REST FOR RESTLESS LEGS

Should you continue that pramipexole prescription for your RLS patient?

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1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "Is it safe for me to take pramipexole long-term for my restless legs? I have been on it for a while now."

Concise Conclusion: It's always good to re-evaluate whether you should continue any medications you take periodically. Though pramipexole is effective, long-term many patients find themselves adding another medication to help with their RLS, as it stops working. I think it would be worth checking for other reasons you might be experiencing these symptoms such as possible mineral deficiencies like your iron levels and trying an iron supplement if you're Alternatively, sometimes other agents in small doses do better to cut through a plateau of symptoms as opposed to increasing one agent. For example, we could try adding or switching to something like pregabalin, a medication often used for nerve pain, that also shows benefits in RLS.

Quick Wrap-up: Don't forget non-pharms like avoiding alcohol, caffeine, certain meds, and treating sleep apnea. Sometimes these are ruled out or reviewed at the time of diagnosis of habits sometimes have a way of creeping back up in patients who may just need a refresher. Avoid benzos (lack of data), and save opioids as a last resort. If patients need motivation to stop their pramipexole or other dopamine agonist, remind them of possible unwanted side-effects that they can cause such as hallucinations and compulsive behaviours.

Dive Deeper

1) https://pubmed.ncbi.nlm.nih.gov/39324694/

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