Patient letters on RLS symptoms and remedies- Page 74

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Sent: Monday, April 30, 2007 2:07 PM
Subject: RLS and antidepressants?

I have had RLS for the last 20 years. It does run in my family but I think mine is worse since I started taking Prozac for OCD and depression. I take 100mg. a day. The higher I got on the dose the worse my RLS got. I did some research and read where some people who have been on Prozac experience twitching or feel annoying movements in their legs. I also get it in my arms occasionally, especially my left arm where the doctor removed 13 lymph nodes.

I have a friend who is on 60 mg of Prozac and said she has the same annoying problem with her legs and she is now taking Requip. I also take clonazepam for anxiety it does not help with RLS. At the presents I am also on Pamelor 50 mg per day. I have tried Requip in the evening around 6:30 PM because soon as I sit down in the afternoon my legs are very uncomfortable.

I was in the hospital 2 months ago and asked them if I could take Requip in the morning as RLS can start acting even during the day a lot of times and I'm unable to sit still at meetings, or read and relax. How often can you take Requip during the day and if you wanted to stop taking it would you have to taper off gradually?

I have read some of the other letters on this web site about Requip and Clonazepam that they make some people sleepy, they do not have that effect on me. I think I'm going to wean myself off the Clonazepam and continue to take the Requip as I get more benefit from the Requip and I need to give up one in order to afford taking the Requip. Is a prescription for Requip the only way you can purchase it?

Katly

Medical Reply

Prozac and other SSRI antidepressants tend to worsen RLS. Not all people have this problem but it seems to be very common. Pamelor also tends to worsen RLS, so you have double trouble. If these medications are necessary to treat your OCD and depression then you should stay on them and simply treat your RLS symptoms with Requip (it is only available by prescription).

Requip is only FDA approved for once daily but most of us specialists give the drug up to three times daily to cover morning to evening RLS symptoms. In the near future, a slow release formulation (Requip CR) will be available that last up to 12 hours.

Clonazepam does not help RLS but simply helps RLS patients fall asleep at bedtime (and there are better sedatives for this purpose). If you do go off this drug (of course, only with the approval of your doctor) make sure you taper off it slowly to avoid withdrawal problems. Requip can be stopped suddenly but then RLS symptoms come back immediately.

A minority of people suffer from sleepiness from Requip (others may have insomnia) so that should not be a big concern.

Sent: Monday, April 30, 2007 7:34 PM
Subject: Substitute for Permax?

I have been on Permax for several years, starting with 1/2 mg, then 1 & for the last year or so, 1 1/2 mg. It has worked fairly well for me but now that is being pulled off the market, I'm wondering what would be the closest substitute for Permax? I am a 55 year old male who has had RLS since grade school.

Tom T.

Medical Reply

Requip or Mirapex are as effective as Permax but much safer (no problems with heart valve damage like Permax).

Sent: Friday, May 04, 2007 2:12 PM
Subject: RLS/Fibromyalgia?

I am 50 years old and have had problems with restless legs (restless seems a bit mild for how it feels) off and on for years. It has gotten worse and worse. Changing shoe styles, long plane or car travel (even if I get out to stretch along the way), and simply sitting or lying in bed aggravates my symptoms.

It used to only happen at night and after I lay down to sleep. Now it can bother me all day and night. I can't seem to stretch enough to get relief and if I'm lucky enough to fall asleep, my husband says my legs will jerk and/or I will wrap my legs around his leg and dig in with my toes. My toes always are in a clench and I get only a few seconds relief from pulling them backwards. In the mornings I am sore from stretching and clenching. Often I ache into my hips and low back as well.

My primary care physician says I have fibromyalgia and I'm not sure which symptoms come from which disorder and therefore what is the best treatment. I take Cymbalta and trazodone for depression/anxiety which began after complications from surgery a few years back. I have taken Requip and it worked only for a couple of weeks. I have just been prescribed Carb/Levo 10-100 and will begin it tonight. It seems I ache and throb from head to toe between the fibromyalgia and RLS.

I have always exercised regularly and never been more than a few pounds over weight and sometimes have been under the average weight for my petite, 5'2 frame. I have don't get much dietary caffeine, but have found that the only OTC pain meds that work contain caffeine. I have a brother who has hemochromatosis and has restless leg problems but not as severely. My mom has some problems of a mild degree with RLS as does my 17 year old daughter.

What relationship to Parkinson's disease, if any is there to RLS? Do my symptoms sound like RLS or all fibromyalgia, or both to you?

Angela H.

Medical Reply

It does sound like you have RLS but please check out the 4 criteria . If you fulfill them, then you have RLS. Combined with your PLMS (leg kicks), family history of RLS and response (at least initial) to Requip, it would be very strange if you did not have RLS.

Patients with RLS often have symptoms that are similar to fibromyalgia and get misdiagnosed as such. Proper treatment of the RLS often "cures" the fibromyalgia.

It is possible that the Cymbalta is worsening your RLS as all SSRI and SNRI antidepressants tend to do so. Changing to Wellbutrin may be helpful. Treating your RLS correctly may even obviate the need for any other treatment for anxiety or depression.

Carb/Levo (Sinemet) is a reasonable drug to use for RLS on an intermittent basis but most experts strongly advise against using this drug on a daily basis as it can cause severe worsening of RLS after a few weeks to months (called augmentation). You may need higher doses of Requip or a change to the other dopamine agonist, Mirapex. If these do not help then other classes of RLS drugs should be tried.

Sent: Saturday, May 05, 2007 5:22 AM
Subject: Dostinex for RLS?

While on 1.5 mg Dostinex a day for my severe RLS I am very concerned about the recent reports of Valvular heart disease with Dostinex. Amongst others I tried Requip and Mirapex before with no success.

Although my neurologist has arranged a cardiologic check each year, do you think I should stop using Dostinex.

Mrs. L. V.
Voorschoten, The Netherlands

Medical Reply

The use of ergot-derived dopamine agonists (pergolide or Permax, cabergoline or Dostinex, Cabaser, bromocriptine or Parlodel) has been recently found to be a problem with heart valve damage. We knew that there was a concern about heart valve damage for several years but it appeared that this was a fairly uncommon problem.

Two new studies (just published earlier this year) have revealed that about 25% of people taking these drugs have at least some evidence of mild scarring of their heart valves. Due to this concern, the makers of pergolide have voluntarily removed this drug from the US market (it is still available elsewhere).

People taking one of these drugs can have a periodic (every 3-12 months) echocardiograms which should help to find very early evidence of any heart valve damage. This should enable anyone to stop their medication before severe heart valve damage occurs.

However, many RLS experts are now no longer prescribing these ergot-derived drugs to completely eliminate the chance of any heart problems. It is difficult to advise you exactly what to do but you should discuss and weigh the risks (now that you know them better) compared with the benefits (especially as the two non-ergot drugs, Mirapex and Requip do not help you) with your doctor and come to a decision that feels right for you.

Sent: Sunday, May 06, 2007 3:48 PM
Subject: Mirapex dose for RLS?

After following your advice, I have just restarted Mirapex. My doctor ordered .125mgms three times daily, but I have only been taking it x2, I am fine during the day but not at night, could I take .25 mg at night and omit the morning dose? Is it alright to take a Restoril at bedtime? So far I have been staying away from any other drugs.

I think it is wonderful that we have RLS sufferers have someone to go to .

Mary M.

Medical Reply

Mirapex should be taken only 1-3 hours before the typical onset of RLS symptoms. For those who have symptoms early in the day, 2-3 total daily doses may be necessary. However, if your daytime RLS symptoms are not that severe and you have the opportunity to "walk them off" then you can certainly skip the daytime doses and only take the medication at night. As such, it would be reasonable to increase your nighttime dose and eliminate your morning dose.

Restoril is reasonable at bedtime if you need additional help to fall asleep. However, this drug does cause tolerance and dependence if used nightly but does not if used intermittently (3-4 days per week). Immovane (zopiclone, only available in Canada, not the USA but similar to our Lunesta) is a better choice for daily use as it has a minimal risk of tolerance or dependence.

Sent: Tuesday, May 08, 2007 1:53 PM
Subject: Child with RLS?

My five year old great granddaughter has been complaining with her legs hurting at night. Her description is it feels like needles or something pulling in her legs. Her doctor said she had growing pains. Do you think she has RLS? .

It runs on my family. My father suffered with it almost all of his life. I also have severe RLS but it has not effected my children or grandchildren as of now. Is there medication for children?

TW

Medical Reply

We should be suspicious that she does have RLS, especially with her family history of RLS. It is often difficult for adults to describe RLS symptoms and of course it is even harder for young children.

There is no approved medication for treating children with RLS, however those of us who specialize in RLS and see children with this disorder do use medication when really necessary. We follow much the same guidelines as for adults.

Sent: Wednesday, May 09, 2007 7:38 AM
Subject: Requip and Addiction?

My wife and I both have problems with our legs at night. We have stopped taking Suboxone for withdrawal from opiates after four surgeries. We have been given a prescription for Requip but are afraid to take it after reading some info about maybe pushing us back to the opiates.

We are taking Neurontin but that makes feel bad the next day. We want to try it but are unsure. Is Requip addictive and would it hurt our attempts to stay off the opiates?

Chris J.

Medical Reply

Requip and other dopamine agonists are not addictive and should help most RLS sufferers stay off opiates.

Sent: Wednesday, May 09, 2007 9:59 AM
Subject: Restless Leg Syndrome from vitamin deficiency or anti-depressant withdrawal?

I recently weaned off my Lexapro (2 weeks ago). At that time, I was experiencing many other problems so my doctor elevated by Synthroid (Hashimoto’s Disease), found a Vitamin D deficiency, and a very low progesterone level and prescribed accordingly.

Since that time, I have VERY annoying legs at night. Only at night and in bed. They keep me from falling asleep. I feel like I have to move them, or move myself like I’m having a fit. The only thing that helps is falling asleep but that’s hard to do sometimes because my legs are driving me nuts.

I call it the fidgets, but I guess it’s RLS. The other night I walked around my neighborhood for an hour before bed, hoping to tire my legs out so they wouldn’t do that.

I am wondering if antidepressant withdrawal, or my Vitamin D or Progesterone deficiencies, can create RLS and if so, is it a matter of time to normalize once my blood work normalizes? I stopped working out 5 months ago and just began again. Hope that will help, too.

Amy,
Michigan

Medical Reply

Generally, getting off Lexapro should help your RLS, not worsen it. There is no known relationship between Vitamin D or progesterone and RLS. It is possible that having too high or low thyroid hormone could worsen RLS but monitoring those levels is very easy so you should not be out of range.

From your current information, it is not clear why your RLS is worse.

Sent: Thursday, May 10, 2007 2:13 AM
Subject: RLS, sleep and depression treatment?

It is 5:04 am and I am typing u this letter because I cannot sleep, of course because my legs are kicking and aching and twitching when I try to lay down so I decided to try to look on the internet to see if there are any "new" solutions for RLS. I am currently taking Requip 3 mg and Topamax 100 mg and Lunesta 3 mg to sleep at night which works pretty well, but I also take Paxil 40 mg during the day.

I would like to find out if there is some way that I could just find one or two meds that would help with my restless legs and my anxiety issues both. Paying for all of these medications are expensive. Doing without the medications is painful and at the same time irritating. That is what has happened now.

I have ran out of the Requip so I can't sleep because I kick and toss and turn and then get up and pace up and down the floors. Then try to lay down again, but to no avail. I have four children I have to take care of, have to get sleep, but it is hard to do when your legs wont let you. What can I possible try that might help, but is cheaper?

Thanks
Sandy W.

Medical Reply

It is difficult to advise you to change a drug regimen that has been medically successful for your RLS as only trouble may ensue. It is likely that the Paxil may be worsening your RLS. If that is the case (and only trial and error by stopping can really determine this) then perhaps changing this drug to the more RLS friendly drug, Wellbutrin may be helpful (it may even let you stop some of your RLS medications that are so costly).

However, if the Wellbutrin does not take care of your depression, then you are better off on the Paxil.

Sent: Thursday, May 10, 2007 2:00 PM
Subject: Requip side effects?

In reference to Requip and retaining fluids, I take Requip 3 times a day, it helps with the nighttime sleeping but I am finding that I have gained a lot of weight, approximately 10 pounds and have not changed my eating habits. I have also missed by monthly cycle and find that the pain in my legs is still there, and getting worse.

The crawly feelings are better, but Requip wears off and I find myself stretching my legs all day long, but like other users, I hesitate to take any more due to the liquid retention and to the drowsy, sleepy feeling I have to go through all day.

I am really concerned about the long term effects of the medication.

Lucia C.

Medical Reply

We have been using Requip for RLS and Parkinson's disease (but at much higher doses) for the past 10 years. So far, there does not appear to be any long-term effects that are of any concern.

It does sound like you need more medication to treat your daytime RLS symptoms. Alternatives include changing to Mirapex which may be better or worse (the only way to know is to try it), or adding an anticonvulsant or painkiller medication during the daytime. They of course, have their own set of potential issues.

Sent: Friday, May 11, 2007 3:49 PM
Subject: Long Time Severe RLS Suffer

Well, I finally know what it i like to get real relief! For over 15 years I have suffered from ever increasing severe RLS. I have been to doctor after doctor. I have been on everything from Requip to gabapentin, to Lortab and all points in between. My RLS had gotten so severe that even on 40 mg of Lortab, 4 mg of Requip, and 1000 mg of Gabapentin per day, I was still sleeping hardly at all. I would go for 3-4 days like this and finally collapse in exhaustion.

About 4 months ago on a trip to India, I was introduced to a medical missionary who was accompanying my group on the trip. It was a wonderful experience to be able to sit and talk to a doctor for several days and have him patiently listen to my symptoms. After two weeks of listening, he told me to contact him when I got back into the USA because he wanted to try something different.

He prescribed 20 mg of methadone. WOW!! for 4 months now I have had zero RLS problems...that's right, absolutely NO problems whatsoever! I had forgotten what it was like to be able to sit for more than a few minutes at a time. I can sit and watch a whole movie; I now sleep completely through the night with no problems. My wife had quit sleeping with me about 8 years ago, and now she is back in bed with me. I wake up refreshed and no longer stay sleepy all day. I can actually pay attention to a conversation without being miserable.

Why do doctors run from this drug so hard. It is the only thing that has worked for me and I have had no side effects, unlike the other drugs especially Requip which made me so nauseated that I couldn't do anything but hug the toilet for the first hour three times a day.

Hope this helps someone,
Evin

Medical Reply

Methadone is actually one of my favorite drugs for severe RLS as it seems to work better than most other potent narcotics. Of course, this potent narcotic should not be used for milder cases that should respond to less potent drugs.

This drug is typically used for treating opioid addiction and as such, most doctors do not have much, if any experience with it. Hopefully, as RLS becomes better known, more physicians will become comfortable using this medication when appropriate.

Sent: Sunday, May 13, 2007 4:14 AM
Subject: Post gastric bypass and RLS

I had gastric bypass in Dec 2002 and my RLS has seemed to worsen since then - I am not able to sleep at all if I don't take something. Have you heard of a link between the two? Also, my doctor has me taking gabapentin 300 mg for the RLS but it really doesn't work that well.

I was on Requip but now have no health insurance and cannot afford it. I also take Prozac for anxiety and have also heard that this might worsen the RLS. Any suggestions that are both effective and low cost?

Carol P.

Medical Reply

Prozac may worsen RLS. Wellbutrin (which is now available as a generic) does not worsen RLS and may work as well as Prozac (of course, only trial and error will tell you for sure).

You may need higher levels of Neurontin (6-900 mg) to treat your RLS. However, the higher doses do increase the odd of having side effects (which consist mostly of drowsiness, even the next day).

Another less expensive alternative is using a daily dose of a painkiller (narcotic or tramadol), but that route should be avoided unless there are no other alternatives.

With your gastric bypass, iron levels may be low and can worsen RLS. It is quite possible that by increasing your iron intake (get your serum ferritin level above 50) you may improve your RLS.

Sent: Sunday, May 13, 2007 7:30 PM
Subject: Medications other than Requip for RLS?

I've been taking Requip for 2 years now for RLS. I started working in an office and needed pills so I could have a normal day. I am not working now and feel like I want to go off reequip and find something that's not so aggressive. I am also available to exercise more during the day and night and this is very helpful to RLS.

Requip makes me sick at night and sometimes in the morning. I thought I would be able to live with the symptoms but its getting harder and I starting to feel depressed.

Over the past 20 years I have been on antidepressants, "downers" and anything I could get my hands on to give me a good nights sleep. doctors don't really understand RLS and I don't know where to turn or who to talk to. Since I've been on Requip I have gained 30 pounds. however, people have told me I needed to gain the weight. muscle relaxers only make it worse, but a small glass of wine always made me "pass-out". this worked for a little while but I had to put a stop to it.

Ann G.

Medical Reply

There are lots of other choices for treating your RLS. If the Requip is causing side effects (it is really not aggressive therapy for those who do not have side effects), you may want to try Mirapex which is similar but may not cause the same adverse reactions. The nausea if often improved if the medication is taken with some food.

Antidepressant medications may also worsen RLS, so a change to Wellbutrin (if effective for your depression) should also be considered. Also, check your serum ferritin levels and if it is less than 50, supplemental iron therapy may be helpful.

Wine does help promote sleep onset but tends to worsen RLS symptoms and disturbs sleep throughout the rest of the night.

Sent: Monday, May 14, 2007 7:59 PM
Subject: Weight gain with Requip ?

I am about to start taking Requip for my RLS and I am very concerned about weight gain, I have been on Mirapex for the past 8 years and I have gained about 25 lbs. Again, I would like to know the percentage of weight gain while taking Requip.

Medical Reply

Weight gain does occur with these drugs but is very unpredictable. There is no way to estimate how much weight (if any) one would gain with any of the dopamine agonists. You may gain some weight with Requip or none at all, but the only way to figure this out is to take the medication.

Sent: Monday, May 14, 2007 8:15 PM
Subject: Back surgery/laminectomy and RLS?

I sent you an e-mail back in March of this year asking about a stimulator and now it’s has turned into back surgery. This will be my 3rd fusion and laminectomy since October 2002 and 5th back surgery. My question is, does the laminectomy make the RLS worse or the laminectomy together with the anesthesia? When I had my other two fusions my RLS were terrible when taken off the morphine.


This time I am having the laminectomy at L1/2 and the fusion from T10 to L3. I just want some way to stop the RLS after surgery so I don’t hurt my back again. I have already been fused from L2 through S1 with a cage at L4/5 and bone at L5/S1. But as soon as they take me off the morphine my legs go crazy and they won’t give me the Neurontin or Mirapex when I need them.

Jeanne R.

Medical Reply

It is not well understood if it is the general trauma from surgery, anesthesia or a combination of the two that may worsen your RLS. However, it is quite common for RLS sufferers to note worsening of their RLS after surgery (especially back surgery).

Generally, this is not a big problem as the post-operative narcotics (morphine or other ingestible opioid followed by oral Vicodin) takes care of the RLS problems. As there is no great reason to withhold these medications (including Mirapex or Neurontin) in the post-operative recovery period, I cannot figure out why your doctors would not give you these medications. You should talk to them before surgery and if they refuse to give you these medications to cover your RLS, get your personal doctor to take care of that issue. If that is not possible, find another doctor to do the surgery.

Sent: Tuesday, May 15, 2007 3:30 PM
Subject: RLS associated with opiate withdrawal?

Is Requip or Mirapex effective in treating RLS due to opiate withdrawal? I’m off oxycodone for 5 days now and can’t sleep due to the RLS. I was on 40-80mg per day for over 2 years, and I’m committed to staying off the opiates, but the RLS is really effecting my quality of life and I just need to know what my best options are. I see my neurologist tomorrow, but I’m afraid to mention that it’s a symptom of withdrawal for fear of being labeled.

Chris,
Phoenix

Medical Reply

Mirapex or Requip both would be fine to treat RLS due to most anything. However, you must be sure that the symptoms that you are having are really RLS and not just withdrawal symptoms that are not related to this disorder.

A Reply from Chris

Sent: Wednesday, May 16, 2007 9:06 AM
Subject: RE: RLS associated with opiate withdrawal?

My symptoms follow all 4 of the RLS criteria and I’ve experienced this sensation since I was a teenager, but only occasionally, until withdrawing from using pain pills. I do get relief by shaking my feet, but if I try to lay still it builds up and makes me thrash and kick. The electrical sensation best describes what I feel combined with a feeling of a sort of tickling on the inside of my legs as well as between my shoulders and my arms.

Do you have any experience with a case like this of RLS due to withdrawal? Can I have a reasonable expectation of cessation of symptoms with more time away from the pills? Or is it possible that I’ve brought forth a chronic condition?

Is there an in between? From everyone’s stories here it seems they all suffer chronically. Is there such a thing as episodic RLS?

Chris,
Phoenix

Medical Reply

RLS can be episodic but most people have it on a chronic, continual basis with some fluctuations. Once RLS gets triggered (such as with your withdrawal from narcotics which may in fact have been treating the symptoms unknowingly) it often stays for quite a while or indefinitely. There is no way to know except t0 see what happens. However, your symptoms should respond to Mirapex or Requip.

Sent: Friday, May 18, 2007 2:12 AM
Subject: Requip and feeling sleepy during the day?

I have managed to get past most of the side effects of Requip because there is really no alternative for me. You do what you have to do. It's a very good drug for RLS. But I still feel sleepy during the day when I am sitting still waiting for something or reading. I thought the amphetamine salts would solve this problem after going thru the add testing.

This helps with concentration but does not make me hyper or even more awake. In fact, if I take more than 30 mg I get more sleepy and can't drive without the risk of an accident. So my next step is to find something that will help me be more awake and able to read for more than five minutes.

I have been reading about Strattera. I take Wellbutrin and it is very helpful. Maybe increasing the epinephrine level in conjunction with the amphetamine salts would be helpful. Some readers may be thinking now that I am just trying to find a legal way to become a speed freak but in all honesty that is not the case. I scared myself to death the other day out on the road. I am 56 and have never caused an accident.

David in Virginia

Medical Reply

Requip is better than than Mirapex in my experience in this regard. But they both can cause sleepiness. And I will never need a sleeping pill at night as long as these drugs are on the market. Thanks again for your time and much appreciated assistance. David in Virginia.

You may need to try another type of medication for your RLS. If both Requip and Mirapex cause sleepiness, perhaps the painkillers (opioids or tramadol) may work better.

It is very curious that your high doses of amphetamines do not seem to keep you awake. Provigil may help but usually the amphetamines help sleepiness as well or better than this more gentle drug.

Sent: Friday, May 18, 2007 8:49 AM
Subject: Problems with RLS treatment?

I am currently on Requip 1mg and have been it for 8 mo. I hate the feeling of nausea soon after taking it. I sleep fairly well until about 5am and can not stay in bed. I have terrible nights on the days I work after being on my feet so long. My physician will not prescribe Vicodin which works well on those difficult days or nights. Is there a doctor in the San Diego area that understands the need for Vicodin for restless leg syndrome.

I have started taking Mirapex during the day if my symptoms are intolerable. My doctor also wanted me to try Sinimet but I have insomnia so bad I will not take it anymore. He also prescribed Valium but I don't like taking it either. It does help relax me on those difficult nights. Why is it that doctors are reluctant to prescribe Vicodin or a sleeping medication for this disorder? It's difficult for me to think I have to live the rest of my life this way.

Everyday is a struggle to figure out what to use to relax and sit still. The urges in the legs are the most horrible feelings. My family just does not understand and they question why I am on so many medications. They feel I have control over this issue. I am very frustrated!!

Martha T.
San Diego

Medical Reply

You may decrease the nausea associated with Requip by taking it with food (dinner?). However, it then takes about one hour longer to onset. If taking it with dinner causes rebound problems (not covering your RLS throughout the night) then you might add a smaller dose just before bedtime. If Mirapex causes less nausea it may be a better choice (it also can be taken with food to diminish any nausea problems). If both of these drugs still cause nausea despite your best efforts, you might do better with Neupro (a dopamine agonist rotigotine that is administered in a transdermal patch formulation) that will be in the pharmacies by July (only approved for Parkinson's disease but most of us will use it for RLS).

Sinemet on a daily basis almost always causes augmentation (worsening of RLS) so I would not recommend that route. If you do need a sleeping pill on a regular basis, then the non-benzodiazepines are a better choice (Ambien or Lunesta).

Doctors are very sensitive about prescribing controlled substances for RLS but if monitored then should present no problem. Unfortunately, most doctors are not knowledgeable enough about RLS and opioids to be comfortable with this regimen. You may have better luck convincing them to prescribe tramadol (not really an opioid but may work as well for RLS) than Vicodin.

Sent: Saturday, May 19, 2007 9:04 PM
Subject: Requip

I have recently started using Requip with exceptionally good success. I am taking .5 mg, and it works very well. However, I'm concerned that I could eventually develop tolerance and this good fortune could go away. Does Requip develop tolerance, and/or do you recommend a vacation time away from Requip periodically ?

Before I used Requip, I was using Ambien. Perhaps a switch periodically with Ambien would be helpful?


SRN,Indiana
Male, 51 years old
RLS for 15 years.

Medical Reply

It is possible to develop tolerance to Requip but fortunately this occurs very infrequently. Also, at the low dose that you are using, it is probably even less likely to occur. Considering your case, the odds are excellent that you will continue for many years without problems.

Rotating drugs or taking drug holidays may prevent tolerance or even work to prevent recurrence after it happens. However, I would recommend waiting for the small possibility of this happening before putting any preventative measures in place.

Sent: Sunday, May 20, 2007 5:17 AM
Subject: RLS and Repreve (Requip)?

my name is Julie and I live in Perth Western Australia. Have suffered with RLS since I was 18 Years, I am now 54. In the last year I have been taking Repreve but I am having to increase the dosage and this is a concern. My brain does not function as well and I am feeling tired and depressed.

What can I take as an alternative or with Repreve. Previously I have been on Sinemet and then tried Cabaser. While on Cabaser I also developed a “Tick” in my throat.

Desperate,
Julie M.

Medical Reply

Repreve which is ropinirole (called Requip here in the USA) is one of the two best drugs for RLS. However, it does have side effects in some patients as you have already found out. You may be able to try Mirapex (pramipexole) and although it is similar to Repreve, it may not have the same side effects.

If that does not work, then you will probably have to try gabapentin or a painkiller for your RLS.

Sent: Sunday, May 20, 2007 7:21 AM
Subject: RLS and clonazepam?

I have had restless legs for 6-8 years now and have tried Requip (which made me sick), tried Neurontin (which only made me sleepy, my legs still moved) and Mirapex which is now loosing is effectiveness. Now I am on the Clonazepam which is making me doze off when driving (I have 3 small children) and I basically cannot function.

Are there any alternatives or am I not doing something right?

Elizabeth

Medical Reply

Clonazepam generally does very little (if anything) for RLS symptoms. It usually only works as a sleeping pill to help RLS patients fall asleep.

It's half-life is how long the body takes to metabolize and eliminate half of the dose taken. Therefore, in 40 hours, you still have half of the pill left in your body acting as a sleeping pill. When compared to Ambien which has a half-life of 2.5 hours (which helps get most of it out of your body by the morning), the 40 hour half-life is extremely long.

If you do not need a sleeping aid, then there is usually no reason to take clonazepam, except to cause side effects.

A Reply From Elizabeth

Sent: Sunday, May 20, 2007 5:59 PM
Subject: RLS and clonazepam?

What do you mean by 40 hour half-life? I don't understand that. I don't need a sleeping aid at night, if my legs would be still I would have no problem going to sleep.

Elizabeth

Medical Reply

I generally do not recommend clonazepam due to its 40 hour half-life and the resultant daytime drowsiness that is so common. If you do need a sleeping pill at bedtime, Ambien or Lunesta are much better choices.

If Mirapex is losing its effectiveness, then you may want to go off it for a month then restart it at a lower dose. In the meantime, you will need a painkiller (opioids or tramadol) to cover you for the time that you are off Mirapex. You may want to stay on low doses of the painkillers (quite safe for most to do) so that you can keep the dose of Mirapex lower.

A Reply From Elizabeth

Sent: Monday, May 21, 2007 2:32 AM
Subject: RLS and clonazepam?

I am going to call my doctor this morning and tell her I am not taking this anymore. But what do I do when I've been through Neurontin, Requip, Mirapex and one other I can't remember? I think a transfusion (if that's the correct term) of iron would be a good try to see if that will eliminate some of the symptoms.

I am also anemic due to heavy cycles. It seems like my problem will never end.

Elizabeth

Medical Reply

Intravenous iron dextran can be very helpful for RLS symptoms but is only given if your anemia does not improve with oral iron therapy.

Painkillers (opioids or tramadol) work very well for RLS and are safe if used in small doses even on a regular basis.

Sent: Sunday, May 20, 2007 7:42 PM
Subject: RLS?

Lately, for the past month, my legs have been keeping me awake. Just as I am about to fall asleep, my legs suddenly jerk, and I wake up. This usually occurs once or twice a week, and can sometimes keep me awake the whole night! I've tried Mirapex, but it seems to worsen the condition. What should I do?

Jenny

Medical Reply

It sounds as if you have hypnic jerks not RLS or PLM. Hypnic jerks are very common but are not well understood. There is no treatment for hypnic jerks (Mirapex should not help), except perhaps sleeping pills. Most people just learn to live with them.

Sent: Sunday, May 20, 2007 7:21 AM
Subject: Restless legs treatment?

I have had restless legs for 6-8 years now and have tried Requip (which made me sick), tried Neurontin (which only made me sleepy, my legs still moved) and Mirapex which is now loosing is effectiveness. Now I am on the clonazepam which is making me doze off when driving (I have 3 small children) and I basically cannot function.

Are there any alternatives or am I not doing something right?

 Elizabeth W.

Medical Reply

I generally do not recommend clonazepam due to its 40 hour half-life and the resultant daytime drowsiness that is so common. If you do need a sleeping pill at bedtime, Ambien or Lunesta are much better choices.

If Mirapex is losing its effectiveness, then you may want to go off it for a month then restart it at a lower dose. In the meantime, you will need a painkiller (opioids or tramadol) to cover you for the time that you are off Mirapex. You may want to stay on low doses of the painkillers (quite safe for most to do) so that you can keep the dose of Mirapex lower.

A Reply from Elizabeth W.

Sent: Sunday, May 20, 2007 5:59 PM
Subject: Restless legs treatment?

What do you mean by 40 hour half-life? I don't understand that. I don't need a sleeping aid at night, if my legs would be still I would have no problem going to sleep. Thanks for your time in answering my questions.

Elizabeth W.

Medical Reply

Clonazepam generally does very little (if anything) for RLS symptoms. It usually only works as a sleeping pill to help RLS patients fall asleep.

It's half-life is how long the body takes to metabolize and eliminate half of the dose taken. Therefore, in 40 hours, you still have half of the pill left in your body acting as a sleeping pill. When compared to Ambien which has a half-life of 2.5 hours (which helps get most of it out of your body by the morning), the 40 hour half-life is extremely long.

If you do not need a sleeping aid, then there is usually no reason to take clonazepam, except to cause side effects.

A Reply from Elizabeth W.

Sent: Monday, May 21, 2007 2:32 AM
Subject: Restless legs treatment?

I am going to call my doctor this morning and tell her I am not taking this anymore. But what do I do when I've been through Neurontin, Requip, Mirapex and one other I can't remember? I think a transfusion (if that's the correct term) of iron would be a good try to see if that will eliminate some of the symptoms. I am also anemic due to heavy cycles.

It seems like my problem will never end,
Elizabeth W.

Medical Reply

Intravenous iron dextran can be very helpful for RLS symptoms but is only given if your anemia does not improve with oral iron therapy.

Painkillers (opioids or tramadol) work very well for RLS and are safe if used in small doses even on a regular basis.

Sent: Monday, May 21, 2007 6:21 AM
Subject: Permax off the market?

I just found out that they had taken Permax/pergolide off the market and I am desperate to find an alternative. I have just enough Permax to last out the month. I have been on Permax for about 10 years since I had to stop taking Sinemet and find that Permax is the only thing that helps. I am having echocardiograms done every 6 months and there has been no increase in valvular problems.

During that time I have been on Permax I have also tried Neurontin, imipramine, amitriptyline, Klonopin, Keppra, Seroquel, Wellbutrin, Ultram. Mirapex would last about 6 weeks before augmentation and rebound set in. I got up to 5 mg of Requip (in divided doses starting in the early morning) with absolutely no help.

Do you have any suggestions as to what my next move might be? I have heard that methadone might help when nothing else does. I have found the most doctors are reluctant use it.

Sherrill

Medical Reply

You would be a good candidate for methadone. You may want to speak to your doctor about it and perhaps use some of the information in my RLS book below. In July, the Neupro patch will be available for Parkinson's disease but should work well for RLS.

Sent: Monday, May 21, 2007 12:09 PM
Subject: RLS and antidepressants?

I have MS, I am 58 and have had RLS and PLM since having back surgery two years ago. I was told that various antidepressants can actually make these two conditions worse? Can you tell me which antidepressants might do this?

 Wendy S.

Medical Reply

All the antidepressants except Wellbutrin and trazodone. The older desipramine may also be somewhat RLS friendly. You can download a free medical alert card from our website that contains this information to carry with you.
 

Sent: Wednesday, May 23, 2007 3:35 AM
Subject: Tapering off Permax?

I have had sever RLS for 15 yrs, tried all the usually methods of treatment (Sinemet, Neurontin, etc) and finally found night time relief with a combination of Permax + Ambien. I never take a nap because I do not want to take the meds in the day. At any rate, I was wondering how one tapers off Permax.

Since the drug was recalled, I have been trying to taper off. I have successfully reduced from 2 mg down to 0.5 mg by adding 0.25 mg Klonopin. I was reducing the dosage by .5 mgs over -10 days. I have had some rough nights during the process, but now find it almost impossible to go below the 0.5 mgs. Perhaps I am going too fast. I was wondering if perhaps I should reduce in smaller increments.

Dana H.

Medical Reply

The problem may not be how fast you are tapering off the Permax but rather that you really need the Permax for your RLS. Klonopin is not a great choice for RLS. It might be better to switch over to Requip or Mirapex.

Sent: Tuesday, May 22, 2007 5:19 AM
Subject: Cipralex (Lexapro) and RLS and other trunk twitching symptoms while sleeping at night???

I have been taking Cipralex and or Celexa for the past three years and have developed RLS at night sometimes when I am trying to go to sleep and/or my boyfriend says that some nights my whole body twitches and jerks while I am sleeping. He is amazed that such symptoms do not awaken me at night!!!

I am not a huge coffee drinker, don't drink alcohol but I am a smoker. Please do not blame the smoking for this, I have been smoking for 30 years! I work in a seniors nursing home and am on the "go" for 7.5 out of the 8 hour shifts. Lots and lots of walking and physical activity involved in the job.

I was wondering if being under stress, taking the antidepressant and being in such a demanding physical active job is this causing my RLS and trunk twitching at night??? I am also going thru the change of life as a woman and am 52 yrs old?? Another thing to put down to menopause???

What other sleep aids would help. I don't waken feeling tired or anything like that. i.e. should I take a nice hot bath before bed or a shower??? What about natural herbs and or remedies for this. Should I be concerned re my sleeping habits???

Laura

Medical Reply

Cipralex (Lexapro in the USA) and Celexa (very similar to Lexapro) are both SSRI antidepressant drugs that tend to worsen RLS and increase PLM (leg twitches). Stopping these medications would help your RLS and PLM (that most likely do not bother you but do bother your boyfriend).

Wellbutrin is an antidepressant that does not worsen RLS, so if it works you should be better.

Smoking may have a small effect on RLS (hard to say) but alcohol and caffeine certainly do.

Sent: Wednesday, May 23, 2007 12:11 PM
Subject: Husband Suffering Terribly from RLS?

My husband suffers terribly with RLS. He is a diabetic (type1), has had several heart attacks, by-pass surgery and has now been on dialysis for the past 5 years....and he's only 55. He is up all night and now he is suffering from this terrible condition all day too. He cannot sit for longer than a few minutes and he's exhausted. I am afraid that soon he will just give up.

He has tried quite a few of the RLS medications, including Mirapex (which created a gambling problem). He is now on Requip, but it's not helping. He sometimes takes Benadryl or Gravol at night hoping this will help him sleep..it doesn't. He is getting worse every day and his health is deteriorating because he cannot rest. His neurologist doesn't seem to know what to do.

Does acupuncture or reflexology work? Are pain killers the answer?

Cindy L.

Medical Reply

About 50% of dialysis patients suffer from RLS. Typically, Mirapex and Requip are the most effective medications in this group however that does not seem the answer for you husband.

Other choices include gabapentin and painkillers. However, doses have to be adjusted carefully as these drugs can easily accumulate and cause side effects in dialysis patients.

Acupuncture, reflexology, etc. do not help RLS.

Make sure he stays away from Benadryl and Gravol as antihistamines worsen RLS. (you can download for free our medical alert card from our website that has what medications to avoid).

Sent: Friday, May 25, 2007 11:53 AM
Subject: RLS & pain

For the past five months my RLS has been awful. I am like a zombie as a result of the lack of sleep I am able to get. Nights are torturous. The longer I lay in bed, the worse the pain gets and the more anxious I become. My worse symptoms are pain and cramping in both of my calf muscles. Is this much pain and cramping really a RLS symptom? I am concerned that there may be something other than RLS going on but I've been going to my family Dr. and a Neurologist trying to get this resolved since January (5 mos. ago).

I don't like the idea of taking Requip because of its side effects. I've tried Benadryl, but it makes me more anxious. Tylenol helps but I'm not sure how safe it is to take it every night. Any ideas on how to get some relief and some SLEEP?

Angela T.

Medical Reply

Benadryl makes RLS worse so that may be why you get anxious when taking it. Tylenol should not help RLS but may help unrelated pain problems. Cramping is not a part of RLS. However, some RLS patients do have painful symptoms in their legs.

If the Requip relieves the painful symptoms then they are definitely RLS. That drug may still be your best choice for RLS symptoms. For painful symptoms, drugs such as gabapentin may work well.

Sent: Friday, May 25, 2007 7:01 PM
Subject: Requip helps peripheral neuropathy?

I have Peripheral Neuropathy. The symptoms are similar to Restless Leg Syndrome. I have been using heavy duty pain relievers for years and still found it difficult to find relief, especially, sleeping at night. After seeing the Requip commercials on TV, I asked my doctor if it would be worth a try? She prescribed Requip for me, and now I sleep like a baby at night, with "0" pain all night! It's the best thing that has happened to me since I was diagnosed with Peripheral Neuropathy.

Patti P.

Medical Reply

There is no real knowledge as to what if anything Requip should do for neuropathy pain. From the lack of response of most RLS patients who also suffer from neuropathy, it appears that it does not generally help their pain. Why or how it seems to have helped your problem is somewhat of a mystery.

A Reply from Patti P.

Sent: Saturday, May 26, 2007 1:57 PM
Subject: Requip helps peripheral neuropathy?

Could it be that maybe I have both RLS & Neuropathy. The Requip does not help the pain, but it does relax my legs and feet, enabling me to sleep at night. I still have to take all the pain meds, but I still swear by Requip for nighttime relief. During the day, while being active, it does not work at all. I can only assume that it works like a relaxer on me, calming my legs and feet.

Patti P.

Medical Reply

About 20% of RLS sufferers may have an associated painful neuropathy. This typically occurs more commonly in those who develop RLS after age 45. If you have an urge to move your legs that is relieved by movement and Requip and gets worse with rest, you likely have RLS.

Sent: Sunday, May 27, 2007 8:29 PM
Subject: Requip for RLS?

I am 71 years old female and have chronic restless legs . I am on Requip low dosage of .5 mg for a year. Helps some, but still have restless legs and only sleep about 4 hour a night. I have starting having hot flashes terrible dreams and I have talked to other people that take Requip and they say it may them sleepy. I does not make me sleepy and also just had blood work done and now have high liver count.

Would like to know if Requip has cause all this. I just hope there can be more research of restless legs. It is very miserable. I have been thinking of switching to Mirapex.

Eunice C.

Medical Reply

You are on a low dose of Requip (most need 1-2 mg) so it may be reasonable to increase the dose a little and see if it helps you (especially as you do not seem to have side effects). Your elevated liver tests likely have nothing to do with Requip.

If after you increase the dose of Requip, you are still not better and not sleeping through the night, then perhaps a change to Mirapex should then be considered.

Sent: Monday, May 28, 2007 6:16 PM
Subject: Worsening of RLS with Requip?

I am a 54 year old female who has been using Requip for about 6 months. Initially, I didn’t like that Requip had to be taken daily since my symptoms were only about once a week. After taking Requip for a short time, I now have severe RLS every evening without exception. The symptoms used to begin about 7:00 PM but the time keeps moving up earlier in the day. I have been told to take Requip about two hours before onset of symptoms.

This is becoming impossible, because once I take .5 mg of Requip I am completely lethargic the rest of the day . This has destroyed the quality of my life. I have an appt. with my PCP later this week but she has admitted in the past that she knows very little about this syndrome.

I have been trying to research on the internet. On my recent lab work my ferritin level was 18 but she thought that was okay. Would I be less lethargic with an anticonvulsant? Should I get a referral to a neurologist? I am desperate for help because the symptoms have become maddening!!!!

Medical Reply

Firstly, you should not have been prescribed Requip for once weekly RLS as it is only for daily RLS (as you have already noted). You have developed augmentation from Requip (worsening of RLS due to the Requip) and you must get off the drug or your RLS will continue to worsen.

When you stop the Requip, have your doctor prescribe an opioid (such as Vicodin or oxycodone) for the 1-2 weeks to treat the worsening of RLS that occurs with stopping Requip. Most likely, your RLS will then return to once or so weekly and you can use a painkiller (opioid or tramadol) or Sinemet only when necessary to treat the RLS symptoms.

Also, we find that treating with iron until your ferritin level is over 50 may help your RLS. Any doctor who can follow these instructions should be able to help you although typically, neurologists and sleep specialists are the ones who are most knowledgeable about RLS.

Sent: Wednesday, May 30, 2007 11:20 AM
Subject: Is Cipralex (Lexapro) RLS friendly?

About 4 years ago I was diagnosed with RLS and PLMD as the result of a sleep study. I tried a whole bunch of meds but side effects seemed to outweigh any benefits. I have been on Celexa for about 3 years and I think that has been helping in addition to treating depression. Over the last 6 months my sleep has become even more disturbed and this apparently would go hand in hand with my depression worsening. I switched to Cipralex a couple of weeks ago and my sleep has deteriorated. I am wondering if this daytime fatigue and easily disturbed night-time sleeping is related to RLS or is it part of breaking in a new med?

Lucy,
Canada

Medical Reply

Cipralex (called Lexapro here in the USA) is a purer form of Celexa. It is certainly possible that the new drug may cause worsening of your sleep while the old one did not but the drugs are very similar. Cipralex (Lexapro) is supposed to be more effective than Celexa and have fewer side effects. They both often cause worsening of RLS and PLM.

A Reply from Lucy

Thank you for your information. I have since gone off Lexapro and am not dozing off in the morning.

Lucy

Sent: Sunday, June 03, 2007 3:55 AM
Subject: Question about mattresses and RLS.

Can a different mattress lessen the RLS symptoms? After taking my prescribed medication I go to another bedroom where the mattress is softer and I seem to quiet down in a short period of time. Last night I tried not taking the medication and I again was able to go back to sleep shortly.

Sandy B.

Medical Reply

Many different things can affect RLS symptoms and that often varies considerably from one person to the next. Some like their legs wrapped tightly while other can't stand to have the bed covers touch them. In your case, a softer mattress seems to help. One explanation may be that by being more comfortable on the softer mattress, you can relax and decrease your anxiety levels that may indirectly calm your legs.

Sent: Sunday, June 03, 2007 5:02 PM
Subject: Refractory RLS

I have emailed you twice before in 2005 and again, Thank You very much for listening to and replying to my concerns. I have a refractory case - have tried multitudes of medications for RLS - & arms, shoulder area also. Since 2005, I have been allowed to stay on Provigil and 8 Vicoprofen a day. My concern is the fact that either my RLS is getting worse (age 46) or I've just been on Vicoprofen too long now (all total nearly a decade - at 8 a day almost 3 years). Also I know this treatment is causing a great deal of havoc with my memory - and I find myself increasingly concerned about what life could be like in the next 10 years at this pace.

I know in 2005 you had suggested methadone but in PA it is a dreaded word - & I'm told is a worse amount of "narcotic" to be taking than the high does I'm already on.
I am always listening for alternate treatments for RLS - particularly ones that work as a narcotic has for me - which has me wondering about Suboxone? Of what I can see, it is for the purpose of quitting narcotics without experiencing the dreaded side effects - one's I'm all to familiar with when I've voluntarily taken breaks - one of which I know is RLS - or some form of it.

Is Suboxone a lesser form of a methadone type of drug? It seems to initiate less of a response among doctors here than methadone does. Are you aware of it being a successful treatment for RLS? - and if yes were the answer - would it be a safer option than the narcotic (in my case the Vicoprofen) itself?

Medical Reply

There is really no data on the use of Suboxone for RLS. However, it contains a partial opioid drug (Buprenorphine) and naloxone which is an opioid agonist and thus runs the risk of worsening RLS.

Smaller amounts of methadone should be much safer than the large amounts of Vicoprofen (not to mention the ibuprofen that it contains which does not help RLS so can only cause problems without benefits).

Sent: Tuesday, June 05, 2007 10:25 AM
Subject: RLS & Edema?

I have been on re-quip for 3 months now for RLS. I take 2 mg each night before bedtime. It has REALLY helped my RLS. But, I often wake up in the wee hours of the morning, sometimes, every hour on the hour. Also, I have been having trouble with by ankles, feet, & hands swelling. Does re-quip cause fluid retention? I have not noticed it as a side effect.

Sherry A.

Medical Reply

Requip may cause problems with insomnia although others sometimes complain of sleepiness. Fluid retention with swelling of ankles and feet (hands are less common) does occur with the drug although it is not the most common side effect.

Sent: Tuesday, June 05, 2007 1:38 PM
Subject: Son with RLS & ADHD & Insomnia

My son is 10 years old and has ADHD He has had trouble sleeping for over 6 years now. We have been on all different types of medications for ADHD and insomnia. We just had a Polysomnographic done and he was found to have RLS as well as obstructive sleep apnea. We will be getting tonsils and adenoids removed. He is on Focalin for his ADHD, trazodone for his insomnia.

The doctor has giving a couple of options for his RLS (Clonazepam or Neurontin) and yet I don't feel comfortable giving my son a medication that isn't approved by the FDA for RLS. I want another opinion on what would work best for him and not make him addicted or having further problems. Please help me with this!

Concerned Mother,
April R.

Medical Reply

RLS is not diagnosed from a sleep study. It is a clinical diagnosis that only occurs while awake (similar to back pain which only occurs while patients are awake to experience the pain). Sleep studies do find PLMS (leg kicks while sleeping) which is often associated with RLS but most often occur by themselves or with other conditions (sleep apnea, narcolepsy, etc.) and may be due to his sleep apnea.

You are correct to have concerns about the treatment of your son's PLMS or RLS as no drugs are approved to treat kids with these conditions and these disorders often require many years (or indefinite) of treatment. Furthermore, it is very controversial whether anyone (adults or kids) need to be treated for PLMS. These are issues that really need to be discussed with an RLS/PLM specialist who also is comfortable dealing with children. Getting a second opinion would be very valuable in this case.

Sent: Thursday, June 07, 2007 6:16 AM
Subject: RLS worse with blood pressure medication?

I have just been put on quinapril (Accupril) for hypertension, Do you know if it's possible for this to cause my RLS to go whacko? I took one pill last night as I picked them up late from the pharmacy and woke up at 4:30 with RLS which never happens anymore. I took one this morning around 5:45 and at 6:00 they went crazy again. I

 have read the sheet that came with the meds and I see nothing that should cause it. Is this just a crazy coincidence? I can hardly sit long enough to type this and I never have RLS in the mornings!

Janis L.

Medical Reply

Accupril is an ACE inhibitor and this class has never been linked with RLS (good or bad). It is most likely that something else has worsened your RLS or you have some very unusual reaction to this drug.

Sent: Thursday, June 07, 2007 7:02 AM
Subject: Muscle cramps from Requip?

I have had RLS for years. I’m 78 and have tried the new drugs, but does not seem to help me. I was on Permax ,but is no longer on the market. I have tried Requip and it gave me horrible muscle cramps. I am now trying carbidopa 25/100 three times a day but does not help me all night. Can I take another pill if I wake up in the middle of the night.  Have others complained of muscle cramping and what do they take for it. I can not take quinine.

Connie

Medical Reply

Muscle cramps are unusual with Requip and other then quinine, there are no other remedies for leg cramps. You may want to consider trying gabapentin (or other anticonvulsants) or painkillers.

You should be careful as the cabidopa (Sinemet) very often causes augmentation (worsening of RLS due to taking the medication), especially at doses of 2 or more of the 25/100 tablets per day.

Sent: Friday, June 08, 2007 12:00 AM
Subject: RLS better with Lamictal?

Have you heard of Lamictal being prescribed for RLS? I've taken this medication for several years and has reduced the sensations about 60% - most of the time; however, now I am feeling really weird -- like I'm in a tunnel. It can happen if I take this drug on an empty stomach or -- at random.

Maryann

Medical Reply

There are a few cases of Lamictal helping RLS which is not surprising as most anticonvulsants help RLS. The side effects of this drug are more difficult to treat. Usually they get better after a few weeks but after a few years, you are likely stuck with them. Changing to or adding another type of drug (Requip or Mirapex) may be helpful.

Sent: Saturday, June 09, 2007 12:00 PM
Subject: RLS affecting the genitals?

Do you have any information or patients with RLS affecting the genital area? this has been a problem all of my life while sitting or resting or trying to get to sleep. Requip helps, but the problem seems to be getting worse.

Arlene

Medical Reply

RLS extending to virtually every body part has been reported. I have several cases of RLS affecting the genitals on our website.

Sent: Saturday, June 09, 2007 4:28 PM
Subject: Severe RLS symptoms

I have had RLS for my entire life, given to me my mother, by her grandmother, and so forth. My symptoms of RLS are NOT just in my legs, but rather in my entire half of my body (right/left leg and arm), and it switches back and forth from left side to the right side. It is the worst, absolute worst, when I go to lay down at night. It starts up as soon as I lay down. If you can imagine, I dread nighttime. But usually if I get up and do some exercise, it would normally help, but this past month and half, NOTHING is working.

I've gotten so frustrated, and out of exhaustion and pain, just hit my arms and legs over and over. This past month, I have NOT had hardly any sleep. The most sleep I've gotten has been 4 hours (and that's a period of sleep all together throughout the whole day and night!) and most of it has been stolen in the day time. I haven't been able to sleep any more then that. I am exhausted. I mean really really really exhausted!

Tonight was the worst, and is spilling over into the day. It has not left, even now I can feeling it and I keep shaking myself while I write this. I have taken everything under the sun to try to get it to leave and nothing works. I don't have insurance to get any prescription drugs and I am currently unemployed. Is there anything, anything at all, that I can do in the meantime to help alleviate RLS so I can get 8 hours of REM sleep without constantly being woken up by this??? Please, any suggestions at all will be appreciated!

Jennifer, 32 years old.

Medical Reply

As your RLS symptoms extend to the arms you must have fairly severe and advanced symptoms. Most with your level of RLS cannot control the symptoms without medication. You have already exhausted most all of the non-drug treatment of the disease.

At this point you must somehow seek out medical treatment as there is not much else of any significant benefit out there to help you.

Cindy W.

Medical Reply

Requip may cause nasal problems and then possibly lead to more sinus problems. If you developed nasal stuffiness and dripping before your sinus problem then perhaps the Requip is indirectly responsible. Generally sinus surgery is a last resort and you might want to get a second opinion from an ENT specialist.

It is less likely that stopping the Requip will help but you never know. If you do stop it for a while, make sure that you have other medication (such as painkillers) to treat your RLS during that period.

Sent: Saturday, June 09, 2007 9:53 PM
Subject: RLS and Effexor?

I started Effexor today and am concerned that it will aggravate my RLS condition. My legs have been better lately, and I don't want to upset that. Is Effexor one of the antidepressants that worsens RLS.

Van M.

Medical Reply

Effexor is one of the medications that tends to worsen RLS (there is a complete list on our RLS Treatment Page). This does not mean that it bothers every RLS patient but rather that it might worsen RLS.

Wellbutrin is a better choice as it does not bother RLS and often works as well as the other antidepressants.

Sent: Jun 13, 2007 9:29 AM
Subject: Prescriptions for RLS

I am sorry I do not have your name. I have suffered from nocturnal myoclonus for nearly forty years. During most of that time I have been taking Klonopin to control the night time jerky legs. Now that drug has very little effect and some side effects that I do not like. I am now trying 0.5 Requip and have been on it for about three weeks. At the same time, I gradually reduced the amount of Klonopin I have been taking and have not used any Klonopin for the last four or five days.

The night time leg jerking is almost totally gone, but I am still wide awake through much of the night. Of course, that means major daytime fatigue.

I have some questions:

1) Is there a problem using Klonopin and Requip together?

2) Is withdrawal trauma to be expected when going off Klonopin?

3) How long does it take the body to rid itself of the effects of Klonopin use?

4) Could Requip, by itself be responsible for my continuing wakefulness? Thank you very much for you help with these questions.

Lawrence A. N.

Medical Reply

Klonopin is a benzodiazepine that works like most of the sleeping pills. Likely, going off of it has created most of your insomnia. I would not recommend going back on this drug as you seem to already be somewhat tolerant to it and it is a drug that can cause dependence (you may also be having some withdrawal from this drug that may last several days to weeks).

Although Klonopin can be taken with Requip, a better choice may be one of the non-benzodiazepine drugs like Ambien or Lunesta that rarely cause tolerance or dependence.

Although Requip can cause insomnia in some people, it is more likely that withdrawal from Klonopin is the major problem with your insomnia.
 

Sent: Jun 13, 2007 4:02 AM
Subject: RLS and Celexa?

I have been taking Celexa (20 mg) for awhile now. Was taking l0 mg previously. For sometime I have been on Sinemet (l0/l00) and my RLS is acting up earlier and earlier in the daytime. My physician just gave me the starter kit yesterday for Requip.

Yesterday I forgot to take my Celexa medication. I had the best day that I can remember. Only took my whole Sinemet before bedtime and omitted the late afternoon 1/2 pill. Could not taking the Celexa just one day make a difference? I understand Celexa can interfere with some meds and make the RLS worse. Should I approach my physician on this?

Sandra B.

Medical Reply

Celexa (and all the other SSRI antidepressant medications) tend to make RLS worse (they do not act on other medications but do this directly). Stopping it even for one day can be helpful for your RLS.

You might ask your doctor about Wellbutrin which may work as well as Celexa but does not bother RLS.

Sinemet worsens RLS with time causing augmentation (the RLS occurs earlier in the daytime and may become more severe) so should not be used on a daily basis for RLS. Requip is a much better choice for treating RLS.

Sent: Friday, June 15, 2007 8:00 AM
Subject: RLS and neuropathy?

I have had RLS all my life. Through the support group, I have learned what I can eat, and the time of day I can eat certain things, and I can control the RLS pretty good. I am 77 years old. I am in good health. But lately I have developed a burning sensation in the front of my legs, from the ankles to about midway up my legs. I went to my doctor yesterday, He was unable to give me an answer, except that it could be neuropathy.

All my lab tests were normal, including glucose. My blood pressure is normal. He said he did not think this was related to the RLS. Since I don't know, I am asking you if this could be a symptom of RLS and what to do about it?

Wanda

Medical Reply

It does sound like you may be suffering from neuropathy. It might be related to your RLS but that would not change the treatment. Neurontin or Lyrica may be helpful for this problem.

Sent: Saturday, June 16, 2007 4:53 AM
Subject: Blood pressure medications and RLS

I have severe RLS and also high blood pressure. I'm taking 2 medications for my high blood pressure. I read an E-mail that said certain high blood pressure medications can make RLS worse. Do you happen to know them?

Carol Ann S.

Medical Reply

Blood pressure pills do not have any effect on RLS. There were a few reports that propranolol (an older blood pressure pill) might help RLS but that has never been confirmed.

Sent: Saturday, June 16, 2007 9:13 AM
Subject: Anxiety meds and RLS

I'm a 50 year old male. I've suffered from RLS and had difficulty falling asleep for most of my adult life. About four years ago I approached a GP with the problem. She tried several different dopamine agonists first, all of which caused vivid dreams and prevented restful sleep. I ended up taking .5 mg of Klonopin. Over the following years, due to tolerance, the dose was increased to 2mg. Although it did relieve my RLS symptoms, I would wake up after about 5 hours of sleep, feeling like I had not gotten a restful sleep. I was constantly tired and groggy. I decided it was better to deal with the RLS than the results of Klonopin addiction.

Against advice from others, I tried to quit the Klonopin "cold turkey". I went for 5 nights with almost no sleep at all. I also experienced very severe anxiety and depression. Eventually it got to the point where I felt I could actually die from sleep deprivation. I went to my GP, and we decided on a replacement/reduction schedule, using Valium as a replacement, then reducing it by stages, one week at a time.

It worked to the point that I got off the Klonopin, and now only take 5mg of Valium before bedtime. However, the anxiety and depression never went away (which I never experienced before this episode), and I still wake up after 4 to 5 hours of sleep. I have also developed an irregular heartbeat (skipped beats), which I have had checked out, and my heart is fine.

I've tried Effexor and Zoloft, which are SSRI's, and which I have now read make the symptoms of RLS worse. I found this to be very true. Again, I couldn't sleep. I have read your advice that Remeron and Wellbutrin are the only antidepressants that don't affect RLS. I've read in other sources that Serzone, Bupropion, Desipramine and Trazodone don't affect RLS.

Considering I am also under a lot of tress from work and home issues, what would be your suggestion for a course of action? I'm at wits end. I need to do something before I end up in a psych ward somewhere.

Thanks,
Glendon

Medical Reply

Remeron (as per my website's Treatment Page) is not recommended for RLS as there are case reports of it worsening RLS. Bupropion is the generic name for Wellbutrin. Serzone may cause severe liver damage (quite uncommonly) so it is not worth the risk of using it for RLS. Trazodone is RLS friendly but not a great antidepressant or anti-anxiety drug.

A Reply from Glendon

Sent: Saturday, June 16, 2007 3:21 PM
Subject: Re: Anxiety meds and RLS

Thanks for the quick response. I should make it clear, however, that I am more immediately concerned with the anxiety/depression than the RLS. So, I guess what I'm looking for is the most effective antidepressant, with the least likelihood of increasing my RLS. My RLS has been behaving itself pretty well lately, as long as I don't take some medication which exacerbates it.

If the only serious side-effect of Serzone is a very remote chance of liver damage, I might tend toward that. I'm otherwise a pretty healthy individual. I just need to get rid of this damn anxiety that was brought on by my week without sleep. I expect the need for the antidepressant to be relatively short-term.

Glendon

Medical Reply

When the anxiety/depression is very significant, it should be treated despite the concerns that some of the medication may worsen RLS. We can usually work around the increase in RLS symptoms by treating them separately (especially if the mood problems are short-lived). Some psychiatrists do use Serzone (and think that it works very well) despite the small but serious risk of liver damage.

Sent: Saturday, June 16, 2007 1:25 PM
Subject: Ferritin for RLS?

I had my ferritin level tested about 8 weeks ago, and it was at 30. I had already been on approximate 200 mg elemental iron, in the form of ferrous sulfate, then later ferrous bis-glycinate a month before my test, so I was probably much lower. I have continued the iron until now. A few days ago, I was retested, at a different lab (because I was in a different area) and it came back 110!

I told them that was impossible because everything I know (mostly from your website) says what a very long and difficult process it is to raise levels to even above 50. They actually retested it and it still came back 109. Is it possible to raise 80 points in less than 8 weeks? Or was my first lab wrong? I think I will retest it there again. I just don't think it was wrong, because I had been donating blood too often, for over a year. (six times), plus other factors. My RLS is much better for now, for whatever reason, so I'm grateful for that.

Linda
Lakeport, CA

Medical Reply

Your dose of 200 mg of elemental iron per day is quite reasonable and certainly could raise your serum ferritin level within 2 months. It usually does take longer (often up to 6 months) but there is a lot of variation in this process. Also, the fact that your RLS has improved supports this improvement in ferritin levels.

A Reply from Linda

Sent: Friday, June 22, 2007 5:29 PM
Subject: Requip dose?

I just came from my first appointment with my psychiatrist and she has started me on Wellbutrin, Restoril, and Requip. The Requip is 1 mg at bedtime.. I asked her if I should start at 1 mg, and she said yes.

Does this sound like too much of a starting dose to you, or should I just trust her judgment? I'm scared to take it. I could split it, but it has a bump in the middle and doesn't split well. Also looks coated. What is your opinion?

Linda
Lakeport, CA

Medical Reply

Typically, we start Requip at .25 mg (1/4 of your 1 mg tablet) then increase to .5 mg then to .75 or 1 mg every 3-7 days. There is a Requip starter kit that starts at .25 mg for two days, then .5 mg for the next 5 days than 1 mg for the next week (then further increases of 1 mg per week if needed).

You may do fine starting with 1 mg but the odds are good that you may have side effects starting at a relatively high dose (and since it comes in lower doses there is no reason to take a chance by starting a higher dose). Furthermore, many patients only need .25 or .5 mg and by starting at 1 mg, you would never know if a smaller dose would be all you need.

Despite the bump in the middle (put there to make this drug easier to manipulate by Parkinson's disease patients), it can be cut in half. There is no coating, so don't worry about splitting for that reason. You may want to go back to your doctor and ask her to give you a Requip starter kit.

Sent: Sunday, June 17, 2007 4:25 AM
Subject: Mirapex Ruining Our Lives?

My husband has RLS. I am writing this letter because I don’t believe he can see or understand what is going on right now. (He is so caught up in what he is doing, he can’t see the forest from the trees .. currently!) My husband changed psychiatrists approximately three years ago. With this change, came a whole new prescription regimen. He battles depression, anxiety, sleeplessness (because of RLS) and of course, the RLS.

When he began going to this new doc, the new prescriptions were Effexor (375mgs) , Ambien, Mirapex and finally Provigil to combat the sleepiness in the day brought on by his sleep meds.(?)

I remember mentioning to his doc (once when they asked me to come to one of his first appointments) that it seemed like my husband had improved greatly .. during the several months he had been on the Effexor. (Sometime throughout this time the Effexor was increased, along with the Mirapex.) I believe it was at approximately the six month mark that he started on all of these meds that he (all of a sudden) began going to the bar every night. Since this time it has gone down hill.

My husband continues to frequent the bar every night. He spends (in my opinion) large amounts of money at the bar, so that he CAN drink. Sometime during this time frame, my once very hard working husband has “decided” that he cannot work any more. He maintains that he cannot focus, nor can he stay on task. There may be more to his “not working” issues, but he hasn’t revealed that to me.

So .. he pretty much stopped working, but continues to drink/spend large amounts of money, as if there are no financial issues. Since husband has been on his new medication regimen, we have refinanced twice. Now he is advocating we do that again. We have a beautiful home on quite a few acres. We HAD a large amount of equity in our home/property. Because of my husband’s insistence on refinancing (twice, now going on three times) and his continuation of the “can’t work” stance, we (in my opinion) are in risk of losing our home.

I find that trying to talk to husband about this is totally futile. It is just one huge argument after another. As I mentioned above, he can’t see the forest from the trees right now.
My husband and I have been married for 28 years. Up until now I have ALWAYS been supportive, stood by him. Currently though, because I can’t get husband to make any changes, I am feeling like I am at the end of my rope.

His doctor told me to write him a confidential letter, explaining to him what has been going on. I’ve done that .. just this past week. I am hoping that this doctor .. at husband’s next appt., will change his Mirapex prescription. In my opinion he should NOT be on any kind of dopamine agonist because of what history shows as an “addictive” personality in my husband.

Considering the above situation, do you have any suggestions as to questions I could ask his doctor .. or suggestions of other meds that might help the RLS without the side effects that my husband is experiencing?

FL

Medical Reply

It is possible that the compulsive drinking may be due to Mirapex. It is much less common to get this behavior with the lower doses used for RLS (you did not state his dose) but it certainly can happen. If that is the case, then the behavior will reverse quickly with stopping the medication (sometimes even with a reduction in the dose).

His RLS may be managed with Neurontin or Lyrica in place of Mirapex (although they may increase daytime sleepiness problems).

A Reply from FL

Sent: Sunday, June 17, 2007 4:29 PM
Subject: RE: Mirapex Ruining Our Lives?

My husband is on 1mg Mirapex nightly. Is that considered a “lower” dose? When I called and talked to our local pharmacist, he told me that the 1mg Mirapex is a pretty “average” dose. I am also wondering if the combo of the high dose Effexor (375mgs) and Mirapex, might be what is “causing” his compulsive drinking problems.

He does (already) have daytime sleepiness that he has to take Provigil for. (The sleepiness is, I presume, caused by the Mirapex.) The Provigil seems to be helping with that, so it hasn’t been a problem .. as long as he takes the Provigil. Should changing to Neurontin Or Lyrica be anymore of a problem than what the Mirapex already is doing to him (daytime sleepiness wise)?

FL

Medical Reply

Your husband's dose of Mirapex 1 mg is actually very high for RLS (but not too high for Parkinson's disease which is likely what your pharmacist was thinking of when he answered your question). The only way to know whether the Mirapex is responsible for the daytime sleepiness is to stop the medication and see what happens (although this is quite likely).

Neurontin may work well but again, the only way to tell if your husband will tolerate this medication and do better with it is to try it.

Effexor should not cause compulsive behavior but Mirapex may be cause it, especially at 1 mg.

Sent: Sunday, June 17, 2007 4:48 PM
Subject: RLS

I have just found this site about RLS and had a few questions after reading most of it. I was diagnosed with RLS about 7 years ago but this condition had gone on for years before the diagnosis. I can remember as a child when my legs would ache (told they were growing pains) and nothing seemed to help...even my Mom massaging them didn't seem to help a lot. As I got older, I can remember moving my legs around in bed and the coldness of the sheets seemed to ease it up some but then when the sheet would warm where my legs were, it would start again. Flexing my feet to tighten the muscles, etc. in the calves of my legs and ankles seemed to ease it but then it would return.

After reading thru your site and some of the emails you had received, I couldn't believe that some medicines that help you to even function could be the cause of it. I have been on anti depressants off and on over 20 years. I now take Zoloft 150 mg a day and was told 4 yrs ago that I would have to stay on an anti depressant for the rest of my life and at that time I was put on Effexor and Xanax but have changed to the Zoloft. Now I find out that possibly my anti depressant is causing this RLS to be worse.

One thing I feel that may cause a lot of my RLS is my back due to the fact I have compression fractures in L1, L3, and L5 along with spinal stenosis/spondylosis and a pinched sciatic nerve. Recently I have had the RLS flare up when I was sitting watching tv or trying to read, crochet or sew. I've also noticed that sometimes my arms feel like my legs do at night. Can RLS also be in the arms? Is it all tied into the nervous system somehow? I can't remember anyone in my family ever having RLS but I do know my younger sister has mentioned it to me before and my oldest son has it and is diabetic.

When first diagnosed, I was given Klonopin. I was reluctant to take it due to knowing that they sometimes give this to people who have seizures and I didn't know what it would do. Eventually I took it and slept all night. Then they put me on Neurontin and I find its an anti seizure medication. I've only taken it a few times when it gets so bad I can't go to sleep. I guess my main concern is if this RLS can be somehow felt all over the body? Mine feels like electrical surges or tingling going up and down my legs. Creepy, crawly sensations, an urge to continue to tighten or strain the muscles.

I am 62 years. old and have never felt so "all by myself" with this..

Granny

Medical Reply

Many medications can worsen RLS and you should download our free medical alert card to show to your doctors (it contains all of the RLS worsening drugs and alternatives). Wellbutrin in your case may work better to not bother your RLS if it works as well for your depression.

RLS typically occurs in the legs but can spread to other body parts.

Requip or Mirapex are the drugs of choice for RLS and you may do better on one of those.

Sent: Monday, June 18, 2007 4:00 AM
Subject: High blood pressure and PLMS

I read that PLM´s can cause hypertension in RLS patients who experience more than 30 PLM´s per sleep hour. My sleep study showed no PLMS while on medication (I have severe RLS). I am also on medication for high blood pressure, which worked well for some years, but the last few years I have seen my blood pressure go up.

I suffer from a lot of PLMW during daytime, when I am on Tramadol, which works for RLS but not PLM. Does more than 30 PLM's per sleeping hour mean the same as more than 30 PLM's per waking hour for blood pressure to go up?

C.M.A.
The Netherlands

Medical Reply

It has been found that PLM are associated with transient increases in blood pressure (and some acceleration of heart beat) when they occur during sleep. The actual clinical ramification of these transient increases in blood pressure are not fully known although some researchers have speculated that it might lead to premature heart disease or strokes. We clearly need more research on this topic.

However, as to your question about PLMW (PLM while awake), it is even less likely that they are of any clinical significance other than the annoyance they cause those who experience them. It is very doubtful that they have any important effect on blood pressure compared to the many other daily events that also raise blood pressure.

Sent: Monday, June 18, 2007 8:20 AM
Subject: Does Mirapex lose it's effectiveness?

I have had RLS since I was 26 years old and have probably tried every possible drug or action to no avail. I am now 63. When I finally found Mirapex, I truly believed it to be a miracle drug. I have been on 0.5 mg three times a day for about 9 years and it has been effective about 90% of the time. Lately that percentage has dropped considerably.

It is now 9:15 AM and I have yet to go to sleep. Staying on the computer helps me as well as walking. Should I assume that my body has adjusted to Mirapex and It is time to try Requip or another med. I previously lived in NYC and even there up until about 10 years ago, it was hard to be taken seriously, Now I'm in a very small community in Missouri and I generally research my own meds and tell the doctor what to prescribe. My country doctor told me this would lead to Parkinson's disease. I asked where he got his data and he couldn't tell me, so hence, I do my own research.

I tried going into a research drug trial in Memphis about two years ago but was told I had to stay off the meds for two weeks, I couldn't even make it through the night. So I had to abandon my hopes of being a trial subject.

Maryann

Medical Reply

After 9 years, it is more likely that your disease is slowly getting worse or perhaps something else (like other medications) may be worsening your RLS rather than you becoming tolerant to the medication. As such, increasing the Mirapex a bit (to .75 three times a day) may be helpful.

Alternatives to increasing Mirapex include adding Neurontin (or an another anticonvulsant) or a painkiller (opioid or Ultram) which should likely resolve your RLS problems.

RLS absolutely does not lead to Parkinson's disease.

Sent: Wednesday, June 20, 2007 11:03 AM
Subject: Periodic leg movements with Paxil?

I am taking 25 mg of Paxil and 30 mg of Buspar. I have been taking Paxil for a long time, but for the past few months I wake up and I noticed pain in my thigh muscle and my both knees. I video taped myself a few night ago and I noticed that I move my leg and jerk my knees really bad when I am sleep.

Can this be caused by Paxil? If I go off Paxil will this go away? are there any SSRI's that do not cause this problem? is there any kind of meds that can help me?

Bobby

Medical Reply

The periodic limb movements (PLM) are very common with all SSRI medications such as Paxil. They are usually not harmful so staying on the medication is not a big problem for most people. The only antidepressant that does not cause or worsen PLM is Wellbutrin.

Sent: Wednesday, June 20, 2007 2:19 PM
Subject: Requip and Sinemet for RLS?

I am a 78-year-old male and have had RLS for more than 20 years or more but did not know what I had or how to treat it. Two years ago I had to have both knees replaced and while I was in the hospital RLS became very bad and if it were not for the morphine pump I don’t think I would have made it.

While on the recovery from the knee surgery I purchased a recumbent bicycle and killed two birds with one stone, therapy for my knees and when RLS struck I would get some relief by riding the bike.

I then went to my PCP and was diagnosed with RLS and put on Sinemet. This did not work very well for me because it did not last very long and was changed to Requip starting with .25 mg and working up to 4 mg until I got some relief. The side effects were bad because I would almost go to sleep while driving but I overcame that.

I then enrolled in two studies in Dallas for Extended Release Requip, the first one was 12 weeks long double blind placebo controlled study and then I enrolled in a 52 week maintenance Study and knew what I was taking, I progressed up to 4mg of Requip a day taken all at once in the evening. My RLS still came back in the afternoon.

After the study was over I had to revert back to regular Requip. The study group called me and ask if I would be interested in another study and this time it was with gabapentin (Neurontin). I then was told to start taking gabapentin and decrease the amount of Requip that I was taking. I had to stop after a week because I had such bad side effects I felt like I had been on a drunk for about a week and woke up with a big hangover, just to name a few. I was actually staggering and was glad the police did not pull me over because I knew I would be in for a sobriety test.

I then tried Mirapex and could not get any sleep at all and felt like a zombie all day.

Then I found out that the half life of Requip was 6 hours and Sinemet was somewhat less but for me was much faster acting than Requip and with very little side effects, I started taking .5mg of Requip in the afternoon and 3mg in the evening. The results were the Requip in the afternoon would make me so sleepy that I had to go take a nap. Then I started taking Sinemet in the afternoon when the RLS hit and that would tide me over until evening.

The formula that works for me (and I know would not work for everyone) is I take 25-100 Sinemet in the afternoon and at 6:30 PM take 1 mg of Requip then about 8:00 PM take another 1 mg, at 9:00 PM when I go to bed take 2 mg of Requip and then I only wake up about one time to go to the bathroom and have no trouble going back to sleep and wake up around 5:00 AM.

I have read all that I could about RLS and I am convinced that trauma has something to do with it. I have had many nights of climbing the walls and looking at the clock and just about thinking what can I do with this horrible stuff.

Not everyone is the same and what works for me, might not work for you but if you are having problems see your doctor and try experimenting some, it just might help.

Ray,
Hurst, TX

Medical Reply

There is nothing inherently wrong with your drug regimen for treating RLS. The only concern is that even on low dose Sinemet, augmentation may occur. If this happens, you will likely have to stop your Sinemet and possibly even your dopamine agonists (Requip).

You may want to consider Neupro (the rotigotine patch) that will be available next month. It gives a steady level of dopamine (even steadier than the Requip CR that you used in the study) and may cause less side effects such as sedation.

You may also want to consider using some painkillers (opioids or tramadol) as they may have less side effects in your case.

Sent: Friday, June 22, 2007 12:01 PM
Subject: Medical marijuana for RLS?

I am recently certified for medical marijuana, and wonder if it has been working on other RLS patients?

Lew P.

Medical Reply

Many RLS sufferers have noted that even a few puffs on a marijuana cigarette will relieve even severe RLS symptoms. There are not studies on this drug for RLS and of course, for most patients, this is not a legal drug.

Sent: Friday, June 22, 2007 3:59 PM
Subject: RLS in one leg?

Is it possible to have RLS in just one leg? I will be seeing my doctor in about one week. She isn't sure either. Thank you

Olivia R.
West Boylston, MA

Medical Reply

RLS usually occurs in both legs but can alternate from side to side (in the same day or on different days). A very small minority of patients have RLS only in one leg but it does definitely occur.

Medical Reply

Sent: Saturday, June 23, 2007 3:49 PM
Subject: Who to see?

I have another question please. What type of specialist should I seek out if it is RLS or to find out if it is in fact RLS? Once again, thank you.

Olivia R.

Medical Reply

A neurologist or sleep specialist know the most about this condition but a good general doctor should be able to figure it out.

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