Medications that make RLS worse

[Jules1953]

I am wanting to put together a list of the names of medications that are known to make RLS worse .

Can you please help.

Eg Amitriptyline

[ziggypiggy]

The list may be smaller if you name those that don't. Just kidding. It would be a very long list. I personally have at least twenty antidepressants and mood stabilizers that do my RLS wrong. I've given up listing them when I go visit the emergency room or see someone new. I just tell them no meds administered without my authorization unless its life or death or I'm unconcious and can't object.

I think rls.org has a list. I'm sure it's not comprehensive and is generalized to certain classes of medications for simplification.

[Jules1953 in reply to ziggypiggy]

Yes, I agree it is a very long list of medications that can make RLS worse. I wonder if people with other neurological conditions face the same issue that we do with prescription and otc medications?Kind regards Julie

[LotteM]

In addition to ziggypiggy's reply: there are also lists on rls-uk.org and on rlshelp.org.

[Jules1953 in reply to LotteM]

Thanks very much for letting me know. We are certainly limited in what we can put in to our bodies. I wonder if people with other neurological disorders face the same issues?

[Hidden]

This is the list from RLS-UK: as it says, it is not definitive (e.g. it doesn't include Atorvastatin which triggered me last year) and again as it says by no means everyone reacts badly to everything here (including Atorvastatin!):

"MEDICATIONS TO AVOID

A number of medications can make RLS worse. In particular, anti-nausea drugs and sedating antihistamines can block the brain’s dopamine receptors, increasing the symptoms of restless legs. Antidepressants that increase serotonin and antipsychotic medications can also aggravate the condition. Let your doctor know if your restless legs symptoms worsen after you take a new medication. A change in dosage or a change to a different medication may help. Below we have listed a number of medications which our forum users suggested made their RLS worse. Please note that this list is not exhaustive and while we have been advised that they have made RLS symtoms worse for some people, this may not be the case for you.

Cold and Flu remedies: Actifed, Avamys, Benadryl, Chlortrimeton, Comtrex, Contact, Corcidin, Dimetapp, Drixoral, Fluticasone, PediaCare,Piriton, Rhinolast, Sinutab, Sudafed, Tavist, TheraFlu, Triaminic, Tylenol (flu, cold, PM, allergy), Vicks.

Note that many cough syrups may contain antihistamines, especially if they are recommended for cold or flu symptoms. Always try to choose non-drowsy options.

Anti-depressants: Many people living with RLS also live with depression and consequently are prescribed anti-depression medication. RLS is also common in two conditions that often co-co-occur with depression: ADHD and PTSD. However some anti-depressants can actually make RLS symptoms worse. If you are prescribed anti-depressants and live with RLS, we recommend you monitor your RLS symptoms to see if your symptoms worsen after starting anti-depressant medication. If so, speak to your medical practitioner to see if you can be prescribed an alternative medication.

Selective Serotonin-Reuptake Inhibitors (SSRIs): Celexa (Citalopram), Cymbalta, Duloxetine, Effexor, Lexapro (Escitalopram), Paxil (Paroxetine), Prozac (Fluoxetine), Serzone, Venlafaxine and Zoloft (Sertraline).

Tricyclic medications: Ascendin (Amoxepine), Elavil (Amitriptyline), Etrafon (Perphenazine and Amitriptyline), Limbitrol (Chlordiazepoxide and Amitriptyline), Norpramin (Desipramine), Pamelor (Nortriptyline), Sinequan (Doxepin), Surmontil (Trimipramine), Triavil (Perphenazine and Amitriptyline), Tofranil (Imipramine), Mirtazapine, and Vivactil (Protriptyline) , as well as others, have been suggested as making the symptoms of RLS worse.

Antacids: Medications to treat nausea can worsen RLS symptoms. This class of drugs includes: Anitvert, Atarax, Benadryl, Bonine, Compazine, Phenergan, Thorazine, Tigan, Trilafon and Vistaril, Zantac."

[SueJohnson in reply to Hidden]

Wow. I thought I had a pretty comprehensive list (10 pages single spaced) but you have 11 ones I didn't have plus alternate names for 5 I did. Thank you. I do have to disagree on a several or at least clarify. Tylenol alone is safe for RLS, non drowsy sudafed is OK and Norpramin (Desipramine) is actually a safe antidepressant. Also some people on the forum report that coffee actually helps and in some cases eliminates their symptoms.

[Jules1953 in reply to SueJohnson]

Thanks Sue for this very helpful medication information And I often have a coffee of an evening because I find it relaxing.

[Jules1953 in reply to Hidden]

Thank you very much for this indepth response to my question.

[Jules1953 in reply to Hidden]

Thank you for this very comprehensive reply. Kind regards Julie

[Heideinthewild in reply to Hidden]

My dr prescribed cymbalta for pain of rls. I asked her if it was an antidepressant and she said no. I think most doctors think people with painful rls are making it up because they are opiod seekers. My dr said as far as she knows rls causes you to want to move your legs and thats it. She does not associate rls with pain.

[Hidden]

And this is the list from rlshelp.org:

"Drugs and Foods to avoid to improve RLS

This section will discuss various drugs and foods that may worsen RLS. Things that cause worsening of RLS in some patients may not bother others in the same way; in fact, others may even be helped by these same medications or foods that worsen others. Please free to email us with any foods or drugs that worsen your RLS problems. Keeping a diary or log of foods, medications taken and worsening of RLS may also be helpful to determine what might be affecting you.

Ice Cream

Some patients have found that ice cream (all flavors) cause worsening of RLS. Avoiding this food eliminates significant RLS worsening, especially in patients who eat a lot of ice cream. The cause of this relationship is unknown. For a possible explanation of why ice cream may exacerbate RLS, click here for a discussion of avoiding Mono and Diglycerides to help RLS.

Caffeine

Drugs and foods containing caffeine are very common. Coffee, tea, and colas are all commonly known beverages which contain significant amounts of caffeine and can cause worsening of RLS symptoms. Chocolate can also contains caffeine.

Many medications use caffeine in their formulation, especially pain pills, so you much check them out one by one. Some common medications with caffeine include: Cafergot, Darvon, Esgic, Exedrin, Fioricet, Fiorinal, Migralam, Norgesic, Wigraine, Anolaor, Butalbital, Femcet, Medigesic, Pacaps, Repan, and Synalgos-DC.

Antihistamines

These include the common allergy and cold remedies, most of which are available over the counter. Examples are Actifed, Benadryl, Chlortrimeton, Comtrex, Contact, Corcidin, Dimetapp, Drixoral, PediaCare, Sinutab, Tavist, TheraFlu, Triaminic, Tylenol (flu, cold, PM, allergy), Vicks. Note that many cough syrups may contain antihistamines, especially if they are recommended for cold or flu symptoms.

The newer, non-sedating antihistamines, Allegra, Zyrtec and Claritin are generally better (and some RLS patients can take these without problems), but can be just as bad as the over the counter medications.

Antidepressants

The tricyclic and serotonin uptake inhibitors (see Antidepressant Medication section above) can cause significant worsening of RLS problems. Paradoxically, some patients have noted marked improvement while on these medications, making it harder to understand why some patients worsen and others improve.

Antinauseants

Medications to treat nausea can worsen RLS symptoms. This class of drugs includes: Anitvert, Atarax, Benadryl, Bonine, Compazine, Phenergan, Thorazine, Tigan, Trilafon and Vistaril.

There is an antinausea medication only available in Canada and Mexico called Domperidone (available over the counter as Motilium 10 in Mexico) , which does not cause worsening of RLS symptoms. This can be obtained by Americans over the internet from Canadian pharmacies (example is canadameds.com or canadapharmacy.com or thecanadianpharmacy.com) with a valid prescription from an American medical doctor.

Reglan (metoclopramide) is an anti-nausea agent that is also used to prevent reflux and has significant anti-dopamine activity, so it should be avoided.

There are two newer anti-nausea medications available in t he USA, Kytril (granisetron hydrochloride) and Zofran (ondansetron hydrochloride) which do not affect the dopamine system and thus should be safe for RLS. The only problem with these medications are that they are very expensive.

Cough syrups

Most OTC cough syrups are fine to use for RLS patients if they are just simple cough medications (like regular Robitussin which contains guaifenesin and the DM version that also contains dextromethorphan). When they are combination preparations (also good for colds, flu, etc.) they likely contain antihistamines which as noted above, worsens RLS. So, check the ingredients carefully before you buy any cough medication (OTC) as they may contain harmful ingredients.

The prescription cough syrups usually contain a narcotic (codeine or hydrocodone). The most common one prescribed is Phenergan with codeine, which contains the anti-nausea agent phenergan which usually worsens RLS. It is countered by the presence of a small dose of codeine, but this may not be enough to cover the RLS worsening effects of the phenergan. Tussionex is an example of the hydrocodone containing syrups. It is combined with chlorpheniramine, a potent RLS worsening antihistamine, but the hydrocodone is at a high dose of 10 mg which usually will overcome any worsening effects of the chlorpheniramine. Hycomine is similar to Tussionex but Hycotuss does not contain any RLS worsening medications so it may be a better choice.

Antipsychotic medications

Many of these drugs are similar chemically to the anti-nauseants (in fact many are used as anti-nauseants). They can worsen RLS just like the antinausea drugs. This class of drugs includes: Clozaril, Compazine, Haldol, Loxitane, Mellaril, Moban, Navane, Prolixin, Risperdal, Zyprexa, Serentil, Stelazine, Thorazine, and Trilafon. Also, lithium, a drug which is very helpful in the manic-depressive disorders, can worsen RLS.

Bladder Control drugs

We have gotten some case reports of worsening RLS with drugs such as Ditropan. These drugs should thus be used with caution in RLS sufferers.

Alcohol

Alcohol had been found by many RLS sufferers to cause worsening of their RLS. The amount that does this can be very small in some cases. Individual tolerance can vary considerably (many may not be bothered at all)."

[SueJohnson in reply to Hidden]

And that adds 8 more to my list.

[Jules1953 in reply to Hidden]

Many thanks for all this very valuable information. Kind regards Julie

[SueJohnson]

As ziggypiggy mentioned the list may be smaller if you list those that don't. I have 10 pages single spaced of those that do, although I have listed all the names each is known by so there is repetition. The best way to check if a medicine is bad for RLS is to ask on this forum and often one of us can list a safe substitute. Also as mentioned, some people are not affected by a medicine. For example I have medicines on my list that affect only 5% of people some of which are mentioned by others. And interestingly coffee has been listed by a number of people as actually helping and in some cases eliminating their symptoms. Plain Tylenol is fine as is the non-drowsy sudafed. Norpramin ( desipramine) is actually a safe antidepressant,

[Zyxx]

Here’s a big one: metoclopramide.It’s an anti-emetic and a dopamine antagonist.

I was suffering from severe nausea as a consequence of getting off Paxil (paroxetine, SSRI) and thought I would be deeply grateful with any anti-nausea med. But 36 hours of relentless RLS proved to be just as bad…

Never again.

I do like Zofran = ondansetron. No RLS from that.

[Mum007 in reply to Zyxx]

Metoclopromide caused me huge restless legs, tremors and agitation after only half a tablet !

[Zyxx in reply to Mum007]

Awful, isn’t it?

[Jules1953 in reply to Zyxx]

Thanks very much for this information. Kind regards Julie

[Jimijj]

I find it odd that sleeping pills are not mentioned.For me ANY type of sleep aid, over the counter, and prescription including melatonin ., makes my legs real bad.

[Jules1953 in reply to Jimijj]

Thanks so much for this information on sleeping medications. Kind regards Julie

[RCHD]

Great idea

[Katielove53]

Hi Jules, I often have a coffee at stupid o clock in the morning because it relaxes me as well. But to answer your question the usual anti depressants for sure are contributors, I’ve personally been on them for decades but do remember a time when not on them and not having RLS. I have recently started HRT patches and found my condition more difficult to deal with, however I am only in my 8th week so time will tell. They haven’t made my menopausal symptoms any easier to deal with but again it could take longer to kick in. I am on my last box before going back to the GP for follow up, I will try and remember to post again with any update

[Jules1953 in reply to Katielove53]

Thanks very much for your response, kind regards Julie

[Hope61 in reply to Katielove53]

That is interesting to me. I have an upcoming appt with a new doctor and I wanted to discuss some menopause issues and I was hoping she would suggest HOrmone therapy. I didn't realize it takes that long to work. Also my old doctor scared me about side affects a couple of years ago so I did nothing. I am hoping to have a better conversation with the new doctor. Anyway thanks for sharing

[LotteM in reply to Hope61]

Hope,we are all different. My rls symptoms reduced for a few years when I started HRT. Also, I noticed that the HRT worked within 2 weeks. I have recently stopped the HRT as a trial to see if I can do without, and it also took 2-3 weeks for the symptoms to re-occur. Unfortunately.

Again, we are all different. Let the different stories make you aware if what may happen, but if you really want to discuss your problems and treatment of these with your doctor, please do so, and let s/he he take you seriously. Don't not do it because of stories from others, as it is notoriously difficult to predict whether those stories will apply to you. But do mention it to your doctor if you worry that HRT may make your RLS worse.

[Hope61 in reply to Katielove53]

Katie were you saying the HRT made RLS worse or that your menopausal symptoms are worsening ? Thank you

[Katielove53 in reply to Hope61]

My RLS has gotten worse and the menopausal symptoms have remained the same however after speaking to the gp yesterday she said that after my 3 months are up and if there are no changes then it would need to be reviewed. I have spoken to women who found the patches didn’t work but the tablets did. There is a lot of medication to choose from depending on your current health situation. I have researched a lot, but everyone is different and hormone balance has to be taken into consideration for that person. Hope this helps xx

[Hope61 in reply to Katielove53]

Thank you so much all !!

[Jules1953 in reply to Katielove53]

Thanks very much for sharing your personal experience on HRT. Please let us know how you get on. Kind regards Julie.

[Hope61 in reply to Jules1953]

Will do !!

[joker826]

Reading all lists of the meds. Not much is left. We need antidepressants. I don’t get it.

[marsha2306 in reply to joker826]

I take Wellbutrin and it’s fine. I’m in the US. I understand you may not be able to get it in the UK.

[Jules1953 in reply to marsha2306]

Thanks for that information. Kind regards Julie

[Jules1953 in reply to joker826]

Yes I agree, so many medications seem to make RLS worse.

[TajarTales]

I know it's been mentioned here, but I'm not sure where. I am anticipating having surgery in the near future. Do you know of any specific meds that might make RLS worse?

[Fingerandus]

rosuvastatin metformin pramipexole asthma puffers .all have side effects

[No_One_]

I found anything with sugar in it. I need to avoid it 6 hours before bed. I take Requip and hate that stuff. It takes 2-3 hours to kick in and it doesn't do me any favors the next day. I wish it would work faster so I wouldn't need to take it every night.

[Jules1953 in reply to No_One_]

Hello, thanks for your message, sugar is a definite no no for those of us with RLS. You mentioned that you are taking Requip to help with your RLS. Are you aware that this is a dopamine agonist medication and have you heard of the term "augmentation"?

I have previously been taking a dopamine agonist medication called Pramipexole. But due to using it long term and increasing its dosage , I eventually experienced "augmentation ". This is when RLS get worse, start earlier in the day and extend to other parts of the body such as the arms.

Dopamine agonist medications are no longer recommended for treating RLS.

Unfortunately, most doctors are unaware of the dangers of long term use of medications such as Requip.

These is lots of information on this site about this issue.

I spent 18 months slowly weaning off the Pramipexole I was taking. During the last few months I used oxycodone 5mg each night to help me with the withdrawal symptoms.

I now use Temgesic sublingual 200mcg tablets to successfully control my RLS. Temgesic is micro dosages of Buprenorphine, an opioid medication. I have suffered with RLS for 51years and I have found the Temgesic to be the most effective treatment for my RLS and does not leave me feeling awful during the day.

Kind regards Julie McGowan from Western Australia.

[Stevie747]

I take. The maximum daily dose of Tramadol 400mg for the past 10 years it has worked well too subdue my RLS . However when taking an oral anti fungal Nystatin my RLS was suddenly off the scale . I eventually found some reports that antifungals can stop the beneficial effects of Tramadol for RLS . I don’t know whether or not this would be the case if your not taking Tramadol. But it’s worth noting for those of us who take Tramadol for relief that y statin and probably others create a withdrawal