Last Super Bowl, a TV commercial lauded the power of Requip (ropinirole), the first drug approved to treat restless leg syndrome, a condition whose signature feature is creepy-crawly leg sensations that interfere with sleep and rest in nearly 1 of every 10 adults. But if taken too long, the drug can actually backfire, causing symptoms to worsen, say doctors who specialize in treating the condition. They say that treatment that rotates through different types of medications may be needed for many patients.
In an article published in the December issue of the Journal of General Internal Medicine, Irene Richard, MD, and fellow neurologist Roger Kurlan, MD, warn primary care physicians that they cannot expect long-term success by simply prescribing ropinirole or a similar medication in its class, which works by activating dopamine receptors in the brain. Instead, the team—experts at treating movement disorders like Parkinson’s disease, Tourette’s syndrome, and restless leg syndrome—recommends that physicians may need to rotate some patients through these drugs along with different types of medications.
The solution, Kurlan and Richard say, might be to switch things up at just the right time, rotating treatment through several different classes of drugs as problems arise, or perhaps before augmentation even appears. Augmentation is similar to what occurs when patients use painkillers for an extended period of time to treat their tension headaches. Soon, the medication actually triggers the headaches and worsens them.
Finessing an ideal rotation is a challenge because it differs from one patient to the next. How long each medication should be used—or not used, a break called a “drug holiday” which may later allow doctors to use them again, effectively—are questions that should be looked at, the doctors say.