Restless legs syndrome patients may need drug rotation

Several strategies can address the tolerance and augmentation that are common.

By Victoria Stagg Elliott, AMNews staff. Dec. 18, 2006.

Periodic medication changes may be necessary to keep restless legs syndrome symptoms in check, according to a case report published in this month's Journal of General Internal Medicine. Physicians at the University of Rochester School of Medicine and Dentistry in New York documented the details of two patients who, in less than a year, required escalating doses of medication in order to control the condition. At some point, the drugs also started to make things worse, indicating the medication class should be switched.

"One cannot simply prescribe a single medication for RLS and expect long-term success," wrote the authors. "Patients with this condition often require careful clinical monitoring and frequent medication adjustments."

Several studies have found tolerance and augmentation rates ranging from 32% to 80%, depending on the drug class. Doctors also say it is something they see in their practices. But while its existence has been documented, it's unknown how to prevent it or predict who will experience it.

"There are a lot of questions that need to be answered," said Sudhansu Chokroverty, MD, professor and co-chair of neurology in charge of clinical neurophysiology and sleep medicine at the New Jersey Neuroscience Institute at JFK Medical Center.