Intractable restless legs syndrome: role of prolonged-release oxycodone-naloxone.
TL;DR: In a recent Phase III trial, oxycodone–naloxone prolonged release (PR) demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments, and the adverse-event profile was consistent with the safety profile of opioids.
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Abstract: Restless legs syndrome (RLS) is a common neurological disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur at night or at time of rest. Pharmacological therapy should be limited to patients who suffer from clinically relevant symptoms. Chronic RLS is usually treated with either a dopamine agonist (pramipexole, ropinirole, rotigotine) or an α2δ calcium-channel ligand (gabapentin, gabapentin enacarbil, pregabalin). Augmentation is the main complication of long-term dopaminergic treatment, and frequently requires a reduction of current dopaminergic dose or a switch to non-dopaminergic medications. Opioids as monotherapy or add-on treatment should be considered when alternative satisfactory regimens are unavailable and the severity of symptoms warrants it. In a recent Phase III trial, oxycodone-naloxone prolonged release (PR) demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments. The adverse-event profile was consistent with the safety profile of opioids. The most frequent adverse events were fatigue, constipation, nausea, headache, hyperhidrosis, somnolence, dry mouth, and pruritus. Adverse events were usually mild or moderate in intensity. No cases of augmentation were reported. Oxycodone-naloxone PR is approved for the second-line symptomatic treatment of adults with severe to very severe idiopathic RLS after failure of dopaminergic treatment. Further studies are needed to evaluate if oxycodone-naloxone PR is equally efficacious as a first-line treatment. Moreover, long-term comparative studies between opioids, dopaminergic drugs and α2δ ligands are needed.
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Citations
Pharmacological Management of Restless Legs Syndrome and Periodic Limb Movement Disorder in Children.
TL;DR: Most children and adolescents with RLS and PLMD have low iron storage; therefore, iron therapy should be considered as the first line of treatment in children.
Restless Legs Syndrome in Chronic Kidney Disease- a Systematic Review
TL;DR: In this paper , the authors provide updated information on the epidemiology, correlating factors and treatment of chronic kidney disease associated restless legs syndrome (CKD-A-RLS) in both adult and pediatric population.
Advancing synthetic therapies for the treatment of restless legs syndrome.
TL;DR: The drugs currently available for the treatment of Restless Legs Syndrome/Willis-Ekbom disease do not always allow for obtaining the optimal control of symptoms, in particular in the long-term treatment.
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Opioids in the treatment of restless legs syndrome: pharmacological and clinical aspects.
TL;DR: The drugs currently available for the treatment of RLS do not always allow to obtain an optimal control of symptoms, in particular, when utilised for long-term treatment.
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Oxycodone/Naloxone PR: A Review in Severe Refractory Restless Legs Syndrome
TL;DR: Results from the well-designed RELOXYN trial have demonstrated the value of oxycodone/naloxone PR as a second-line therapy for severe refractory RLS; further investigation of this combination product as a first-line treatment for severe RLS is now warranted.
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References
Restless Legs Syndrome Prevalence and Impact: REST General Population Study
Richard P. Allen,Arthur S. Walters,Jacques Montplaisir,Wayne A. Hening,Andrew Myers,Timothy J. Bell,Timothy J. Bell,Luigi Ferini-Strambi +7 more
TL;DR: Clinically significant RLS is common (prevalence, 2.7%), is underdiagnosed, and significantly affects sleep and quality of life.
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Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: A study of 133 patients diagnosed with new standard criteria
Jacques Montplaisir,Sylvie Boucher,Gaétan Poirier,Gilles Lavigne,Odile Lapierre,Paul Lespérance +5 more
TL;DR: A strong relationship was found between these complaints and polysomnographic findings; increasing sleep latency and number of awakenings and decreasing sleep efficiency were associated with worsening symptoms.
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Opioid-induced bowel dysfunction: pathophysiology and potential new therapies.
Andrea Kurz,Daniel I. Sessler +1 more
TL;DR: Current management of opioid-induced bowel dysfunction among patients receiving opioid analgesics consists primarily of nonspecific ameliorative measures and recent clinical studies with alvimopan suggest that it may normalise bowel function without blocking opioid analgesia in abdominal laparotomy patients with opioid-related postoperative ileus.
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Epidemiology of restless legs syndrome: A synthesis of the literature
TL;DR: Overall, individuals with RLS have a poorer health than non-RLS but evidence for specific disease associations is mixed and future epidemiological studies should focus on systematically adding frequency and severity in the definition of the syndrome in order to minimize the inclusion of cases mimicking RLS.
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Incidence, Prevalence, and Management of Opioid Bowel Dysfunction
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