title: Best practice guide for the treatment of REM sleep behavior disorder (RBD).
abstract: Modifying the sleep environment is recommended for the treatment of patients with RBD who have sleep-related injury. Level A Clonazepam is suggested for the treatment of RBD but should be used with caution in patients with dementia, gait disorders, or concomitant OSA. Its use should be monitored carefully over time as RBD appears to be a precursor to neurodegenerative disorders with dementia in some patients. Level B Clonazepam is suggested to decrease the occurrence of sleep-related injury caused by RBD in patients for whom pharmacologic therapy is deemed necessary. It should be used in caution in patients with dementia, gait disorders, or concomitant OSA, and its use should be monitored carefully over time. Level B Melatonin is suggested for the treatment of RBD with the advantage that there are few side effects. Level B Pramipexole may be considered to treat RBD, but efficacy studies have shown contradictory results. There is little evidence to support the use of paroxetine or L-DOPA to treat RBD, and some studies have suggested that these drugs may actually induce or exacerbate RBD. There are limited data regarding the efficacy of acetylcholinesterase inhibitors, but they may be considered to treat RBD in patients with a concomitant synucleinopathy. Level C.
authors.affiliation: Mount Sinai Medical Center, New York, NY, USA.
authors.forename: R Nisha
authors.initials: RN
authors.lastname: Aurora
authors.forename: Rochelle S
authors.initials: RS
authors.lastname: Zak
authors.forename: Rama K
authors.initials: RK
authors.lastname: Maganti
authors.forename: Sanford H
authors.initials: SH
authors.lastname: Auerbach
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Casey
authors.forename: Susmita
authors.initials: S
authors.lastname: Chowdhuri
authors.forename: Anoop
authors.initials: A
authors.lastname: Karippot
authors.forename: Kannan
authors.initials: K
authors.lastname: Ramar
authors.forename: David A
authors.initials: DA
authors.lastname: Kristo
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
mesh_terms: D052160:Benzothiazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002492:Central Nervous System Depressants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002998:Clonazepam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008550:Melatonin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077487:Pramipexole; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy
chemical_list: D052160:Benzothiazoles; D002492:Central Nervous System Depressants; D018491:Dopamine Agonists; D018757:GABA Modulators; D002998:Clonazepam; D000077487:Pramipexole; D008550:Melatonin