How Should You Take Methadone for Restless Legs Syndrome (RLS)?

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Opioids are a consensus treatment for moderate to severe restless legs syndrome (RLS) when first-line approaches like IV iron, gabapentin (Neurontin®, Horizant®), and pregabalin (Lyrica®) are insufficient. ‪@andyberkowskimd‬ of ReLACS Health discusses how one should take methadone, one of the most commonly used opioids for RLS, which is used much differently than for pain conditions and opioid use disorder.
To learn the basics of methadone for treatment of RLS, watch this video:
• Methadone for Restless...
In this video, ‪@andyberkowskimd‬ indicates when methadone may be helpful for a small portion of those with RLS. In his clinical practice, buprenorphine is generally the first opioid medication used for RLS due to lower risks compared to other opioid medications with similar effectiveness. The use of buprenorphine for RLS is discussed in greater detail here:
• Buprenorphine for Rest...
If buprenorphine is not tolerated, methadone may be the next best option and has been one of the most commonly prescribed opioids for this condition for more than three decades. This video addresses the available tablet doses of methadone available in the US as well as the oral solution of methadone, which may allow for greater flexibility. Information in this video includes the strength of methadone, the time for methadone to take effect after administration, the long-acting nature of the medication, and how these factors lead to the appropriate strength, timing, and adjustment of doses for RLS.
It is important to note that though very low doses of methadone are used for RLS, this medication does have a risk of breathing problems, addiction, dependence, and other side effects as do all opioid medications. This is a DEA schedule II controlled substance. Misuse and/or overdose in combination with other drugs and substances can cause severe and potentially life-threatening effects not limited to impairment, shallow breathing, coma, and death. Methadone can also be used inappropriately for non-medical purposes, and there is still a risk for dependence and/or addiction, even with appropriate use, though it has a significantly lower risk for abuse than most standard opioids other than buprenorphine. Opioids require strict supervision and management by a licensed medical clinician.
For a more-detailed analysis of the side effects of opioids, read A ReLACSing Blog #28:
www.relacshealth.com/blog/10-of-the-most-common-side-effects-of-opioids-for-restless-legs-syndrome
In the wake of the opioid crisis in the US, the medical field has swung far to the other side in terms of the prescribing of opioids. Even when some patients are appropriate candidates and need opioids for RLS, they can be denied this treatment by their clinicians. Some RLS patients may even be put on medications that RLS expert recommend against over opioids, even when fully indicated.
To read in detail why doctors are unwilling to prescribe opioids for RLS, read A ReLACSing Blog #21: www.relacsheal...
These videos are for general medical information, but those who live in or near Michigan, Ohio, or Florida can hire ‪@andyberkowskimd‬ of ReLACS Health for consultation regarding treatment of RLS as well as any sleep disorder that requires a little more time and expertise. Go to www.relacsheal... for more information.

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5 окт 2024

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Комментарии : 33

@stacYvonne 11 месяцев назад

I was prescribed Tramadol for my RLS for 12 years. As it got worse my then doctor just increased the dose until I eventually was taking 400mg a day. Once I was at that dose and it kept getting worse is when I started researching and finally learned about augmentation with Tramadol. I then started seeing a neurologist that specializes in RLS who started me on Methadone. I started with 2.5mg as I slowly decreased the tramadol. After about 6 weeks I was completely off the Tramadol and taking 5mg of Methadone twice a day. The dose that works for me now, after almost three years, is 5mg in the morning and 7.5 at night. It has been an absolute lifesaver. As without it I have full body RLS 24/7. And I still tell my doctor how grateful I am for finding her and for her knowledge bc I don't think I could have handled the absolute misery I was experiencing much longer.

@andyberkowskimd 10 месяцев назад

Yes, thanks for sharing your experience with tramadol. I address this complex medication for RLS here: www.relacshealth.com/blog/is-tramadol-for-restless-legs-syndrome-treatment-a-wolf-in-sheeps-clothing

@letsridehard 9 месяцев назад

After suffering many years from severe RLS augmentation all over my body, And trying many meds (Ropinirole, Gabapentin, etc) Methadone 5mg was a miracle treatment for me. I take it one hour before bed and I can now sleep well all night with absolutely no RLS symptoms. Please ask your Dr to prescribe you with Methadone if nothing else works.

@andyberkowskimd 9 месяцев назад

Methadone has possibly been the most-prescribed opioid in the past few decades for good reason. It is increasingly difficult, however, for those with severe RLS in desperate need of opioids like methadone to obtain it due to the backlash against opioids in medical field. www.relacshealth.com/blog/why-are-doctors-unwilling-to-prescribe-opioids-for-restless-legs-syndrome

@monicamestas7566 9 месяцев назад

@@andyberkowskimd Iam part of an ongoing RLS Foundation survey regarding my methadone use -- two or three times a year over the last three or four years. I'm eager to check out the link above about why drs are unwilling to prescribe opioids for RLS.

@monicamestas7566 9 месяцев назад

Thank you so much for discussing the medicinal treatments, particularly methadone. Why are drs so reluctant to suggest opioids? I suffered for 35 years, trying all the dopamine agonists, before discovering the Morphine connection on my own while hospitalized after a serious accident. Then it took another five years to find a neurologist who would prescribe not Morphine but Methadone. It has been an absolute blessing for seven years now. Works 80 percent of the time. I take 5 - 10 mgs at bedtime. Lately it seems a bit less effective. Do we build a tolerance over time? Could I need to increase the dose? I am now 68.

@Yowzoe 9 месяцев назад

Great questions. Glad to hear you had success for such a long time. I'm wondering what your intake of iron is like?

@monicamestas7566 9 месяцев назад

@@Yowzoe Yes. What comprehensive iron panel should I ask my doctor to order?

@andyberkowskimd 8 месяцев назад

Drug tolerance to opioids is possible but less common at low doses as well as in RLS compared to chronic pain conditions. For further information on why doctors do not suggest opioids, you can read this blog post which has more detail: www.relacshealth.com/blog/why-are-doctors-unwilling-to-prescribe-opioids-for-restless-legs-syndrome

@andyberkowskimd 8 месяцев назад

Ferritin and iron-total iron binding capacity (TIBC) are the tests that should be ordered at least annually for RLS. The iron/TIBC x 100=transferrin saturation, also called iron saturation, so there are many names.

@monicamestas7566 8 месяцев назад

@@andyberkowskimd Thank you for the information. Much appreciated.

@robertnewell5057 10 месяцев назад

I want to apologise for my earlier comment on this and Dr Andy's other opioid vid. I've seen a couple of contrary comments to my comment on this and Dr Andy's other vid about opioids in RLS. I though about simply withdrawing my comment, but I'll let it stand along with the comments which follow it. Instead, I will apologise here and also clarify. My comments regarding methadone (and other opioids) were over the top. I should have made it clear that I was considering only situations where the prescribing and monitoring regimen were inadequate. I have often found this to be the case, with the consequences I have suggested. Opioids are generally safe where proper prescribing and monitoring are undertaken. Indeed, in another vid I have commented on medical practitioners' reluctance (at least here in the UK) to prescribe opioids. Apologies once again.

@andyberkowskimd 10 месяцев назад

At least in the US currently, clinicians are very hesitant now to prescribe opioids and very cautious and thorough when doing so. In fact, compared to 25 years ago, the pendulum may have swung too far to clinicians refusing to prescribe opioids even when legitimately needed: www.relacshealth.com/blog/why-are-doctors-unwilling-to-prescribe-opioids-for-restless-legs-syndrome

@Yowzoe 9 месяцев назад

A very thoughtful apology indeed.

@daniellecoleman6979 8 месяцев назад

My partner has the worst rls. He had to run in place for 8 solid hours the other night because it just wouldn’t stop. It was traumatizing for both of us. He is on methadone and it may sound ridiculous but it must be his metabolism that makes it wear off too soon because on occasion it does and he has said if he had a gun he would use it and that hurts to hear but it is understandable. When he takes the methadone in several split doses it never wears off but if he takes one dose, he can count on rls all night long. It’s awful. He has tried everything literally. All meds, stimulations, vitamins just everything and nothing ever helped. Methadone helps tremendously.

@RicoHolzmann-m4i Год назад

Hi Doctor, can you tell me what your opinion on oxycodone regarding the treatment of RLS is? I am living in Germany and it is the "Gold Standard" in opiots for RLS. Many thanks in advance!

@andyberkowskimd Год назад

Extended-release oxycodone was part of a landmark randomized-controlled trial and the largest for opioids for RLS, done in Europe a few years ago, which is why it may be considered a gold-standard opioid depending on what is available in each country. Here is the study: www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70239-4/fulltext However, most RLS experts believe that nearly all opioid medications can be effective for RLS and should be chosen by how they work (e.g. long-acting v. short-acting), side effects, ability to afford or access, etc. customized to an individual patient. From my experience, buprenorphine is the gold-standard: Video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-nCoKMINDiwk.html Research abstract: academic.oup.com/sleep/article/46/Supplement_1/A307/7182410 However, in the US, doctors are free to prescribe a lot of different medications without restrictions to specific condition (known as "off-label") whereas doctors in some countries may not be allowed or do not have access to some of the options that are available in the US. Because we can use buprenorphine and methadone here for long-acting opioids, many like me rarely need to use extended-release oxycodone but if you don't have all of the options, it can work very well if indicated for the treatment of RLS.

@RicoHolzmann-m4i Год назад

Hi Dr. Berkowski, As you said, it is now consensus that dopamine antagonists should no longer be chosen as first-line agents. Does that mean that they should no longer be used at all or that they should be used as second-line agents?

@andyberkowskimd Год назад

The current consensus among RLS experts is that dopamine agonists should no longer be used for RLS except in rare, short-term circumstances. Augmentation may be inevitable or at least generally occur if the dose is high enough or the medication is taken for a long enough period. Because RLS is often a lifelong condition, then how can you justify prescribing medication that will eventually make things worse if a person is expected to live more than 6-12 months? Some clinicians are so rushed in their practice that they do not have time to think critically about the implications of this phenomenon. It is only a quick fix.

@monicamestas7566 9 месяцев назад

@@andyberkowskimd I experienced the augmentation/rebound phenomenon. In fact, finishing my bachelor's degree at 50, I wrote a paper titled, "Requip: A Love - Hate Relationship. My dr's solution was to try a different dopamine agonist. I was a suicidal insomniac for decades before eventually coming to Methadone at 62. It has been a lifesaver. Do drs not know about opioids for RLS or they are afraid to prescribe? Typically pharmacists assume I am taking it for pain.

@davidkruse4030 Год назад

i know it will agrivate rls at first but i think LDN is a better option.

@andyberkowskimd Год назад

Low-dose naltrexone is being studied in RLS, particularly in those with SIBO (small intestinal bacterial overgrowth), however there has not been published evidence yet showing it works for RLS in those without SIBO or even what dose should be used. Theoretically, the naltrexone may stimulate the opioid system that is somewhat defective in RLS and not actually block it at low doses. Thus it could provide relief of symptoms while avoiding some of the potential side effects of opioids. Hopefully, we will learn more in the next few years.

@captainblando Год назад

All meds have stopped working for me, never tried for rls but I cant even get Tramadol here in canada

@Yowzoe 9 месяцев назад

I'm assuming you are supplementing with Iron?

@valeriyb6617 8 месяцев назад

Pregabalin doesn't work for me , i tried horizon didn’t work, gabapentin didn’t work, and finally my dr. Said i need methadone but it controlled substance and i must take a urine test ( which i did yesterday) now i have to answer some questioners.

@andyberkowskimd 8 месяцев назад

Unfortunately, alpha-2-delta ligand drugs as these three are not consistently effective, particularly after augmentation from dopamine agonists. Opioids are often the only option for severe RLS and/or augmentation but of course come with more risks, difficulties obtaining, and significant hassles so they are not considered first line.

@robertnewell5057 11 месяцев назад

Well you shouldn't. Take no notice unless you have RLS which is so severe that you cannot function AT ALL. The RX of opioids and theiur synthetic analogs for RLS is a recipe for disaster as they are addictive. I mean this in the precise sense that they give rise to habituation, which leads to the need to increase the does to achieve the same effect, which in turn leads to dependence. I have moderate to severe RLS and would not dream of taking this treatment. I spent 30 years working in the field of substance misuse. Good luck to all of you with RLS.

@andyberkowskimd 11 месяцев назад

Clinician experience of more than four decades of opioid-prescribing in this condition (actually dating back to the 1600s) does not show abuse to be very common or doses of opioids requiring escalation over time. Here are some studies that show long-term stability: Winkelman JW, Wipper B, Zackon J. Long-term Safety, Dose Stability, and Efficacy of Opioids for Patients With Restless Legs Syndrome in the National RLS Opioid Registry. Neurology. Published online 2023:10.1212/WNL.0000000000206855. doi:10.1212/wnl.0000000000206855 Silver N, Allen RP, Senerth J, Earley CJ. A 10-year, longitudinal assessment of dopamine agonists and methadone in the treatment of restless legs syndrome. Sleep Med. 2011;12(5):440-444. doi:10.1016/j.sleep.2010.11.002

@Bibs123 11 месяцев назад

You are wrong. I have taken 20 mg of methadone for 4 years. It is not a very addictive drug. The other option for many is a lifetime of suffering, even a high risk of suicide. Should we trust you or the many doctors that suggest them?

@robertnewell5057 10 месяцев назад

I apologise. I have answered this in another vid by Dr Andy, but I meant my comments to apply to poorly supervised prescribing. This is the context in which I have seen repeated cases of addiction to methadone and similar. Methadone is, in fact, highly addictive, and difficult to withdraw from in poorly controlled situations. Unfortunately this is a common practice (at least outside centres of excellence) and is equalled only by reticence about prescribing opioids. @@Bibs123

@robertnewell5057 10 месяцев назад

Thanks, Andy, I was aware of the first paper, but not the second. I hope you will have seen my retraction and clarification on this and your other opioid video. @@andyberkowskimd

@Yowzoe 9 месяцев назад

@@Bibs123 Has the methadone worked consistently for you? What percentage of the time? Are you noticing any drop-off in effectiveness over time at all?