinal stenosis was not pursued at that time. Levodopa, ropinirole, zolpidem, and gabapentin were discontinued and propoxyphene 65 mg q HS was prescribed with dramatic improvement in symptoms. The subsequent course of medication therapy is summarized in Table 3. Like the first case, medication was administered only at bedtime. In this patient, several different medication combinations were tried over a period of several years. Dosages were increased when symptoms were inadequately controlled and the drug was not causing significant side effects.
Medications were tapered and discontinued when augmentation appeared. Augmentation was evidenced by onset of symptoms during the day and an increased severity of symptoms above pretreatment levels. Tolerance developed usually within 4 to 12 weeks with all drug types but features of augmentation were seen only with the dopaminergic medications. The patient underwent lumbar laminectomy and spinal fusion surgery for spinal stenosis approximately 3 years after first presenting to us.
She was treated with hydrocodone therapy postoperatively. Surgery did not appear to improve RLS symptoms. As illustrated by our cases, tolerance often develops within a few weeks with several different drug classes used to treat RLS, including dopaminergics levodopa, dopamine agonists , benzodiazepines clonazepam , and narcotic analgesics propoxyphene, codeine, hydrocodone.
Tolerance was manifested by loss of beneficial effects with a need for steadily increasing dosages or the addition of other medications. The problem of tolerance is magnified in RLS in that ongoing therapy is associated not only with loss of efficacy but with augmentation, a worsening of symptoms beyond the severity at the time treatment was initiated. While tolerance can be seen with any of the medications used to treat RLS, augmentation is associated with dopaminergic therapy in particular.
It is currently unknown how long the dopaminergic drug holiday should last before the medication can be effectively reintroduced. Reintroduction of dopaminergic medications was associated with symptoms of augmentation in both of our patients after 1 month holidays. In general, we now aim for a dopaminergic drug-free period of at least 3 months.
It is unclear if the latency from starting therapy to onset of augmentation shortens each time a dopaminergic drug is reintroduced but this appears to have been the case in both of our patients. In our first patient, augmentation appeared 7 months after initial levodopa therapy but after only 2 months upon reintroduction of the drug. Our second patient developed augmentation a few years after initiation of dopamine agonist therapy and then about 4 months after reintroduction of this type of drug.
It is unknown if augmentation is dose related but both of our patients experienced the phenomena with what would be considered relatively low dosages of medications 50 to mg of levodopa, 1 mg of ropinirole, 0. In our experience, symptoms of augmentation resolve quickly, usually within about 1 week, once the dopaminergic drug is discontinued. A recent pharmacokinetic and polysomnographic study found that symptoms and signs of augmentation were related to low plasma levodopa levels in patients treated with this drug, 17 but the detailed pathogenesis of this problem is unknown.
The development of augmentation during treatment of RLS with medications other than dopaminergics has not received attention in the literature and it is unclear whether or not this might occur. The recognition of tolerance and augmentation is critical in the optimal pharmacotherapy of RLS. Treating physicians may have insufficient information about these potential problems.
It is important to note that recent published trials of ropinirole therapy of RLS, for example, excluded subjects with prior augmentation, did not monitor for this problem during the study, and may have been too brief to observe augmentation. Often, one cannot simply prescribe a single medication for RLS and expect long-term success. Patients with this condition often require careful clinical monitoring and frequent medication adjustments.
Dopaminergic drugs may not be the best first-line treatment because of associated augmentation. We generally employ a rotation approach between dopaminergics, clonazepam, and low potency narcotic analgesics. We have not found other medications to be predictably effective. There is no evidence on which to base combination therapy, although we try this in some cases. For any new medication, even if previously used, we introduce it at low dosage and titrate the dosage to control symptoms, avoid side effects, and in response to tolerance.
As soon as augmentation is evident, we switch from a dopaminergic drug to a different medication class. It is unknown whether routine drug class rotation, modifications in drug dosing schedules, or drug-free periods prior to the onset of augmentation might avoid this phenomenon. National Center for Biotechnology Information , U.
J Gen Intern Med. Address correspondence and requests for reprints to Dr. Hope Professional Building, Mt. This article has been cited by other articles in PMC. Abstract Restless legs syndrome RLS is a common condition characterized by an unpleasant urge to move the legs that usually occurs at night and may interfere with sleep.