Appropriate Use of Dopamine Agonists and Levodopa in Restless Legs Syndrome in an Ambulatory Care Setting

Abstract

Spanish

French

Background:

Dopaminergic agents are the mainstay therapy for the management of restless tegs syndrome (RLS). There are no clear guidelines on RLS management, and no study has evaluated the appropriate use of dopaminergic agents in RLS.

Objective:

To evaluate the appropriateness of use of dopaminergic agents in RLS management in an ambulatory care setting based on the most current scientific evidence.

Methods:

A retrospective drug utilization evaluation was conducted in patients who received levodopa or dopamine agonist for RLS from July 1, 2006, to July 31, 2007. Patients’ medical records were reviewed and data were collected on demographics; comorbidities; laboratory values; doses of levodopa or dopamine agonists; prescribing physician's specialty; and use of alcohol, tobacco, and caffeine. RESULTS: A total of 27 patients were included in the study for data collection and analysis. Twenty-two (81%) patients were on levodopa and 5 (19%) were on ropinirole. RLS severity was documented in only 2 (7%) patients. Serum ferritin levels and transferrin-iron saturation (Tsat) percentages were not obtained in 18 (67%) and 20 (74%) of the patients, respectively. Two (7%) patients had ferritin levels less than 50 ng/mL, and 7 (26%) patients had ferritin levels greater than 50 ng/mL. Fourteen (52%) patients were taking concurrent antidepressants and 6 (22%) were taking sedating antihistamines. Alcohol and tobacco use was documented in 2 (7%) and 8 (30%) patients, respectively. Twenty-six (96%) of the prescribing physicians were primary care providers.

Conclusions:

The findings of this study confirm the need for provider education about the appropriate use of levodopa and dopamine agonists in patients with RLS. Appropriate use of these drugs may help decrease unnecessary adverse effects, complications, and costs.

Keywords

dopamine agonists iron levodopa restless legs syndrome

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References

Hening

, Walters

, Allen

, Montplaisir

, Myers

, Ferini-Stram-bi

. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Med 2004;5:237–46.

Phillips

, Young

, Finn

, Asher

, Hening

, Purvis

. Epidemiology f restless legs symptoms in adults. Arch Intern Med 2000;160: 2137–41.

Nichols

, Allen

, Grauke

et al. Restless legs syndrome symptoms in primary care: a prevalence study. Arch Intern Med 2003;163: 2323–9.

Ekbom

. Restless legs: a clinical study. Acta Med Scand 1945;158 (suppl):1–123.

Walters

. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995; 10:634–42.

Allen

, Picchietti

, Hening

, Trenkwalder

, Walters

, Montplaisir

. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis nd epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101–19.

Silber

, Ehrenberg

, Allen

et al. An algorithm for the management f restless legs syndrome. Mayo Clin Proc 2004;79:916–22.

Hening

, Allen

, Earley

, Picchietti

, Silber

. An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 2004;27:560–83.

Turjanski

, Lees

, Brooks

. Striatal dopaminergic function in restless egs syndrome: 18F-dopa and 11C-raclopride PET studies. Neurology 1999;52:932–7.

10.

Ruottinen

, Partinen

, Hublin

et al. An FDOPA PET study in patients with periodic limb movement disorder and restless legs syndrome. Neurology 2000;54:502–4.

11.

Sanz-Fuentenebro

, Huidobro

, Jajadas-Rivas

. Restless legs syndrome nd paroxetine. Acta Psychiatr Scand 1996;94:482–4.

12.

Bakshi

. Fluoxetine and restless leg syndrome. J Neuro Sci 1996; 142:151–2.

13.

Ozturk

, Eraslan

, Kumral

. Oxcarbazepine treatment for paroxe-tine-induced restless leg syndrome. Gen Hospital Psychiatry 2006;28: 264–5.

14.

Mindell

, Owens

. A clinical guide to pediatric sleep: diagnosis and management of sleep problems. Philadelphia: Lippincott Willams and Wilkins, 2003: 125.

15.

Merlino

, Piani

, Dolso

et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21:184–90.

16.

Marconi

, Govoni

, De Vito

et al. Pregnancy as a risk factor for restless legs syndrome. Sleep Med 2004;5:305–8.

17.

Allen

. Dopamine and iron in the pathophysiology of restless legs syndrome (RLS). Sleep Med 2004;5:385–91.

18.

Sun

, Chen

, Ho

, Earley

, Allen

. Iron and the restless legs syndrome. Sleep 1998;21:371–7.

19.

Allen

, Earley

. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol 2001;18:128–47.

20.

Woloshin

, Schwartz

. Giving legs to restless legs: a case study of how the media helps make people sick. PLoS Med 2006;3:el70.

21.

Kohnen

, Allen

, Benes

et al. Assessment of restless legs yndrome–methodological pproaches for use in practice and clinical trials. Mov Disord 2007;22(suppl 18):S485–94.

22.

Bogan

, Fry

, Schmidt

, Carson

, Ritchie

. Ropinirole in the treatment of patients with restless legs syndrome: a US-based randomized, double-blind, placebo-controlled clinical trial. Mayo Clin Proc 2006;81:17–27.

23.

Walters

, Ondo

, Dreykluft

, Grunstein

, Lee

, Sethi

. Ropinirole is effective in the treatment of restless legs syndrome. TREAT RLS 2: a 12-week, double-blind, randomized, parallel-group, placebo-controlled study. Mov Disord 2004;19:1414–23.

24.

Conti

, de Oliveira

, Andriolo

et al. Levodopa for idiopathic restless legs syndrome: evidence-based review. Mov Disord 2007;22:1943–51.

25.

Earley

, Allen

. Pergolide and carbidopa/levodopa treatment of the restless legs syndrome and periodic leg movements in sleep in a consecutive eries of patients. Sleep 1996;19:801–10.

26.

Ondo

, Romanyshyn

, Vuong

, Lai

. Long-term treatment of restless legs syndrome with dopamine agonists. Arch Neurol 2004;61: 1393–7.

27.

Erikson

, Jones

, Beard

. Iron deficiency alters dopamine transporter unctioning in rat striatum. J Nutr 2000;103:2831–7.

28.

Blake

, Williams

, Pall

, Fonseca

, Beswick

. Iron and akathisia. Br Med J (Clin Res Ed) 1986;292:1393.

29.

Allen

, Barker

, Wehrl

, Song

, Earley

. MRI measurement of brain iron in patients with restless legs syndrome. Neurology 2001; 56:263–5.

30.

Trenkwalder

, Hogl

, Benes

, Kohnen

. Augmentation in restless legs syndrome is associated with low ferritin. Sleep Med. Epub 5 Oct 2007. DOI 10.1016/j.sleep.2007.07.020