What are the potential side effects of dopaminergic treatments for Restless Legs Syndrome that I should discuss with my patients?

Potential side effects of dopaminergic treatments for Restless Legs Syndrome (RLS) that should be discussed with patients include:

• Augmentation: This is a worsening of RLS symptoms that may require increasing the dose of dopamine agonists. It is a common and significant risk associated with dopaminergic therapy in RLS.
• Impulse Control Disorders (ICDs): These include compulsive behaviors such as gambling, hypersexuality, binge eating, and obsessive shopping. Patients and their families should be informed about the risk and signs of ICDs, as these may be concealed by the patient.
• Rebound symptoms: Abrupt discontinuation of dopamine agonists can cause dramatic rebound worsening of RLS symptoms, so gradual tapering is recommended.
• Other adverse effects: Although less specifically detailed for RLS, dopaminergic treatments can cause side effects such as excessive sleepiness, hallucinations, nausea, vomiting, and orthostatic hypotension, as seen in related dopaminergic therapies for Parkinson’s disease.

Patients should be regularly monitored for augmentation and impulse control disorders during dopaminergic treatment, and a long-term management plan should be discussed, including possible addition of other treatments and gradual tapering of dopamine agonists if needed.

Given these risks, gabapentinoids are now generally preferred as first-line treatment, but dopamine agonists may still be used in selected cases with careful monitoring.

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