RLS - Medical Information

Medications for RLS

DISCLAIMER - SDA does not recommend or endorse any of these medications. The list is given for general information only. You should talk to your doctor about which, if any, medications may be suitable for your individual circumstances.

Medical Practictioners Specialising in RLS

DISCLAIMER - SDA does not recommend or endorse any of these doctors. This list is given as general information only of the doctors we know to have a special interest in RLS. There may be other specialists not on the list, as we are not yet aware of them. It is up to each individual to find a doctor that suits their needs.

List of practitioners:
In ACT
In NSW
In QLD
In SA
In VIC
In WA

Medications

Dopamine Agonists
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Opiates
list to be loaded

Benzodiazapine Receptor Agonists
list to be loaded

Alpha-2 Delta Drugs
These drugs interact with one of the calcium channel proteins, alpha-2 delta protein. Calcium channels allow the charged calcium ion to move into the nerve cell and are therefore important in activating, deactivating and stabilizing the electrical activity of the nerve cell. The alpha-2 delta drugs are also used to treat patients with nerve-damage related pain even in those without RLS.

There are currently two drugs available in Australia that fall into the alpha-2 delta class of drugs:
~ Gabapentin (Neurontin®)
~ Pregabalin (Lyrica®)

The alpha-2 delta drugs are an effective treatment option for many patients with RLS and should be considered one of the choices for first line treatment of RLS.

Possible Side Effects from Alpha-2 delta Drugs:
~ dizziness* or light-headedness
~ feeling tired or drowsy*
~ unfriendliness*
~ unusually overactive*
~ forgetfulness, loss of concentration or confusion
~ difficulty speaking
~ changes in your weight*
~ constipation, diarrhoea
~ nausea and/or vomiting*, indigestion
~ dry mouth, red swollen gums
~ muscle pain or cramps, back pain
~ swelling of the hands or feet
~ runny or blocked nose
~ fever*
~ bronchitis*, lung infection*
~ sore throat and discomfort when swallowing, coughing.

The above list includes the more common side effects of Neurontin®. They are usually mild and short-lived. Less common side effects are:
~ weakness, unsteadiness when walking including falling, reduced co-ordination or slowed reactions
~ unusual changes in mood* or behaviour such as restlessness, nervousness, or excitement
~ signs of new onset of, or increased irritability or agitation
~ signs of depression
~ seeing or hearing things that are not there, irrational thinking
~ blurred or double vision, uncontrollable jerky eye movements, difficulty seeing
~ signs of frequent infections such as fever, severe chills, sore throat or mouth ulcers.

The side effects marked * have been specifically reported in children taking Neurontin®

Iron Supplementation
Since the 1950s, it has been known that iron therapy, even without the presence of anemia has had benefits for RLS symptoms. Studies have shown a strong relation between body iron stores, as determined by serum ferritin, and the severity of RLS symptoms. A study has shown that in patients whose serum ferritin was < 75 µg/l, oral iron therapy (325 mg ferrous sulfate twice a day on an empty stomach) on average improved RLS symptom after 3 months.

A recent study has shown that giving oral iron more than once a day or at a dose greater than 85 mg per day does not necessary lead to a greater increase in absorbable iron. Oral iron equivalent to 65-85 mg of elemental iron will be best absorbed if given once a day. It should NOT be given with solid or liquid food/dietary supplements or with milk. It should be given on an empty stomach an hour before eating or two hours after eating along with 100-200 mg of vitamin C.

An iron panel (early morning fasting blood to check iron, ferritin, TIBC, and percent iron saturation) should be done after three months to check on the progress of the treatment. Oral iron should be stopped 2 days before the iron studies are done. The goal is to get the serum ferritin above 100 µg/l.

If the patient cannot tolerate the iron, or, if after three months there has been very little change in the iron stores, an iron infusion may be appropriate. Delivering iron directly into the blood by vein allows the iron to bypass the gastrointestinal tract, which can limit absorption of iron when iron is given orally. Several different formulations of iron are designed for intravenous treatment and are used for the treatment of anemia. Two formulations of iron dextran exist (Dexferrum and INFeD), with the low molecular weight (LMW) iron dextran (INFeD) demonstrating a better safety profile than the older version of iron dextran, Dexferrum (Chertow et al. Nephrol Dial Transplant 2004:19,1571). Other iron formulations currently available for intravenous use include: iron sucrose (Venofer®), iron gluconate (Ferrlicit®), ferumoxytol (Feraheme®) and ferric carboxymaltose (Ferinject®).

Two, randomized, double-blind, placebo-controlled clinical studies using 1000 mg of ferric carboxymaltose versus placebo (subjects just received the solution with no iron in it), have shown that RLS patients who received the iron had significantly greater improvement in RLS symptoms (Allen et al. Sleep Medicine 2011: 12, 906; Cho et al. Sleep Medicine 2016:25,16). None of these patients had anemia and some of the subjects had serum ferritin values of greater than 100 ug/l before the iron infusion. Approximately 35 percent of subjects who had received the iron treatment still remained off all RLS medications even 6 months after the treatment.

From clinical experience in using LMW iron dextran (INFeD) in RLS patients, we find that the maximum effect of the iron infusion may take as long as six weeks. As part of our clinical practice, we will repeat an early-morning, fasting iron panel about 8 weeks after the infusion to establish the new iron status and may repeat another iron panel in about two months to make sure that the iron levels are stable and not dropping.

*2 Iron Supplementation information supplied by Hopkinsmedicine.org

Non-Drug Treatments
Several non-drug related treatments that patients suffering with this disorder may use include:
~ Powdered Magnesium supplement (Good quality magnesium from a Naturopath)
~ Hot or warm bath
~ Massaging and rubbing the affected areas
~ Applying hot or cold packs
~ Restricting the use of caffeine, alcohol and cigarettes
~ Moderate physical exercise
~ Stretching Exercises

Whilst any of these methods may bring about some relief from symptoms, a good night’s sleep may still prove elusive.

Medical Practitioners

Practitioners in ACT
Dr Richard Rowe
Gordon, Canberra ACT

Practitioners in NSW
Dr C Mendelsohn
502-508 Anzac Pde, Kingsford
02 9313 6722

Dr Hilton Lowe, BMIIMC
268a Oxford St, Bondi Junction
02 9386 9377

Dr Phillip King
4/149 Hawkesbury Rd, Westmead
02 9891 4866

Dr Brendon Yee, Sleep Clinic
RPA Hospital, Missenden Rd, Camperdown
02 9515 8190

Dr Anup Desai, Sleep Unit
RPA Hospital, Missenden Rd, Camperdown
02 9351 0672

Dr Hanna
30 Chamberlain St, Campbelltown
02 4628 5110

Dr Belinda Bailey
Leeton Medical Centre, 11 Wade St, Leeton
02 6953 2699

Dr Peter Jones
5 Pym St, Milthorpe
02 6366 3770 (1 month wait list)

Dr Jennifer Wray
80n Princes Hwy, Narooma
02 4476 2999 (2 week wait list)

Practitioners in QLD
Dr Jeff Karrasch, Suite 11 Peninsula Specialist Centre
George St, Kipparing
07 3284 9044

Dr Robyn O’Sullivan
Greenslopes Sleep Clinic, Brisbane
07 3397 1488 (fully booked)

Dr Allan Finnimore, Sunnybank Sleep Clinic
Newdgate St, Brisbane
07 3216 9511

Practitioners in SA
Prof Robert Wilcox, Neurology South Australia
150 Main Rd, Blackwood SA
08 7324 2590

Dr Huw Davies, Adelaide Institute for Sleep Health
Repatriation General Hospital, Daws Rd, Daws Park, SA
08 8275 1187

Practitioners in VIC
Dr John Sweica
Suite 50, 166 Gibbs St, East Melbourne
03 9419 5992 (3-4 week wait)

Dr David Cunnington
Suite 50, 166 Gibbs St, East Melbourne
03 9928 6858

Dr Paul Eade
196-200 Ontario Ave, Mildura
03 5023 7311

Practitioners in WA
Dr Bede Rogers
Perth Medical Centre
08 9481 4342

Dr Ross Goodheart
Perth Medical Centre
(08) 9481 4342
web page: perthmedicalcentre.com.au