Clonazepam, benzodiazepines & alternatives.

[dickJones]

Maybe a naive question, but having benefitted from clonazepam for a year or so my plmd is now increasingly resistant. Is this resistance specific to clonazepam or is it likely to be generic to any other benzodiazepine I might try as an alternative?

If I've had it with benzodiazepines, what SRIs or dopamine agonists might be an effective alternative (any recommendations bearing in mind side effects and dependency/withdrawal problems?

[Hidden]

Hi, i cant really recommend what you should try. We all react differently to meds, regarding side effects, etc. All i can do is post these websites for you to look at the treatments available. rlshelp.org look at the treatment page rls-uk.org

[dickJones in reply to Hidden]

Thanks anyway, Elisse.

[piglet292]

I imagine that the resistance to clonazepam would apply to all benzodiazepines, but I'm no expert! You could try another benzo, like lorazepam, and see if that helps, but it's a question of trial and error, I'm afraid.

The only relief I've ever had from RLS has been when I've been taking opiate painkillers, and specifically Tramadol. My RLS is a result of taking quetiapine, and is a known side effect. I take a drug called tapentadol, which is an opiate, and it does seem to help, but the reduction in my RLS symptoms may well be due to an accompanying reduction in my dose of quetiapine. I don't take Tramadol any more, because it is contraindicated with psychiatric medication. I have a feeling that Tramadol can be prescribed for RLS, but taking it for any length of time does result in dependence, and withdrawing from it can be difficult.

Sorry not to be of more help!!

[dickJones in reply to piglet292]

Thanks, piglet. I'll talk to my GP about switching benzodiazepines, but I think you're probably right about the resistance issue. As for Tramadol etc. and withdrawal, that's a cross we have to bear, I guess. Withdrawal from clonazepam first time around wasn't a problem, but it's a significantly less intrusive medication.

[howlinwoolf]

From my experience, lorazepam and temazepam are more effective benzodiazipines for RLS snd PLM tHan clonazepam. At least that's what I've been prescribed. I actually take both clonazepam for anxiety and mood stabilization and lorazepam for the RLS. Maybe you could talk to your doc about that?

Both lorazepam and temazepam are fast acting and strong whereas clonazepam has a time release mechanism that sustains its action. All benzodiazipines are definitely not created equal. I hope you get some relief.

Also, I have heard of rebound effects from benzos so you might want to watch out for that. Taking them at the same time of night is super important.

As a side note, I also do visualizations and meditation to try to kick the night kicking. It seems to be helping quite a lot. I think RLS is a beast that requires many tools to fight.

Good luck!

[dickJones in reply to howlinwoolf]

Many thanks, howlinwoolf (Chester Burnett?!) I'll consult my GP about lorazepam and temazepam. He's always cautious about any medications with dependency potential (which, one way or another, is probably most!), but he's supportive and generally sound re the PLMD situation so hopefully he'll prescribe.

As to rebound effect, I suspect that I might be dealing with just that now. Clonazepam, which did well for me for a year, tailed off in effectiveness against my nocturnal plmd at the end of the summer. I withdrew from my dosage about 6 weeks ago and since then the PLMD spasms have increased from 2 - 3 a night to 3 - 4, occasionally more. I'm back on Clonazepam at present - 0.5 as before - as part of a staggered 3-week by 3-week regime set up by a sleep specialist. I'm due to phase out the dosage this coming weekend and to phase in Mirtazepine (which I'm very reluctant to do, bearing in mind weight-increase side effects). So maybe the plms will ramp up again!

Re taking the Clon at the same time each night, I've been careless about that so in the final week (unless I extend) I'll stick closely to the 30 minutes pre-bedtime requirement.

I do some relaxation/mindfulness exercises prior to going to bed. Maybe I should extend the routine. However, my condition is PLMD, not RLS (which I used to have in adolescence/youth/early middle age) and although their presentation is similar, there remains uncertainty a to shared provenance.

Thanks again for the thoughts.

Dick