Medicines for Restless Legs Syndrome

Definition

"Restless Legs Syndrome" (RLS) is defined as a complex neurological disorder, typical of sleep: the affected patient perceives the constant desire to move the lower limbs to find relief and comfort. RLS syndrome is a sleep disorder because symptoms occur mainly during rest, and are relieved by movement.

Causes

The precise trigger for restless legs syndrome is unknown; probably, the disease is transmitted genetically by an autosomal dominant mechanism. Risk factors: amyloidosis, rheumatoid arthritis, celiac disease, diabetes, folate deficiency, Lyme disease, kidney disease, Parkinson's, uremia.

Symptoms

Symptoms that accompany restless legs syndrome are quite difficult to define: nocturnal leg twitching, motor restlessness, uncontrolled leg movements, need to move the lower limbs, itching / tickling, tingling in the legs.

The information on Restless Legs Syndrome Medicines is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Restless Legs Syndrome Medicines.

Medicines

Pharmacological treatment for patients with mild forms of restless legs syndrome may not be necessary: in fact, the symptoms accompanying the disorder may be light and sporadic, sometimes almost unnoticeable.
This is different for patients with moderate or severe forms of restless legs syndrome.Let us briefly recall that the primary form of RLS cannot be cured at the root because it is genetically transmitted, therefore not related to any precise and identifiable cause: in such situations, pharmacological treatment is purely symptomatic.
The secondary form of the syndrome can instead be treated after identifying the underlying cause. In such circumstances, it is necessary to report two different therapeutic approaches:

Symptoms are frequent, and occur in the subject at least 3 nights a week → drugs to relieve symptoms must be taken continuously.
Symptoms of restless legs syndrome are sporadic, with spontaneous remissions lasting weeks or months. However, the symptoms - when they occur - create discomfort for the patient → in this case, the irregular intake of specific drugs is justified.

In addition to the administration of drugs, it is advisable to implement simple precautions:

Take relaxation courses, yoga stretching
Practice a "sleep hygiene
Avoid heavy, high-fat meals, especially before bed

For further information: read the article on remedies for restless legs syndrome.

The following are the classes of drugs most used in the therapy against Restless Legs Syndrome, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Martial therapy (administering iron-containing drugs)
Indicated to treat restless legs syndrome dependent on severe iron deficiency. Ferrous sulphate (eg Ferrograd) is particularly suitable: iron supplementation must be continued as long as serum ferritin levels exceed 20-50 mcg / L. To facilitate the absorption of the mineral, the drug can be combined with a vitamin C supplement.

Folic acid and vitamin B12
The supplementation of folic acid and vitamin B12 is particularly useful for reducing the symptoms of restless legs syndrome in pregnant women.
We briefly recall that pregnant women should always supplement their diet with folic acid supplementation, which is essential to protect the unborn child from spina bifida. In case of predisposition to restless legs syndrome, expectant mothers should take quantities superior of vitamin B9.
The dosage should be carefully established by the doctor.

Dopamine Agonists (Dopamine Agonist Drugs): Drugs mimic the effects of dopamine by stimulating neurons to react. Dopaminergic agonists are the drugs of choice for the treatment of restless legs syndrome.
Let us briefly recall that dopamine is a messenger substance contained within the cerebral districts, useful for the control of movement and coordination. Even in the restless legs syndrome, it seems that dopamine plays a leading role: the neurological disorder can depend on from alterations in the functioning of dopamine.

Rotigotine (eg. Leganto, Neupro): available in the form of a transdermal release patch of 1, 2, 3, 4, 6 or 8 mg, the rotigotine It is indicated for the treatment of moderate or severe restless legs syndrome, especially when the disorder is apparently not related to any specific cause. Apply the patch once a day, at approximately the same time, on dry, clean and healthy skin. It is recommended to apply it to the abdomen, thighs, shoulders, hips or upper arm. After 24 hours, the patch should be removed and replaced with a new one. to be applied in a different point. Do not exceed 3mg / 24 hours.
Pramipexole (eg. Sifrol, mirapexin, pramipexole accord, pramipexole teva, oprymea). The drug is available in immediate-release tablets. For restless legs syndrome it is recommended to take immediate release 0.088 mg (1 tablet) once a day. If necessary, increase the dose every 4-7 days, up to a maximum of 0.54 mg. The drug is also used in therapy for the treatment of Parkinson's disease
Carbidopa + levodopa (Levodopa/Carbidopa/ Entacapone Orion): The combination of multiple active ingredients such as carbidopa and levodopa can also significantly improve RLS symptoms. In general, the suggested posology for restless legs syndrome is 25-100 mg / day, to be taken before the onset of symptoms (before going to bed for the night's rest). However, the dosage should be carefully determined by the doctor.
Ropinirole (eg Requip): for restless legs syndrome, take 0.25 mg of the drug orally, once a day, 1-3 hours before bedtime. After 2 days, possibly increase the dose to 0.5 mg / day. If necessary, the dosage can be progressively increased from week to week, up to a maximum of 4 mg per day. Consult your doctor.

Long-term therapy can induce severe side effects: hallucinations, hypotension, fluid retention and sleepiness; The appearance of obsessive-compulsive behaviors such as hypersexuality, gambling and compulsive eating behavior is also possible.

Benzodiazepines: although effective, these drugs exert their therapeutic activity exclusively on sleep disorders, not interacting on the root cause.

Clonazepam (eg Rivotril): the drug is used in therapy for restless legs syndrome; it acts by raising the threshold of awakening reactions, thus counteracting frequent awakenings. The dosage should be carefully established by the doctor (generally it varies between 0.5 and 2 mg, to be taken before bedtime). Due to its pharmacokinetic profile, clonazepam is the most widely used benzodiazepine for restless legs syndrome.

Opiates

Second-choice drugs for the treatment of restless legs syndrome. They are used in therapy when previous drugs are not effective in reducing symptoms.

Tramadol (eg. Tralenil, Tramadol, Fortradol)
Oxycodone (eg. Oxycontin, Targin): generally, the recommended dosage is 15 mg, to be taken before bedtime

The dosage of the drugs reported must be established by the doctor on the basis of the severity of the disorder.
Medicines can be addictive.

Antiepileptic drugs

For restless legs syndrome, antiepileptic drugs must be used in low dosages.

Gabapentin (eg. Gabapentin, Apentin, Gabexine, Neurontin): the drug (also used for the treatment of convulsions) is taken orally, once a day, at a dosage of 600 mg. Taken at 5.00 am, the drug excellently exerts its therapeutic action in reducing motor symptoms. We recall, in fact, that restless legs syndrome seems to follow very specific circadian rhythms.