It is wise to find out what possible side effects are before taking a particular drug.
I know, for example, that with certain medicines there is a very high chance of augmentation. Augmentation means that your symptoms may return over time and you will experience more restless legs than ever before.
For me, this is a reason not to take such drugs. I hope it never comes to the point where I have to go back on this decision.
There are several medications for restless legs.
Some of these fall under the so-called dopamine agonists. Dopamine agonists simulate the action of dopamine in the brain. These drugs are prescribed for moderate or severe RLS.
Other medicines for restless legs are anti-epileptics. Anti-epileptics ensure that nerves are less stimulated. As a result, the nerves are less likely to send signals to the muscles.
A third group is that of the opiates. Opiates are narcotics or painkillers. With opiates there is always the risk of addiction.
Finally, there are sleeping pills or benzodiazepines. You also run the risk of becoming addicted to it. With prolonged use, habituation occurs. As a result, you need more and more of it for the desired effect.
Ropinirole and pramipexole
The first drugs I want to discuss regarding side effects are ropinirole and pramipexole.
Ropinirole and pramipexole are both dopamine agonists. The hallmark of a dopamine agonist is that it kind of fools your brain. The substance pretends to be dopamine,
These drugs were actually developed for the motor symptoms of Parkinson’s disease. The dose is much higher in this disease than in restless legs syndrome.
In Parkinson’s, the first choice is levodopa. To delay the use of that drug or when the effect of levodopa diminishes over time, ropinirole or pramipexole is chosen.
In the case of restless legs, the doctor will only prescribe ropinirole or pramipexole if there is moderate to severe primary RLS.
In primary RLS, the cause is idiopathic. Idiopathic means that the RLS has its own cause. So not by something else as with secondary RLS.
The use of ropinirole and pramipexole should be built up gradually. The same goes for downsizing.
The potential side effects are much greater in Parkinson’s than in restless legs. I assume this is because the dosage in Parkinson’s is a lot higher.
Side effects that often occur in Parkinson’s disease occur less often or less severely in RLS.
Vomiting and nausea are very common with ropinirole. Common side effects include drowsiness, dizziness, abdominal pain, fatigue, and nervousness. Sometimes there is confusion or hallucinations.
Nausea and dizziness are very common with pramipexole. Common side effects include abnormal dreams, insomnia, constipation, fatigue, confusion, hallucinations, and vomiting. Sometimes there is hyper sexuality, impulse control problems, compulsive behavior or sudden sleep attacks.
There is a very good chance that you will suffer from augmentation at some point when taking ropinirole or pramipexole. Between 50 and 80 percent of users will experience this within 1 to 10 years.
Augmentation means that the medicines work less and less well and you therefore need more and more for the desired effect. Your symptoms worsen and the RLS may spread to other parts of the body, such as the arms and trunk.
Restless Leg Syndrome is a progressive condition. By this I mean that the complaints also get worse on their own over time. Unfortunately.
Stopping this medication can lead to dopamine agonist withdrawal syndrome. Symptoms of this include depression, anxiety, excessive sweating, pain and apathy.
Gabapentin and pregabalin
The second pair of drugs I’m going to mention here for side effects are gabapentin and pregabalin.
Gabapentin and pregabalin are antiepileptic drugs. This medication is normally prescribed for epilepsy and nerve pain in various forms of neuropathy.
Anti-epileptic drugs make brain cells less sensitive to stimuli. Nerves therefore send fewer stimuli to the muscles.
In restless legs, gabapentin and pregabalin are alternatives to the dopamine agonists described above. Gabapentin is a precursor to pregabalin.
Gabapentin and pregabalin are also only prescribed for moderate to severe RLS.
Anti-epileptics are addictive. You become dependent on the drug when you use it. Weaning can therefore be quite problematic, including withdrawal symptoms.
Another issue is habituation. Over time, the effectiveness of the medication decreases and you need more and more for the desired effect.
The combination of gabapentin or pregabalin with opioids is risky and can cause serious breathing problems.
With gabapentin, side effects of drowsiness, dizziness, fever and loss of control of movements are very common. The other side effects that often occur form a long list. Some of these are infections, insomnia, headaches, confusion, anxiety, depression, stomach and intestinal complaints, skin rashes, muscle and back pain and itching.
The very common side effects of pregabalin are drowsiness, headache and dizziness. Common side effects include confusion, insomnia, nausea, gastrointestinal upset, abnormal coordination, difficulty concentrating and pain in limbs.
Methadone and oxycodone
The third group of drugs that are sometimes prescribed for restless legs include methadone and oxycodone.
Methadone and oxycodone are opiates (or opioids). Opiates are narcotic or analgesic drugs. There are more, but I mention these here because I have read with a number of fellow sufferers that they take or have taken these drugs.
A feature of opiates is that they can be highly addictive. For that reason, doctors are generally very reluctant to prescribe it. In the case of restless legs, opiates are therefore only opted for in the case of a severe form of RLS.
Oxycodone is a morphine-like pain reliever. Signals arrive less strongly in the brain. As a result, you feel the restless legs less or react more calmly to them. Oxycodone is prescribed for RLS when other drugs do not work well or have too many side effects.
Like oxycodone, methadone is a morphine-like pain reliever. It is a heavy narcotic that is prescribed, among other things, for severe chronic pain. It is a morphine agonist. This means that methadone mimics the action of morphine.
Methadone dampens the transmission of pain signals.
Methadone is best known as a drug for heroin addicts. It is also addictive, but unlike heroin, you can phase out methadone. However, with long-term use, this is often accompanied by severe withdrawal symptoms.
It should be clear that opiates are problematic in any case, because long-term use can lead to habituation and addiction. If it is chosen, then it is actually an emergency measure.
One of the side effects of oxycodone is constipation. For that reason, there is also a variant of oxycodone with naloxone. The naloxone reduces constipation.
Common side effects of oxycodone include drowsiness, gastrointestinal upset, dizziness, and itching. Sometimes symptoms include dry mouth, shivering, dizziness, headache, nervousness, confusion and insomnia.
Oxycodone is a gradual build-up drug. If you stop suddenly, you will experience withdrawal symptoms. It is therefore advisable to gradually reduce it.
The most common side effects of methadone are nausea and constipation. Frequently there is also vomiting, dry mouth, sweating, insomnia and drowsiness. Sometimes breathing problems, low blood pressure, cardiac arrhythmias and poor vision occur.
Zopiclone and diazepam
The fourth group of drugs that I discuss are the so-called benzodiazepines, or sleeping pills.
There are several variants. Some are short-acting and help you fall asleep. Others work longer and help you sleep through the night.
I choose zopiclone as an example of a short-acting sleep aid. As an example of a longer-acting drug I mention diazepam.
When using sleeping pills, habituation occurs. After a while they stop working or you need more and more for the desired effect. This already happens when used for more than two weeks.
With regard to zopiclone, I know from a fellow sufferer that she has been benefiting from this for a while. However, her GP is reluctant to give her a follow-up prescription. She finds that difficult to stomach and that is understandable.
A sleeping aid is a temporary solution. Preferably for no longer than a few days. The GP wants to protect his patient from addiction. She just wants to sleep. What is wisdom here?
Diazepam is prescribed in an emergency for up to two to four weeks for an anxiety disorder, if antidepressants or cognitive behavioral therapy do not work sufficiently.
Exceptionally, this also happens with insomnia if there is acute insomnia or severe dysfunction during the day. Maximum for a few days.
Restless legs is essentially also a form of insomnia. It is one of the most common sleep disorders.
In such situations, it is preferable to opt for short-acting agents such as zopiclone.
Common side effects of sleeping pills in general include daytime drowsiness, reduced concentration and an increased risk of falling in the elderly.
Other side effects include headache, difficulty breathing, fatigue, dizziness, depression and memory loss.
When used for more than two weeks, habituation develops and the effectiveness deteriorates. You also run the risk of becoming addicted. If you stop, you will probably experience withdrawal symptoms. This happens especially at higher doses.
Very common side effects with zopiclone are drowsiness, dry mouth, bitter taste and drowsiness. Sometimes headaches, stomach and intestinal complaints, dizziness and fatigue occur.
Common side effects with diazepam include a flattening of emotions, drowsiness, and decreased alertness. Less commonly, there are stomach and intestinal complaints, breathing problems, headache, concentration problems, daytime sleepiness and dizziness.