Opioids and antiepileptics

If treatment of RLS with a dopamine agonist is unsuccessful or contraindicated, there are several other agents that can be used. Opioids are clinically effective in RLS, however are regarded as second-line treatment in RLS as controlled studies are still lacking. The one double-blind randomized trial with oxycodone revealed a mean dosage of 15 mg reduced sensory and motor symptoms and was well tolerated [77]. In an observational study, tramadol was effective in RLS at a dosage of 50-150 mg/day [78]. Opioids seem to have a long-term efficacy in the treatment of RLS and are generally well tolerated [79]. Clinical or polysom-nographic monitoring for the development of sleep apnea is, however, recommended in patients on long-term opioid therapy [80].

Antiepileptic medications may also be second-line agents in the treatment of RLS. Patients with painful paresthesias may respond positively to anticonvul-sants like gabapentin [81,82]. Studies have been performed with a mean dosage of 1800 mg and have proven to be effective. Carbamazepine and valproic acid have also demonstrated significant effects in small groups of patients (for overview see also [66]).

Sleep Apnea

Sleep Apnea

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