Medications for restless legs syndrome in pregnancy.
According to epidemiological data, pregnant women have a two or three times higher risk of experiencing restless legs syndrome (RLS) than the general population. Current evidence suggests that dopaminergic dysfunction, impaired iron homeostasis, and genetic predisposition may be involved in the pathophysiology of RLS. Four classes of medications have been used for patients with RLS, but pregnancy elicits a therapeutic concern. Although two dopamine agonists, ropinirole and pramipexole, have been approved by the FDA for the treatment of RLS and are currently the first-line treatment for daily symptoms, there is very little information on the teratogenic risks of these new medications. Therefore, they are not currently recommended for use during pregnancy. Medications with a more extensive safety record in pregnancy include opioids; antiepileptics, such as carbamazepine and gabapentin; and certain benzodiazepines. Ruling out iron deficiency should be an integral part of a treatment plan for RLS in pregnancy. Before management with medication is introduced, every patient should be assessed for iron status with measurement of serum ferritin.
Djokanovic
Nada
N
The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto ON.
Garcia-Bournissen
Facundo
F
The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto ON.
Koren
Gideon
G
The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto ON.
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D000090463:Iron Deficiencies; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D011297:Prenatal Exposure Delayed Effects; D012148:Restless Legs Syndrome / Q000188:drug therapy*; D012307:Risk Factors; D013723:Teratogens
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D018491:Dopamine Agonists; D013723:Teratogens; D001569:Benzodiazepines; D007501:Iron