Restless Legs Medication and Augmentation: What You Need to Know if Your Drug Stops Working

If you take medication to control restless legs syndrome (RLS), you may at some point experience augmentation, the worsening of symptoms as your body becomes tolerant to the drug.

RLS seems to be caused, in part, by a shortage of dopamine in the brain, so physicians often prescribe dopamine agonists such as ropinirole (Requip) and pramipexole (Mirapex) to relieve symptoms quickly and effectively. Although the medications are not without side effects, many patients can take them for years and experience significant improvement.

However, for an estimated 10% to 15% of patients, these same medications may stop working after years or even months. In some cases, they even backfire, and RLS symptoms return with a vengeance—occurring earlier in the day, more frequently, or more severely than before treatment. (Levodopa, an older drug that also acts on dopamine levels, is even more apt to provoke augmentation, and doctors therefore tend to prescribe it only at low doses and for mild cases of RLS.)

In 2006, researchers at the University of Rochester published an article that examined the cases of two older women who, for more than six and seven years, respectively, took numerous medications (including dopamine agonists) for their RLS symptoms.

When the study was released, the lead author remarked on the drugs’ tendency to “turn traitor” and “boomerang” after a limited time, just as painkillers and some headache medications can do if used for an extended period. Increasing the dosage or taking the medication earlier in the evening may help combat mild augmentation, but if it becomes severe, more of the same drug will only make things worse.