Opioids are a consensus treatment for moderate to severe restless legs syndrome (RLS) when first-line approaches are insufficient. ‪@andyberkowskimd‬ of ReLACS Health presents 10 of the most common adverse effects to watch out for when initiating treatment with opioids for RLS. For a more-detailed analysis of the side effects of opioids, read A ReLACSing Blog #28:
www.relacshealth.com/blog/10-of-the-most-common-side-effects-of-opioids-for-restless-legs-syndrome
In the wake of the opioid crisis in the US, the medical field has swung far to the other side in terms of comfort with prescribing of opioids. To read in detail why doctors are unwilling to prescribe opioids for RLS, read A ReLACSing Blog #21: www.relacshealth.com/blog/why...
In contrast to the opioid-prescribing hesitancy among clinicians, the need for opioids for RLS has never been greater. Dopamine agonists (e.g. pramipexole, ropinirole) had been the mainstay of treatment for two decades and have been shown to worsen RLS with long-term use, called augmentation. This artificially severe form of RLS has created a myriad of patients suffering with a degree of RLS that has not been seen until now. If lifestyle and behavioral sleep interventions, elimination of RLS-triggering medications, IV iron infusions, and alpha-2-delta ligand medications like gabapentin, Lyrica®, and Horizant® are ineffective, then the standard is to turn to opioids in moderate to severe cases of RLS. Because opioids are so powerful a low doses for relieving symptoms of RLS, they may be needed in the majority of those with augmentation, who are unable to taper off dopamine agonists without severe RLS withdrawal symptoms.
To read why dopamine agonists are bad for RLS, read A ReLACSing Blog #4: of ReLACS Health for consultation regarding treatment of RLS as well as any sleep disorder that requires a little more time and expertise. Go to www.relacshealth.com/ for more information.
What is augmentation from dopamine agonists? Watch this video:
• What is Augmentation i...
After a thorough evaluation, an experienced clinician may suggest an opioid medication a person struggling with RLS may be recommended to start on an opioid. For any treatment, the benefits of the treatment must outweigh the risks or side effects to start in the first place. If one moves forward with opioid therapy for this condition, it is important to be aware of these common side effects: respiratory depression (shallow breathing or the inability to breathe at all), abuse (taking the drug to get high or for purposes not intended with treatment), dependence (reliance on the medication to be taken daily or withdrawal symptoms may occur), nausea & itching, constipation, symptoms of depressed mood, low testosterone, dental problems from buprenorphine, and heart conduction problems from methadone. These are discussed in more detail in this video.
As always, the most important thing with any treatment, even if side effects do occur, is to report these and make changes under the strict guidance of a licensed medical professional.
These videos are for general medical information, but those who live in or near Michigan, Ohio, or Florida can hire ‪@andyberkowskimd‬ of ReLACS Health for consultation regarding treatment of RLS as well as any sleep disorder that requires a little more time and expertise. Go to www.relacshealth.com/ for more information.