Alpha2-Agonists: Clonidine (Catapres) may be helpful in relieving the symptoms of RLS. The dose may range from about 0.1mg to as much as 0.6mg per day, depending upon tolerability. Sedation, hypotension, and dizziness represent the major adverse effects.
Benzodiazepines: These may be beneficial when there are associated sleep problems, such as sleep-onset insomnia. Triazolam (Halcion), a shorter-acting benzodiazepine (BZD), or one of the BZD agonists will be more efficacious when RLS prevents sleep initiation. Zolpidem (Ambien) and zaleplon (Sonata) are fast-acting BZD agonists; zolpidem has a longer half-life. For the patient who may also be awakened by RLS throughout the night, a longer-acting BZD, such as temazepam (Restoril) or clonazepam (Klonopin), may be more useful. All these agents may have a role for intermittent use. With chronic use, the potential problems of dependency and daytime somnolence may become an issue.
Opiates: For refractory RLS, opiates represent a definite option, even given their side-effect profile. Low-potency opiates, such as codeine 30 to 60mg (with or without acetaminophen), may be useful. The potential adverse effects include dependency, constipation, daytime drowsiness, increased risk of falls, and nausea.
When the patient fails to respond to a single agent, consider combinations chosen on the basis of responses and adverse reactions to the individual drugs already tried.
Other treatments: Case or small studies involving one or a few patients suggest other possible treatments that can be tried after more rigorously studied approaches have failed. These include a lumbar corset that simulates abdominal pressure of walking12 and other medications, such as sodium valproate (Depakote, Depakene) 250–1,500 mg,12 methadone 5–10 mg,13 or tramadol (Ultram) 50–100 mg.
Given the wide range of effective treatments available today, you should be able to help most RLS patients achieve a significant improvement in their quality of life.
Dr. Selman is attending neurologist at Northern Westchester Hospital, Mt. Kisco, N.Y., and associate clinical professor of neurology at Columbia University College of Physicians and Surgeons in New York City, where he has a private practice.
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This article originally appeared on Clinical Advisor