A number of other therapies have be evaluated for RLS including opioids, gabapentin and pregabalin, clonazepam, and case reports of melatonin, buproprion, and other agents. Overall, there is a long experience with opioids and those drugs have been especially useful in dopaminergic resistant RLS with augmentation problems. Clonazepam has also been widely used but is not particularly efficacious and now has been largely replaced by dopaminergic agents. In April 2011, the FDA approved extended release gabapentin for use in moderate to severe RLS. This anticonvulsant agent has recently been shown to be beneficial in RLS and may be especially useful when dopamine agents provide incomplete resolution of RLS symptoms and/or augmentation issues arise. Please remember that the extended release form of gabapentin gives different concentrations of drug than the shorter acting form. Finally, it is important to note that all epilepsy drugs carry a suicide warning label including gabapentin.
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