Drug therapy may be initiated if appropriate treatment of an underlying disorder has not alleviated associated RLS; it is a treatable idiopathic form of RLS; or lifestyle changes have not appropriately improved symptoms. The pharmacologic treatment of RLS may be extremely complex and must be carefully adapted to most effectively and appropriately treat each individual with the disorder. According to the medical literature, the large number of different drugs that may be used to help treat patients demonstrates the complexity of RLS management.
Physicians typically consider a number of factors when initiating drug therapy for RLS. For example, because certain drugs may aggravate other conditions that are present, physicians will consider a patient’s medical history (including any diagnosed disorders, current medications, etc.) in determining which medications to prescribe. If possible, physicians may attempt to treat RLS and another existing condition with a single, appropriate medication.
When a particular drug therapy is initiated for the treatment of RLS, the medication is usually started at a low dose and then gradually increased as necessary to the minimum level of effectiveness. In addition, they may stress that the medication should be taken only as needed, such as during certain circumstances that provoke symptoms or on those days during which symptoms usually occur. If increasingly higher dosages of a specific medication are required to ensure its continued effectiveness (known as developing tolerance), physicians may temporarily suspend the drug’s use or prescribe a different medication.
In some patients, symptoms may vary in range and severity or may cease altogether for a period of time (remission). Therefore, physicians also may suggest a variety of medications to treat RLS. Generally, physicians choose from dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. Dopaminergic agents, largely used to treat Parkinson’s disease, have been shown to reduce RLS symptoms and PLMD and are considered the initial treatment of choice. Good short-term results of treatment with levodopa plus carbidopa have been reported, although most patients eventually will develop augmentation, meaning that symptoms are reduced at night but begin to develop earlier in the day than usual. Dopamine agonists such as pergolide mesylate, pramipexole, and ropinirole hydrochloride may be effective in some patients and are less likely to cause augmentation.
The newest treatments for RESTLESS LEGS SYNDROME are medications like ropinirole (Requip®) which increase the dopamine in the body and directly overcome the cause of the disorder in most people. As far as the FDA is concerned, dopamine agonists like Requip®, Mirapex® and Permax® are the preferred form of treatment for those with Restless Legs Syndrome and all of these are relatively new medications. Side effects include feeling tired. In rare cases, there have been patients who developed gambling addictions while taking the drug. Fainting or low blood pressure has also been recorded.
Other medications used include the use of pain medications like propoxyphene or Ultram which can become addictive if used excessively. Other medications, often used for Parkinson’s disease, include carbamazepine and gabapentin. Some of these medications increase dopamine directly by being precursors to dopamine in the system. These include Sinemet and Eldepryl. Because Parkinson’s disease involves a lack of dopamine in some areas of the brain, the medications work on both Parkinson’s disease and RLS in much the same way.
Many people with Restless Legs Syndrome are on medications that relax a person such as the benzodiazepines (diazepam, triazolam, temazepam, clonazepam) which are often successful but which are also highly addictive and sedating. Muscle relaxants like baclofen and alpha-agonists like clonidine also have been found to be helpful. All of these medications act as general anti-anxiety medications or muscle relaxants so that they will work in those who need some overall relaxation to control their restless legs.
Now that medications like Requip® have been created, anyone with a television set can have a glimpse into what the future holds for them in terms of possible treatment options. Restless Legs Syndrome has taken front seat and more and more patients are diagnosing themselves or talking to their doctors all the time.
What this advertising has done is open both doctor’s and the public’s awareness of this condition. Believe it or not, it would be rare for a doctor to ask specifically about Restless Legs Syndrome as long as you, the patient, doesn’t bring it up. Advertising has done a great deal to increase the awareness of the disease and this means more people will be helped, particularly if they ask for it
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