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Then down to #6 Drugs and Food to avoid to improve RLS.
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6) Drugs and Foods to avoid to improve RLS
This section will discuss various drugs and foods that may worsen RLS. Things that cause worsening of RLS in some patients may not bother others in the same way; in fact, others may even be helped by these same medications or foods that worsen others. Please free to email us with any foods or drugs that worsen your RLS problems. Keeping a diary or log of foods, medications taken and worsening of RLS may also be helpful to determine what might be affecting you.
Some patients have found that ice cream (all flavors) cause worsening of RLS. Avoiding this food eliminates significant RLS worsening, especially in patients who eat a lot of ice cream. The cause of this relationship is unknown. For a possible explanation of why ice cream may exacerbate RLS, click here for a discussion of avoiding Mono and Diglycerides to help RLS.
Drugs and foods containing caffeine are very common. Coffee, tea, and colas are all commonly known beverages which contain significant amounts of caffeine and can cause worsening of RLS symptoms. Chocolate can also contains caffeine.
Many medications use caffeine in their formulation, especially pain pills, so you much check them out one by one. Some common medications with caffeine include: Cafergot, Darvon, Esgic, Exedrin, Fioricet, Fiorinal, Migralam, Norgesic, Wigraine, Anolaor, Butalbital, Femcet, Medigesic, Pacaps, Repan, and Synalgos-DC.
These include the common allergy and cold remedies, most of which are available over the counter. Examples are Actifed, Benadryl, Chlortrimeton, Comtrex, Contact, Corcidin, Dimetapp, Drixoral, PediaCare, Sinutab, Tavist, TheraFlu, Triaminic, Tylenol (flu, cold, PM, allergy), Vicks. Note that many cough syrups may contain antihistamines, especially if they are recommended for cold or flu symptoms.
The newer, non-sedating antihistamines, Allegra, Zyrtec and Claritin are generally better (and some RLS patients can take these without problems), but can be just as bad as the over the counter medications.
The tricyclic and serotonin uptake inhibitors (see Antidepressant Medication section above) can cause significant worsening of RLS problems. Paradoxically, some patients have noted marked improvement while on these medications, making it harder to understand why some patients worsen and others improve.
Medications to treat nausea can worsen RLS symptoms. This class of drugs includes: Anitvert, Atarax, Benadryl, Bonine, Compazine, Phenergan, Thorazine, Tigan, Trilafon and Vistaril.
There is an antinausea medication only available in Canada and Mexico called Domperidone (available over the counter as Motilium 10 in Mexico) , which does not cause worsening of RLS symptoms. This can be obtained by Americans over the internet from Canadian pharmacies (example is canadameds.com or www.canadapharmacy.com
) with a valid prescription from an American medical doctor.
Reglan (metoclopramide) is an anti-nausea agent that is also used to prevent reflux and has significant anti-dopamine activity, so it should be avoided.
There are two newer anti-nausea medications available in t he USA, Kytril (granisetron hydrochloride) and Zofran (ondansetron hydrochloride) which do not affect the dopamine system and thus should be safe for RLS. The only problem with these medications are that they are very expensive.
Most OTC cough syrups are fine to use for RLS patients if they are just simple cough medications (like regular Robitussin which contains dextromethorphan and guaifenesin). When they are combination preparations (also good for colds, flu, etc.) they likely contain antihistamines which as noted above, worsens RLS. So, check the ingredients carefully before you buy any cough medication (OTC) as they may contain harmful ingredients.
The prescription cough syrups usually contain a narcotic (codeine or hydrocodone). The most common one prescribed is Phenergan with codeine, which contains the anti-nausea agent phenergan which usually worsens RLS. It is countered by the presence of a small dose of codeine, but this may not be enough to cover the RLS worsening effects of the phenergan. Tussionex is an example of the hydrocodone containing syrups. It is combined with chlorpheniramine, a potent RLS worsening antihistamine, but the hydrocodone is at a high dose of 10 mg which usually will overcome any worsening effects of the chlorpheniramine. Hycomine is similar to Tussionex but Hycotuss does not contain any RLS worsening medications so it may be a better choice.
Many of these drugs are similar chemically to the anti-nauseants (in fact many are used as anti-nauseants). They can worsen RLS just like the antinausea drugs. This class of drugs includes: Clozaril, Compazine, Haldol, Loxitane, Mellaril, Moban, Navane, Prolixin, Risperdal, Zyprexa, Serentil, Stelazine, Thorazine, and Trilafon. Also, lithium, a drug which is very helpful in the manic-depressive disorders, can worsen RLS.
Bladder Control drugs
We have gotten some case reports of worsening RLS with drugs such as Ditropan. These drugs should thus be used with caution in RLS sufferers.
Alcohol had been found by many RLS sufferers to cause worsening of their RLS. The amount that does this can be very small in some cases. Individual tolerance can vary considerably (many may not be bothered at all).
(7) Pregnancy and RLS
Pregnancy can cause a worsening of RLS (in at least 50% of patients who have RLS and become pregnant) or be the first time that a patient experiences RLS symptoms. It usually occurs in the third trimester and has been reported in up to 12% of all pregnancies. 10% of women will have their first experience with RLS during pregnancy. The RLS symptoms will usually go away after the pregnancy, then often come back later in life. Various problems such as iron or folate deficiency have been postulated as causes, but the real reason why RLS worsens with pregnancy is unknown.
If the symptoms are severe enough to warrant drug therapy, then the sedative category of medication has been used for treatment (with the approval of the patient's obstetrician). Many RLS specialists will prescribe the opioid category of medication during pregnancy, due to their safety in pregnancy.
The risk of RLS medication in pregnancy is as follows (Category A,B,C,D,X, where A is the best and X is the worst and should never be taken during pregnancy; Category A drugs are quite safe and have a proven track record in pregnancy, Category B drugs have limited data and experience and should be used only if clearly needed, Category C drugs generally have no adequate or well controlled studies in pregnant women and should be used only if the potential benefit justifies the potential risk to the fetus):
Pregnancy Risk Category
Pergolide (but limited data), Ambien, Percodan (short term use), Dostinex, Ambien, methadone (low dose), Percocet, Percodan, OxyContin
Mirapex, Requip, Sinemet, Ultram, Darvon (short term use), codeine (short term use), Vicodin or Lortab (for short term use), Sonata, Lunesta, Tegretol, Neurontin, Catapress
Xanax, Klonopin (and most benzodiazepine sedatives),
Darvon, codeine, Vicodin, Percodan, all for long term use, methadone (higher doses)
Pregnant women should be checked for anemia and proper iron supplementation as indicated. Magnesium (used for treatment of toxemia of pregnancy) has recently been looked at for treating RLS, but this is only in the preliminary stages.
Nursing mothers can be treated with Darvocet (Darvon). Small levels of this drug will get into the breast milk, but no adverse effects have been noted in the infants getting the breast milk. Sedatives do get into the breast milk and can cause lethargy in the infants, so this class of medication should be avoided in nursing mothers. Dopamine agents may decrease lactation (milk production).
For more information on the risks of drugs in pregnancy or with breast feeding check out Motherisk Program or the Organization of Teratology.
This drug rarely (less than 5%) helps RLS and is only included on this page to help avoid RLS sufferers from receiving this drug for their disorder. It is probably one of the most common drugs prescribed by doctors unfamiliar with RLS when they hear the RLS complaints of their patients. This inappropriate treatment occurs because the RLS symptoms are confused with leg cramps for which quinine is the correct treatment.
We have received several reports from RLS sufferers that quinine has helped them, but we cannot be sure whether they have RLS and leg cramps, or in fact only leg cramps. I have treated several patients who definitely had RLS and found that quinine helped (sometimes very significantly) their RLS, but this is still a very small minority of RLS sufferers. As with many of the treatments above, some remedies seem to help only a few RLS patients and therefore cannot be recommended to the majority.
(9) Other RLS Information and Associations
Many patients have found that there is a seasonal variation in their RLS. They do fairly well for most of the year, then start to have worsening of their RLS symptoms in the late spring or early summer. This generally will occur with a change in the weather to hotter and more humid. There is of course, no understanding of why this phenomenon occurs.
The treatment of this increased RLS in the summer is to increased the dose of current medication. If that does not suffice, then addition of other classes of medications may be necessary until the fall months.
Menstrual Cycle RLS
There is a subset of female RLS sufferers who find that their RLS symptoms wax and wane with their menstrual cycles. Generally the RLS will worsen before menstrual flow and abate several days after. This seems to follow the pattern of PMS. This association is not understood at all and brings up the question if RLS is associated or related to PMS or other hormonal conditions (such as RLS in pregnancy).
We have also seen changes during the onset of menopause and after menopause. This can vary quite a bit amongst female patients with RLS. Some RLS sufferers will have their RLS complaints get better with menopause, and some have even noted worsening if placed on estrogen replacement therapy.