Ask the Experts: Restless legs syndrome

Neurology Now
June-july 2012
Volume 8(3)
p 39

Abstract

Is there any way to reduce the side effects of medication for restless legs syndrome? Ropinirole makes me sleepy during the day, even when I take it at night.

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RESTLESS LEGS SYNDROME

QIs there any way to reduce the side effects of medication for restless legs syndrome? Ropinirole makes me sleepy during the day, even when I take it at night.

DR. MARK MAHOWALD RESPONDS:

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A The short answer is no, but several different medications can be tried, and some may have fewer side effects.

Restless legs syndrome (RLS) is a neurologic movement disorder resulting in a need to rub or move the legs while falling asleep. In some cases, RLS is associated with iron abnormalities—a low serum ferritin level. If that is the case, iron supplementation may be effective in reducing symptoms.

Medications that can be helpful for treating RLS include dopaminergic agents (relating to tissues or organs affected by dopamine), such as ropinirole (Requip) or pramipexole (Mirapex), which are often used to treat Parkinson's disease (although the effectiveness of these drugs for RLS does not imply a relationship between RLS and Parkinson's disease); opiates such as codeine and methadone, which, when used as prescribed to treat a condition for which they are effective, infrequently result in abuse; and gabapentin, an antiepileptic drug.

Often, changing the type of medication until you find one that controls symptoms without drug-related side effects may help. A change would be indicated if symptoms are not well controlled or if undesirable side effects occur.

None of the complementary therapies for RLS, such as the use of valerian root, have been shown to be effective. Making small lifestyle changes—for example, lowering intake of caffeine, alcohol, and tobacco—and engaging in physical exercise can reduce symptoms in those who have mild to moderate RLS. Additionally, some supplements may be prescribed for deficiencies in folate and magnesium. Keeping a regular sleep routine as well as massaging the legs, taking a hot bath, or using a heating pad or ice pack before bed may also reduce symptoms. Although some of these measures may offer partial relief, they will not likely eliminate all symptoms of RLS.

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