Medication for RLS: The Pros and Cons of Dopamine Agonists and Other Treatments

The television commercials will certainly tell you: Restless legs syndrome (RLS) is out there, and so are the pills to treat it. Thanks to aggressive pharmaceutical marketing, doctors and patients have heard a lot in the past few years about this controversial condition.

RLS is diagnosed when a patient meets four specific criteria; if symptoms are severe enough, medication may help keep them under control. (Milder cases are often treated with lifestyle adjustments, and doctors remain divided as to whether drugs are currently over- or under-prescribed for the condition.)

Requip and Mirapex: The newest hope for relief
Two recent FDA approvals have fueled much of the media hubbub: Requip (generic name ropinirole) and Mirapex (generic name pramipexole), both originally used to treat Parkinson's disease. This class of drugs, called dopamine agonists, activates receptors in the brain that produce dopamine, a chemical that helps regulate movement and mood.

Because RLS seems to be caused by a dopamine shortage in the brain, Requip and Mirapex—taken an hour or two before bed—improve nighttime symptoms in many patients. The two medications work similarly, although patients often respond differently to each; most doctors use trial and error to find the best regimen.

"We joke in sleep medicine that these drugs are some of our favorites because the patients actually get better," says Mary Susan Esther, MD, president-elect of the American Academy of Sleep Medicine. "It's so rewarding to treat someone who responds at low doses to a new medicine, especially after they've been suffering for years without it."

In separate studies, patients who took either Requip or Mirapex were more likely to feel improvement over a 12-week period than those who took placebos; both drugs have also been shown to be safe and effective for up to nine months.

Based on these results, the drugs are now advertised to those suffering from moderate to severe primary restless legs syndrome—meaning symptoms that aren't caused by any other known condition, like nerve damage or a vitamin deficiency.