Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Daily drug treatment is recommended only for people who have restless legs syndrome (RLS) symptoms at least three nights a week, or as determined by your doctor. Drugs used to treat primary RLS do not cure the condition, but only relieve symptoms. People whose RLS symptoms occur sporadically may be prescribed medication to take when they have symptoms.
The following drugs are most widely prescribed to treat RLS. They may be given alone or, in certain cases, in combinations.
Dopaminergic agents: These agents increase the level of the neurotransmitter dopamine in the brain. They may improve the leg sensations in RLS. An example is the drug combination of
levodopa (Larodopa) and carbidopa (Sinemet).
Dopamine agonists: These agents also increase dopamine levels in the brain but are less likely than levodopa to cause certain side effects. These drugs have their own side effects. These side effects may be especially difficult for older people. Examples are
pergolide mesylate (Permax),
bromocriptine mesylate (Parlodel), pramipexole (Mirapex), and
ropinirole hydrochloride (Requip).
Benzodiazepines: These agents are sedatives. They do not so much relieve symptoms as help you sleep through the symptoms. Examples are temazepam (Restoril), alprazolam (Xanax), and clonazepam (Klonopin)
Opiates: These drugs are most often used to treat pain, but they can relieve RLS symptoms. Because opiates are very addictive, they are usually used only when other drugs don't work. Low-potency opiates, which are used in people with mild or intermittent symptoms, include codeine and propoxyphene (Darvon, Dolene); higher potency agents, such as
oxycodone hydrochloride (Roxicodone),
methadone hydrochloride (Dolophine), and
levorphanol tartrate (Levo-Dromoran), are used in more severe cases.
Anticonvulsants: These agents are used to treat severe muscle spasms. In RLS, they are used mainly for people who have pain, neuropathy, or daytime symptoms. The most widely used examples
are gabapentin (Neurontin)
and pregabalin (Lyrica).
Alpha2 agonists: These agents stimulate alpha2 receptors in the brain stem. This activates nerve cells (neurons) that "turn down" the part of the nervous system that controls muscle movements and sensations. An example is
clonidine hydrochloride (Catapres). This drug may help in cases of primary RLS but has no effect on periodic limb movements during sleep (PLMS).
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 12/27/2011