Survey of the recent published research to identify the most common causes of pharma-induced RLS and PLMs.
Copied below in case the link breaks:
Pharmacologically Induced/Exacerbated Restless Legs Syndrome, Periodic Limb Movements of Sleep, and REM Behavior Disorder/REM Sleep Without Atonia: Literature Review, Qualitative Scoring, and Comparative Analysis
Romy Hoque, M.D.; Andrew L. Chesson Jr, M.D.
Sleep Medicine Program, Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA
Background: Pharmacologically induced/exacerbated restless legs syndrome (RLS), periodic limb movements in sleep (PLMS), and REM behavior disorder/REM sleep without atonia (RSWA) are increasingly recognized in clinical sleep medicine. A scoring system to evaluate the literature was created and implemented. The aim was to identify the evidence with the least amount of confound, allowing for more reliable determinations of iatrogenic etiology.
Methods: Points were provided for the following criteria: manuscript type (abstract, peer-reviewed paper); population size studied (large retrospective study, small case series, case report); explicitly stated dosage timing; identification of peak symptoms related to time of medication administration (i.e., medication was ingested in the evening or at bedtime); initiation of a treatment plan; symptoms subsided or ceased with decreased dosage or drug discontinuation (for RLS articles only); negative personal history for RLS prior to use of the medication; exclusion of tobacco/alcohol/excessive caffeine use; exclusion of sleep disordered breathing by polysomnography (PSG); and PSG documentation of presence or absence of PLMS.
For RLS and PLMS articles were also given points for the following criteria: each 2003 National Institutes of Health (NIH) RLS criteria met; exclusion of low serum ferritin; and exclusion of peripheral neuropathy by neurological examination.
Results: Thirty-two articles on drug-induced RLS, 6 articles on drug-induced PLMS, and 15 articles on drug-induced RBD/RSWA were analyzed.
Conclusion:
Based on scores ≥ 10 and trials of medication reduction/cessation, the strongest evidence available for drug induced RLS are for the following drugs: escitalopram; fluoxetine; L-dopa/carbidopa and pergolide; L-thyroxine; mianserin; mirtazapine; olanzapine; and tramadol.
Since none of the PLMS articles assessed PLMI in trials of medication reduction/cessation, the strongest evidence based on scores ≥ 10 are for the following drugs: bupropion, citalopram, fluoxetine, paroxetine, sertraline, and venlafaxine.
Based on scores ≥ 10 and/or trials of medication cessation, the strongest evidence for drug induced RBD/RSWA is for the following drugs: clomipramine, selegiline, and phenelzine.
Keywords: Pharmacologically induced, periodic limb movements of sleep, rapid eye movement behavior disorder, REM sleep without atonia, restless legs syndrome
Published Research - Pharmaceutical
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ViewsAskew
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Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
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SquirmingSusan
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- Contact:
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SquirmingSusan
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Buproprion is almost always recommended as the "rls-friendly" antidepressant. So it always seems to come down to how things affect each individual and that can vary widely.
And no mention of Benadryl as a drug that worsens RLS? That one seems to be one of the few that almost always makes RLS go crazy.
And no mention of Benadryl as a drug that worsens RLS? That one seems to be one of the few that almost always makes RLS go crazy.
Susan
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ViewsAskew
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Wow...this is a bit crazy. This study showed selective changes in decision making in RLS patients (untreated) against controls!!!
While not directly about pharma, it does include a warning to watch patients taking dopaminergics very closely.
The following is reprinted in case we lose the link:
Decision making in restless legs syndrome.
Bayard S, Yu H, Langenier MC, Carlander B, Dauvilliers Y.
Department of Neurology, Gui de Chauliac Hospital, Montpellier 34295, France.
Abstract
The dopamine system is implicated in reward-based decision making with explicit information (decision making under risk) and implicit probabilities (decision making under ambiguity). Although the pathophysiology of restless legs syndrome (RLS) is not yet fully understood, the genetic factors, iron status, and dopaminergic system are thought to play a role. RLS provides an opportunity to test the dopaminergic hypothesis in a drug-free population and to characterize reward processing using decision-making paradigms. We investigated impulsivity, impulse control disorders, and decision making in 50 untreated patients with primary RLS compared with 60 sex- and age-matched normal controls using one night of polysomnography recording, a structured psychiatric interview, and questionnaires (RLS Severity Scale, Beck Depression Inventory, and Urgency Premeditation Perseverance Impulsive Behavior Scale). Subjects performed the Iowa Gambling Task to assess decision making under ambiguity and the Game of Dice Task to assess decision making under risk. Patients with RLS showed selective changes in decision making on the Iowa Gambling Task and normal decision making on the Game of Dice Task compared with controls. Patients with RLS had greater depressive symptoms than controls, but no difference was found in impulsivity, impulse control disorders, or addictive behaviors. Clinical and polysomnographic variables were unrelated to decision-making performance. Results indicate reduced decision-making performance under ambiguity in drug-free patients with RLS. From a clinical perspective, when using dopaminergic medication to treat RLS, patients with abnormal baseline behaviors should be closely monitored. (c) 2010 Movement Disorder Society.
PMID: 20669306 [PubMed - as supplied by publisher]
While not directly about pharma, it does include a warning to watch patients taking dopaminergics very closely.
The following is reprinted in case we lose the link:
Decision making in restless legs syndrome.
Bayard S, Yu H, Langenier MC, Carlander B, Dauvilliers Y.
Department of Neurology, Gui de Chauliac Hospital, Montpellier 34295, France.
Abstract
The dopamine system is implicated in reward-based decision making with explicit information (decision making under risk) and implicit probabilities (decision making under ambiguity). Although the pathophysiology of restless legs syndrome (RLS) is not yet fully understood, the genetic factors, iron status, and dopaminergic system are thought to play a role. RLS provides an opportunity to test the dopaminergic hypothesis in a drug-free population and to characterize reward processing using decision-making paradigms. We investigated impulsivity, impulse control disorders, and decision making in 50 untreated patients with primary RLS compared with 60 sex- and age-matched normal controls using one night of polysomnography recording, a structured psychiatric interview, and questionnaires (RLS Severity Scale, Beck Depression Inventory, and Urgency Premeditation Perseverance Impulsive Behavior Scale). Subjects performed the Iowa Gambling Task to assess decision making under ambiguity and the Game of Dice Task to assess decision making under risk. Patients with RLS showed selective changes in decision making on the Iowa Gambling Task and normal decision making on the Game of Dice Task compared with controls. Patients with RLS had greater depressive symptoms than controls, but no difference was found in impulsivity, impulse control disorders, or addictive behaviors. Clinical and polysomnographic variables were unrelated to decision-making performance. Results indicate reduced decision-making performance under ambiguity in drug-free patients with RLS. From a clinical perspective, when using dopaminergic medication to treat RLS, patients with abnormal baseline behaviors should be closely monitored. (c) 2010 Movement Disorder Society.
PMID: 20669306 [PubMed - as supplied by publisher]
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
I was prescribed bupropion for fibromyalgia, have taken it for 3 months. I haven't noticed anything. Fibro not any better, doesn't bother my RLS. So I'm going to call the doctor and get off it. Benadryl is poision for me. It will make me crazy. My legs, on benadryl have a mind of their own. Lying down, my legs will fly in the air, weird. 
Have tried trazadone, and tramadol, doesn't do much good but doesn't make the RLS worse.
Who can figure?????
BETTY/WV
Have tried trazadone, and tramadol, doesn't do much good but doesn't make the RLS worse.
Who can figure?????
BETTY/WV
Thanks to rls.org, I have learned so much about my condition. I have received encouragement from my friends here. This is a site I can come to when I am up most of the night, and I vent, and know those who read my messages understand
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ViewsAskew
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This isn't published research...yet. But, let's hope it works!
Copied below in case link is lost:
By Medical College of Georgia
Published: 2010-12-06
A drug prescribed for Parkinson's disease may also treat restless leg syndrome without the adverse side effects of current therapies, Medical College of Georgia researchers say.
* * *
Rasagaline works by prolonging the effect of dopamine, a chemical that transmits signals between nerve cells in the brain. The cause of RLS is unknown, but research suggests a dopamine imbalance. Parkinson's is caused by a dopamine insufficiency.
"The hope is that Rasagaline, because it prolongs the effect of existing dopamine, instead of producing more, will not come with adverse side effects," said Dr. Shyamal Mehta, an MCG neurologist and neuroscientist. "We are trying to evaluate its safety and efficacy in treating RLS at this point. When it has been used to treat Parkinson's, it's been well-tolerated with few side effects."
Current RLS therapies include a group drugs that work by activating existing dopamine receptors, prompting the brain to make more dopamine. The problem, Mehta said, is that those drugs usually come with adverse effects, because dopamine increases feelings of euphoria.
"People taking those drugs often report behavioral problems like addiction, because the pleasure they get from things like shopping is multiplied," he said. "They can cause impulse-control problems, like gambling or hypersexuality as well. They can also cause increased sleepiness and sudden sleep attacks, which can be quite disruptive and dangerous."
Some reports also suggest decreased efficacy after extended use, as well as symptoms beginning earlier in the day.
Restless leg syndrome, which affects 10 percent of the population, is characterized by prickling or tingling in the legs and an urge to move the legs. Symptoms are more noticeable at rest, such as during bedtime or a long car ride. RLS can also cause depression and daytime sleepiness, Dr. Mehta said, and is linked to conditions including iron deficiency, renal failure, pregnancy and Parkinson's.
MCG is one of seven centers participating in the 14-week trial, which will enroll 52 participants nationally. Participants must have an RLS diagnosis and be off any related medications for at least 30 days before the study.
Read more: http://www.disabled-world.com/health/ne ... z17RXSdxe6
Copied below in case link is lost:
By Medical College of Georgia
Published: 2010-12-06
A drug prescribed for Parkinson's disease may also treat restless leg syndrome without the adverse side effects of current therapies, Medical College of Georgia researchers say.
* * *
Rasagaline works by prolonging the effect of dopamine, a chemical that transmits signals between nerve cells in the brain. The cause of RLS is unknown, but research suggests a dopamine imbalance. Parkinson's is caused by a dopamine insufficiency.
"The hope is that Rasagaline, because it prolongs the effect of existing dopamine, instead of producing more, will not come with adverse side effects," said Dr. Shyamal Mehta, an MCG neurologist and neuroscientist. "We are trying to evaluate its safety and efficacy in treating RLS at this point. When it has been used to treat Parkinson's, it's been well-tolerated with few side effects."
Current RLS therapies include a group drugs that work by activating existing dopamine receptors, prompting the brain to make more dopamine. The problem, Mehta said, is that those drugs usually come with adverse effects, because dopamine increases feelings of euphoria.
"People taking those drugs often report behavioral problems like addiction, because the pleasure they get from things like shopping is multiplied," he said. "They can cause impulse-control problems, like gambling or hypersexuality as well. They can also cause increased sleepiness and sudden sleep attacks, which can be quite disruptive and dangerous."
Some reports also suggest decreased efficacy after extended use, as well as symptoms beginning earlier in the day.
Restless leg syndrome, which affects 10 percent of the population, is characterized by prickling or tingling in the legs and an urge to move the legs. Symptoms are more noticeable at rest, such as during bedtime or a long car ride. RLS can also cause depression and daytime sleepiness, Dr. Mehta said, and is linked to conditions including iron deficiency, renal failure, pregnancy and Parkinson's.
MCG is one of seven centers participating in the 14-week trial, which will enroll 52 participants nationally. Participants must have an RLS diagnosis and be off any related medications for at least 30 days before the study.
Read more: http://www.disabled-world.com/health/ne ... z17RXSdxe6
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
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Polar Bear
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Yikes !!! off rls medications for 30 days before the study.......
Betty
https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation
https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation
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badnights
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Have you noticed that just about all RLS studies are done on patients who don't have really severe RLS? ie patients who can go off meds for longer than a few days without going stark raving mad and throwing themselves in front of a train. I have to wonder how meaningful the results are for the others of us.
I also wish someone would come up with a better severity scale. If symptoms that interfere with your sleep 2-3 nights a week are severe, what are symptoms that have risen to such heights that the days are as horrid as the nights and the evil singing in your veins never sleeps? When moving doesn't relieve it, but you have to move because movement is the difference between being tortured and having your mind snap?
I also wish someone would come up with a better severity scale. If symptoms that interfere with your sleep 2-3 nights a week are severe, what are symptoms that have risen to such heights that the days are as horrid as the nights and the evil singing in your veins never sleeps? When moving doesn't relieve it, but you have to move because movement is the difference between being tortured and having your mind snap?
I agree Bethf. Until I started Mirapex about a year and a half ago, I hadn't slept for more than 2 or 3 hrs a night for 30 or so years. I still have insomnia. They should read some of the post on this site to get a real clue as to how some suffer and I do mean SUFFER.
BETTY/WV
BETTY/WV
Thanks to rls.org, I have learned so much about my condition. I have received encouragement from my friends here. This is a site I can come to when I am up most of the night, and I vent, and know those who read my messages understand
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Polar Bear
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Bethf: I agree wholeheartedly with both of your comments.
If I had to go 30 days without meds I'd be kicking down doors... I'd be locked up. I may be the 'average' very severe rls sufferer, as opposed to an average sufferer (whatever that is) and compared to others who are so much worse off than me. There is no way that I would do a survey that meant being without medication...... only my own point of view. I just could not do it.
And on the point of measuring severity ?? If 2 - 3 nights per week is considered severe - what comes after severe. When you have walked for an hour, can't take any more medication for fear of taking too much, and then if you are lucky, all of a sudden you feel the sensations start to fade.......
Yes, wonder how they could do a survey on us 24/7 medicated sufferers.
If I had to go 30 days without meds I'd be kicking down doors... I'd be locked up. I may be the 'average' very severe rls sufferer, as opposed to an average sufferer (whatever that is) and compared to others who are so much worse off than me. There is no way that I would do a survey that meant being without medication...... only my own point of view. I just could not do it.
And on the point of measuring severity ?? If 2 - 3 nights per week is considered severe - what comes after severe. When you have walked for an hour, can't take any more medication for fear of taking too much, and then if you are lucky, all of a sudden you feel the sensations start to fade.......
Yes, wonder how they could do a survey on us 24/7 medicated sufferers.
Betty
https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation
https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation
It wouldn't be a pleasant experience for anyone doing research on people like us. I wouldn't even try to do it. I worry at times, what would I do if I couldn't get medication??? I remember walking the floor ALL night, crying. The next morning my legs would hurt so bad from the walking, and kicking. And I hated when night time came, it was terrifying. There were times when I almost went to the ER, I thought I just couldn't take it anymore. But somehow I would survive until about 5:30 am when it was like a switch was turned off and the RLS stopped.
BETTY/WV
BETTY/WV
Thanks to rls.org, I have learned so much about my condition. I have received encouragement from my friends here. This is a site I can come to when I am up most of the night, and I vent, and know those who read my messages understand
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ViewsAskew
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Yeah, I'd never be able to do a study, either. Crazy what you'd have to do!
I'm just glad someone CAN do it or we'd have no meds ever!
I'm just glad someone CAN do it or we'd have no meds ever!
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
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cornelia
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sleepdancer
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Quitting meds for a study
Several years ago I was at a high dose of Mirapex for RLS and PLMD and experiencing severe augmentation. Had been considering giving up and changing meds, but did not plan to do it abruptly. Unwisely left on a week long trip and didn't have time to get my Rx refilled. After a couple days I thought since it had been causing trouble anyway, might as well just stay off and try a new med when I got home. Developed sensations called synesthesia, where the senses get glitched or crosswired, and neuro doc said it was due to stopping med abruptly while on a high dose. But, the severe augmentation was relieved and I was left with my prior normal RLS and PLMD symptoms. Docs and I decided to test things by doing a "before" sleep study, then starting and gradually increasing the Mirapex to see if my RLS/PLMD symptoms improved and/or augmentation symptoms reappeared. At the 3rd increase up to my former dose the wild flailing reappeared and another sleep study was performed to confirm the changes. Weaned off the med and the flailing went away again. Being off all meds was a very difficult period. Only way it was tolerable was the hope that this testing would produce information that would help future treatment. of not just me, but others. Just thinking, seems pain meds would be ok even if off dopamine meds, up till the last few nights. Don't know though. I really wouldn't do a long term study where I might get the placebo.