Starting medication

[TDan]

Hi all,

I’m looking for advice on medication.

I’m a 58 yo male. Non smoker, given up alcohol and caffeine (almost). Not on any meds or herbals

Parents, Gparents and sister all have or had RLS.

PLM stopping me get to sleep and leg movements continue when I am asleep. Legs often ache on a morning probably due to continuous movement. Sleep very poor as a result

GP is okay and knows a bit about RLS. Ferritin levels borderline but a month course of iron hasn’t improved my PLM. GP has suggested dopamine medication - what should I try and what are the downsides?

Thank you.

[SueJohnson]

You don't want to start dopamine medication - ie dopamine agonists like ropinirole (requip) and pramipexole (Mirapex). They used to be the first line treatment for RLS but no longer are. Gabapentin is. Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know about it including the latest treatment and refer your doctor to it atHttps://mayoclinicproceedings.org/a... What was your ferritin? One month is really not enough to improve it. It usually takes 3 months.

[DicCarlson]

Sue's advice is spot-on - don't go down the DA road!

[Munroist]

For clarity many people taking dopamine agonists eventually suffer from augmentation which is when the medication actually makes things worse and people start to get symptoms for longer periods, during the day and in other limbs e.g. arms and upper body.

There is some evidence that the medication also permanently affects your dopamine receptors and can make you less receptive to other treatments such as gabapentin and pregabalin and can lead to refractory RLS where it's very difficult to treat.

A few people do manage on dopamine agonists and find good relief, usually taking low doses and sometimes by taking holidays from the drug to "reset" their reaction to the drug. You should google "Refractory RLS" and "Augumentation" to find out more. Reading the posts on this site for a month or so will give you a good overview.

[Hidden]

Sue's advice is correct in the main, however alpha 2 delta ligands (also known as gabapentinoids) are recommended first line pharmacological treatment. This includes gabapentin AND pregabalin.