Pharmacologic Treatment of Restless Legs Syndrome / 대한정신약물학회지

ABSTRACT

Restless legs syndrome (RLS) is defined as the urge to move one's legs, accompanied by unpleasant sensations in one's limbs, and is typically more severe at night. Sleep hygiene measures should be recommended and all causes of secondary RLS such as iron deficiency and medications (antidepressants, antiemetics, antipsychotics, and antihistamines) should be excluded before pharmacological treatment of RLS is initiated. In view of evidence of their efficacy and tolerability, ropinorole, pramipexole, gabapentin, and oral iron should be considered as first-line treatments for RLS. Ropinirole and pramipexole are the only drugs approved for the treatment of RLS in Korea. Ropinirole is metabolized by cytochrome P450 1A2 in the liver. On the other hand, pramipexole is metabolized only to a minor degree, and urinary excretion is the major route of elimination; thus, doses of pramipexole should be reduced in patients with impaired renal functioning. Gabapentin, which is known to be effective for pain and sleep disturbances in patients with RLS, is also secreted unmodified by the kidneys. An oral iron supplement is recommended for patients with low normal serum ferritin levels (< or = 75 ng/mL). Levodopa, pergolide, cabergoline, valproic acid, carbamazepine, and IV iron dextran are classified as second-line treatments. Clonazepam, bupropion, and some opioids can also be used in patients with RLS. In conclusion, pharmacological treatment of RLS should be individualized according to the physical status of patients as well as their RLS symptoms, and augmentation should be carefully monitored when dopaminergic agents are used for long periods.