The other question I have about zolpidem for RLS is whether you consider that first-line therapy or if patients have tried and failed on other more conventional therapies for RLS? We have a ton of RLS patients at my VAMC, but most of them are being treated with ropinerole and iron. In fact, if I saw Ambien on the profile of an RLS patient, I am not sure I would have connected the dots. Particularly if the patient had another diagnosis that was related to insomnia (which most of our patients do).
I have used Ambien 1st line a few times when the main complaint is the leg jerking waking them up. Perhaps their legs still jerk but it doesn't interfere with sleep???? I have used Mirapex if there is severe jerking or when the partner complains too. In the 6-7 patients I've treated with RLS, they improved on their respective treatments. I did find the abstract of this review below.
Trenkwalder C et al. Treatment of restless legs syndrome: An evidence-based review and implications for clinical practice. Mov Disord. 2008 Oct 16.
Only in the last three decades, the restless legs syndrome (RLS) has been examined in randomized controlled trials. The Movement Disorder Society (MDS) commissioned a task force to perform an evidence-based review of the medical literature on treatment modalities used to manage patients with RLS. The task force performed a search of the published literature using electronic databases. The therapeutic efficacy of each drug was classified as being either efficacious, likely efficacious, investigational, nonefficacious, or lacking sufficient evidence to classify. Implications for clinical practice were generated based on the levels of evidence and particular features of each modality, such as adverse events. All studies were classed according to three levels of evidence. All Level-I trials were included in the efficacy tables; if no Level-I trials were available then Level-II trials were included or, in the absence of Level-II trials, Level-III studies or case series were included. Only studies published in print or online before December 31, 2006 were included. All studies published after 1996, which attempted to assess RLS augmentation, were reviewed in a separate section. The following drugs are considered efficacious for the treatment of RLS: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin. Drugs considered likely efficacious are rotigotine, bromocriptine, oxycodone, carbamazepine, valproic acid, and clonidine. Drugs that are considered investigational are dihydroergocriptine, lisuride, methadone, tramadol, clonazepam, zolpidem, amantadine, and topiramate. Magnesium, folic acid, and exercise are also considered to be investigational. Sumanirole is nonefficacious. Intravenous iron dextran is likely efficacious for the treatment of RLS secondary to end-stage renal disease and investigational in RLS subjects with normal renal function. The efficacy of oral iron is considered investigational; however, its efficacy appears to depend on the iron status of subjects. Cabergoline and pergolide (and possibly lisuride) require special monitoring due to fibrotic complications including cardiac valvulopathy. Special monitoring is required for several other medications based on clinical concerns: opioids (including, but not limited to, oxycodone, methadone and tramadol), due to possible addiction and respiratory depression, and some anticonvulsants (particularly, carbamazepine and valproic acid), due to systemic toxicities. (c) 2008 Movement Disorder Society.
