Looking for guidance on RLS and Parkinson's Management

[gardening57]

Good Morning,

Read this forum regularly... thank you for sharing ...

Looking to learn more about RLS and Parkinson's, especially from persons with these two conditions particularly their medication management.

My husband has both conditions, RLS since mid 2000s, Parkinson's since 2018. And we are struggling with RLS severe symptoms for past few weeks. Received Iron Infusion 2 weeks ago - had a previous one in 2019 without much effect on RLS symptoms. Keep a daily diary re triggers, sleep and exercise habits etc.

Current meds for RLS are:

Neurostil (Gabapentin) 1600 mg divided in two doses evening and bedtime

Neupro (Rotigotine) 4mg transdermal patch Daily evening

Targan Prolonged Release 10mg/5mg mg 2 tablets at bedtime Oxycodone hydrochloride/naloxone hydrochloride

For Parkinson's

Sinemet Plus 25 mg 1 tablet three times a day

Ongentys (Opicapon) 50 mg 1 tablet daily

For other health conditions

Lestace 20 mg Daily am Lisinopril (HTN)

Lecalpin 20 mg Daily am Lercanidipine hydrochloride (HTN)

Lanzol 30mg Daily, evening Lansoprazole (GERD)

Molaxole Powder 13.125-gram sachets 2, Daily, evening

Toviaz 8mg Prolonged release 8mg 1 tablet daily Fesoterodine (urinary urgency/frequency)

Betmiga 50 mg 1 tablet daily Mirabegron (urinary urgency/frequency)

Tadalafil Krka FC 20 mg prn Tadalafil (erectile dysfunction)

I have concerns about augmentation on current medications, especially since Sinemet is not having any effect on the motor symptoms for Parkinson's. Wondering what options to consider next. Next Neurologist appt is in December (saw him end of May) when he prescribed the Ongentys. Thanks in advance for any guidance.

[SueJohnson]

The gabapentin is not well absorbed above 600 mg so he should take 600 mg 1 to 2 hours before bedtime, 600 hours 4 hours before bedtime and 400 mg 6 hours before bedtime or if that is inconvenient he could switch to pregabalin which does not be divided. He can make a direct switch to 275 mg and take it 1 to 2 hours before bedtime.

Parkinsons patients have sufficient iron. Gabapentin is used to improve the rigidity, bradykinesia, and tremor of parkinsonism. so that should help both RLS and Parkinson's. You should ask your doctor about Rasagiline (Azilect). Rasagiline is used for Parkinson's and has been used to treat RLS. It is not a dopamine agonist."The hope is that Rasagiline, because it prolongs the effect of existing dopamine, instead of producing more, will not come with adverse side effects," Intense exercise can slow the progression of Parkinson's but will exacerbate RLS, however I would think that would be worthwhile since Parkinson's is a more serious disease.

I have read that patients with both RLS and Parkinsons do not typically get augmentation on daily levodopa. I do not know whether that is true of carbidopa/levadopa.

Lecalpin and Lercanidipine hydrochloride are calcium channel blockers and most make RLS worse You are already taking an ACE inhibitor, Lestace, for high blood pressure which is safe for RLS.

Some medicines that are safe for high blood pressure are propranolol (Inderal, Hemangeol,InnoPran), Isosorbide Mononitrate (Monoket, Imdur) which is not a beta blocker nor calcium channel blocker. And then there are the ace inhibitors which you are already taking one of. . Other possibilities are: Clonidine (Catapres) an Alpha-2-Agonist used to treat high blood pressure which may help RLS and which also treats insomnia, tenex (Guanfacine, Intuniv), prazosin (Minipress) an alpha-adrenergic blocker that is also useful in managing sleep-related problems caused by PTSD

Tadalafil is a Vasodilator that not only treats erectile dysfunction but also treats high blood pressure

[gardening57 in reply to SueJohnson]

Hi Sue,

Thank you for your quick reply and detailed response. It is helpful information to keep in mind when discussing treatment plans with GP (seeing him in two weeks time re 24 B/P monitoring results) and neurologist. I wasn't aware of Azilect to treat RLS. So much to read and absorb from the scientific literature. I really appreciate your guidance for my husband. Here's hoping we get to a stable level of medication management whereby his quality of life is improved.

Regards

Kathleen