Restless Legs Syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations. These symptoms typically worsen during periods of rest or inactivity, particularly in the evening and at night, leading to sleep disturbances and a significant impact on quality of life. While lifestyle changes and non-pharmacological treatments can help manage RLS, medications are often necessary for those with moderate to severe symptoms. This blog post explores the various medications available for treating RLS, how they work, and their potential side effects.

Understanding Restless Legs Syndrome

RLS is a condition that affects the nervous system, causing uncomfortable sensations in the legs and an uncontrollable urge to move them. The exact cause of RLS is not fully understood, but it is believed to involve genetic factors, iron deficiency, and abnormalities in dopamine signaling in the brain.

When Are Medications Needed?

Medications are typically considered for RLS when:

• Symptoms are moderate to severe and significantly impact daily activities and sleep.

• Non-pharmacological treatments and lifestyle changes have not provided sufficient relief.

• The patient experiences symptoms more than two to three times per week.

Medications for Restless Legs Syndrome

Dopamine Agonists:

How They Work: Dopamine agonists mimic the action of dopamine, a neurotransmitter involved in controlling movement. They help reduce the abnormal brain activity associated with RLS.

Common Medications:

• Pramipexole (Mirapex): Often taken before bedtime to reduce symptoms.

• Ropinirole (Requip): Another common medication that can be taken once daily.

• Rotigotine (Neupro): A transdermal patch applied once daily.

Side Effects: Nausea, dizziness, fatigue, and impulse control disorders (e.g., compulsive gambling or shopping).

Alpha-2-Delta Ligands:

How They Work: These medications, originally used for epilepsy and neuropathic pain, work by modulating calcium channels in the nervous system, which can help alleviate RLS symptoms.

Common Medications:

• Gabapentin (Neurontin): Often prescribed for RLS and taken in the evening.

• Gabapentin enacarbil (Horizant): A prodrug of gabapentin specifically approved for RLS.

• Pregabalin (Lyrica): Another option for managing RLS symptoms.

Side Effects: Dizziness, fatigue, weight gain, and swelling.

Iron Supplements:

How They Work: Iron deficiency is common in people with RLS. Iron supplements can help increase iron levels in the brain, potentially reducing symptoms.

Common Supplements:

• Ferrous sulfate: A common form of iron supplement.

• Ferric carboxymaltose (Injectafer): An intravenous option for those who cannot tolerate oral iron.

Side Effects: Gastrointestinal issues such as constipation, nausea, and stomach pain.

Benzodiazepines:

How They Work: Benzodiazepines are sedatives that can help improve sleep quality by reducing nighttime awakenings caused by RLS symptoms.

Common Medications:

• Clonazepam (Klonopin): Often used for its longer duration of action.

• Temazepam (Restoril): Another option to help with sleep.

Side Effects: Drowsiness, dizziness, risk of dependence, and impaired coordination.

Opioids:

How They Work: In severe cases where other treatments have failed, low-dose opioids can be used to alleviate RLS symptoms by acting on the central nervous system to reduce pain and discomfort.

Common Medications:

• Codeine: A milder opioid option.

• Tramadol (Ultram): A synthetic opioid with additional serotonin and norepinephrine reuptake inhibition.

• Oxycodone (OxyContin): For more severe cases.

Side Effects: Risk of dependence, constipation, drowsiness, and respiratory depression.

Choosing the Right Medication

The choice of medication for RLS depends on various factors, including:

• Severity and frequency of symptoms.

• Patient’s overall health and medical history.

• Potential side effects and risk of interactions with other medications.

• Patient preference and response to previous treatments.

It's essential to work closely with a healthcare provider to determine the most appropriate medication and dosage. Regular follow-up appointments are necessary to monitor the effectiveness of the treatment and adjust as needed.

Non-Pharmacological Treatments

While medications can be highly effective, combining them with non-pharmacological treatments can provide better symptom control. These may include:

• Lifestyle Changes: Regular exercise, avoiding caffeine and alcohol, and maintaining a consistent sleep schedule.
• Behavioral Therapy: Cognitive-behavioral therapy (CBT) can help manage the anxiety and stress associated with RLS.
• Leg Massages and Warm Baths: These can help relax the muscles and reduce symptoms before bedtime.

Conclusion

If you or someone you love are continuing to have sleeping trouble, that may be a sign of an underlying problem. Please click the orange button below to take a free online sleep test and talk with one of our sleep health professionals.