The drugs used for the treatment of RLS have a number of side effects and
caution is needed in certain situations. Levodopa was regarded as the first line
treatment of RLS, however many patients develop rebound (occurrence of
symptoms during the night) or augmentation (symptoms occur earlier in the day
before levodopa dosing in the evening and may also involve the trunk or upper
limbs). Augmentation affects up to 82% of patients treated with levodopa and
therefore its use in the long-term is limited in most cases.
Most dopamine agonists have been shown to be effective for RLS. These
treatments are preferential in the long-term treatment of RLS as they are long-acting
preparations that can be taken as a single dose at bedtime. These drugs
have been reported to alleviate symptoms in 70 - 100% of patients. Treatment
with some dopamine agonists can also lead to augmentation but this is usually
mild and can be treated by increasing the dose. The most common adverse effect
of these drugs is nausea, which can be counteracted by domperidone.
Levodopa and the dopamine agonists are to be used with caution in angle-closure
glaucoma or if there is a history of malignant melanoma. Close monitoring
is required if patients have cardiac disease or peptic ulcer disease. Many patients
experience gastrointestinal effects as a result of levodopa use. These include
anorexia, nausea and vomiting. Other practical issues in relation to therapy
include:
- The age of the patient should be taken into account (for example
benzodiazepines may cause cognitive impairment in the elderly).
- Use medication cautiously in pregnancy as there are no controlled clinical
trials that have assessed the safety of medications in RLS and pregnancy.
Furthermore, RLS symptoms usually improve after parturition.
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