In this article we take a look at restless leg syndrome remedies.
Drug Therapy
As of today, there is no known effective cure, for restless leg syndrome.
Presently there is not a single drug therapy that is effective in treating everybody.
There are benefits and relief that many of the currently available drugs offer most people with restless leg syndrome.
These medications can be divided into several categories:
- opiates
- dopamine-related medications
- iron supplementation
- alpha-2 delta medications
- benzodiazepines receptor agonists (BRAs).
Opiates
Dr. Willis included the benefits of opiates in treating RLS symptoms in his description of this disease in 1685. Opiates remained the only effective treatment for restless leg syndrome for over 300 years. This category of drugs for treating this disease includes hydrocodone, codeine, oxycodone hydromorphone, morphine, pentazocine, buprenorphine, and methadone.
It is estimated that about 85 to 90 percent of anyone with RLS respond remarkably to opiates. Based on an analysis of how patients responded to drugs over a 2-10 year period revealed that 85 percent of patients who commenced treatment with methadone were still dependent on it compared to fewer that 20 percent of those who commenced their treatment with a dopamine drug. In this study, the median daily starting dose for methadone was 10mg with a range of 2.5 mg and 20 mg daily.
Another thing to note is that most patients with RLS experience don’t necessarily experience painful sensations, and the disease is not generally associated with pain; it simply is an uncomfortable and abnormal sensation. Opiate tolerance when treating RLS is usually associated with less problems than that which is observed when treating other chronic pain disorders.
Dopamine-Related Medications
One of the many chemicals produced by the body is dopamine, which is produced by certain cells in the brain. Dopamine-based drugs operate by either increasing the level of dopamine produced by the brain cell (levodopa) or increase the chemicals signal to surrounding cells by imitating dopamine in the brain. Drugs that are related to dopamine include levopoda, ropinirole, pramipexole and rotigotine.
These drugs are also regularly used to manage Parkinson’s disease. However, there are no indications that RLS is a precursor, or a gateway disorder to Parkinson’s disease. The medications listed are known to be very effective, reducing symptoms in up to 90 percent of patients with RLS. Increased compulsive behaviour, excessive sleepiness and augmentation, which indicates the worsening of symptoms, are some of the side effects that can occur as a result of over dependency or extended use of these drugs.
Benzodiazepines Receptor Agonists
These drugs are also known as sleeping pills with valium-like action. Benzodiazepine was designated as the structure of the parent compound, but was later identified as a benzodiazepine receptor after subsequent research was carried out. It was found that this receptor interacts with a larger GABA receptor compound.
There are newer benzodiazepine receptor agonist (BRA) drugs that are without the benzodiazepine structure found in the previous parent compound, but are seen to be bound to the benzodiazepine receptor. Another class of drugs that was the dribble choice used to treat RLS is clonazepam, but it has not been established that anyone this set of drugs is a better remedy for RLS. BRAs like Zolpidem (Ambien), zaliplon (Sonata), eszopiclone (Lunesta) are all shorter acting compared clonazepam and may be equally effective. Patients who experience mild symptoms of restless leg syndrome may benefit more from BRAs.
Alpha-2 delta Drugs
Alpha-2 delta drugs interact with alpha-2 delta protein which is one of the calcium channel proteins. The calcium channels let the energized calcium ion move into the nerve cell, where they are needed for activation, deactivation and the stabilization of electrical activities that occur in the nerve cells. The alpha-2 delta drugs are commonly used to treat people with pain related to nerve-damage including those who do not have RLS. Pregabalin (Lyrica), gabapentine (Neurontin) and gabapentin enacarbil (horizant) are currently the three popular drugs that are considered alpha-2 delta class of drugs.
Of the three alpha-2 class drugs, only gabapentin enacarbil has been approved by the FDA for use in treating RLS. The other two drugs have only been used in treatment trials for RLS. Gabapentin enacarbil is known as a prodrug to gabalentin. What this means is that the compound is transformed into gabapentin and mimics gabapentin in the brain. The advantage of gabapentin enacarbil over regular gabapentin is that it is readily absorbed and lasts longer.
These drugs mainly operate by stimulating alpha-2 receptors if the brain stem. This process activates the neurons which shut down the portion of the nervous system that is responsible for involuntary muscle movements and sensations. Another drug to mention is clonidine (Catapres).
In several clinical trials of the effectiveness of pramipexole vs pregabalin have also shown that pregabalin is significantly more effective in improving RLS symptoms. Generally, the alpha-2 class of drugs have proven to be an effective treatment option for many patients with RLS. They should also be considered as a first mine of treatment for RLS.
Iron Supplementation
Iron deficiency has been established as one of the leading causes of RLS. The benefits of using iron therapy in the treatment of RLS has been known since the 1950s. In a study, patients with low serum ferritin were administered 325 mg ferrous sulphate twice a day before they had any meals. A remarkable improvement in their symptoms was recorded after three months.
Where patients are intolerant to iron, or their iron stores have not improved significantly after three months, employing an iron infusion is another way to go about it. By introducing iron into the blood intravenously, the iron supplement would have bypassed the gastrointestinal tract, which is often responsible for inhibiting the absorption of iron when administered orally.
Scientists have come up with different formulations of iron that are suitable for intravenous applications and are also used for treating anemia. There are two main iron formulations – (INFed and Dexferrum). Other formulations that are used intravenously include iron gluconate (Ferrlicit®), ferric carboxymaltose (Ferinject®), iron sucrose (Venofer®) and ferumoxytol (Feraheme®).
Non-Drug Therapies
There is quite a number is non-drug therapies that people suffering from RLS have used to alleviate the symptoms. These include reducing alcohol and caffeine intake, applying cold or hot packs, engaging in moderate exercise, hot baths and massaging and running of affected limbs. In as much as any of these non-drug therapies can bring about immediate relief, the results don’t last long and patients still tend to be unable to enjoy their night rest.