The use of rotigotine in the treatment of restless legs syndrome

Restless legs syndrome (RLS) is a neurological disorder characterized by an urge to move the legs often accompanied by unpleasant sensations. Symptoms appear during periods of rest or inactivity, particularly in the evening and at night, and are usually relieved by movement. The prevalence of RLS among Whites is approximately 5—15%. RLS can be distinguished into primary and secondary forms. Most patients (70—80%) are affected by the primary form of RLS. The uncomfortable sensations related to RLS often cause a minimal discomfort, thus a therapeutic approach is not necessary. However, almost 3% of the general population reports to be affected by severe symptoms of RLS, requiring pharmacological treatment. Secondary forms of RLS are relieved by the remission of the underlying clinical condition. Dopamine agonists are considered to be first-line treatments for primary RLS. Rotigotine is a nonergoline dopamine agonist with selectivity for D1, D2 and D3 receptors. It is administered once a day in the form of an adhesive matrix patch. The efficacy and safety of the drug in patients with primary RLS has been demonstrated by four clinical trials using dosages of 0.5, 1, 2, 3 and 4 mg/24 h. A dose—response relationship was observed between the dosages of 0.5 and 3 mg/24 h. Side effects were usually mild, the most frequent being skin reaction at the site of patch application. More trials are ongoing and results will soon be published for the long-term (5 years) treatment of RLS with rotigotine transdermal patches. Rotigotine is a promising drug for the treatment of RLS. Its continuous delivery throughout 24 h makes it especially indicated for those cases also presenting daytime symptoms, and for those presenting the so-called augmentation syndrome after prolonged treatment with L-dopa or dopamine agonists.