Restless Leg Syndrome


Dopamine agonists 

  • Licensed for restless leg syndrome

  • Work by increasing dopamine levels, which are often low.

  • May cause impulse control disorders (ICD), including pathological gambling, binge eating, and hypersexuality. Inform patient. Ergot- and non-ergot-derived dopamine-receptor agonists do not differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists will not control these side-effects.

  • Excessive daytime sleepiness and sudden onset of sleep can occur with dopamine-receptor agonists.



Monitoring and Impairment

Ropinirole IR

 Initially 250 micrograms once daily for 2 days, increased if tolerated to 500 micrograms once daily for 5 days, then increased if tolerated to 1 mg once daily for 7 days, then increased in steps of 500 micrograms daily, adjusted according to response, dose to be increased at weekly intervals; usual dose 2 mg once daily, doses to be taken at night; maximum 4 mg per day.

BP for hypotension

Avoid if creatinine clearance less than 30 mL/minute

Pramipexole IR

Initially 88 micrograms once daily, dose to be taken 2–3 hours before bedtime, dose to be increased by doubling dose every 4–7 days if necessary, repeat dose titration if restarting treatment after an interval of more than a few days; maximum 540 micrograms per day.

Caution if creatinine clearance less than 20 mL/minute

Rotigotine skin patch

Initially 1 mg/24 hours, then increased in steps of 1 mg/24 hours every week if required; maximum 3 mg/24 hours per day. Apply patch to clean, dry, intact, healthy and non-irritated skin on torso, thigh, hip, shoulder or upper arm by pressing the patch firmly against the skin for about 30 seconds. Patches should be removed after 24 hours and the replacement patch applied on a different area (avoid using the same area for 14 days)

Caution in severe hepatic impairment


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