Restless Legs Syndrome in Opioid Dependent Patients
A 32-year-old male with no significant family history and past history of trichotillomania was dependent to opioid (DPP and codeine containing cough syrup) for last 12 years. He tried to quit multiple times, also underwent rapid detoxification under anesthesia a year back, but relapsed eventually.\nAll these three patients were brought to Drug Deaddiction and Treatment Center, Postgraduate Institute of Medical Education and Research, Chandigarh. They had received clonidine (0.6-0.3 mg/day), non-steroidal anti-inflammatory drugs (ibuprofen/ketorolac) and benzodiazepine (BZD) (clonazepam/nitrazepam) as standard detoxification regime to relieve the withdrawal symptoms. With these medications rhinorrhea, lacrimation, loose motion, bodyache, anxiety had been resolved, but sleep problem persisted in the form of sleep induction and maintenance problem The dose of BZD was increased in each case (nitrazepam up to 30 mg and clonazepam up to 4 mg), but sleep disturbances continued even after 2 weeks.\nOn further enquiry, they complained creeping/crawling/burning sensation in both the lower limbs especially at night when they lie down, relieved partially by stamping feet on the bed or by walking around. Clinically, this was fulfilling the criteria for RLS. So a neurology consultation was taken to substantiate the diagnosis. Serum urea, creatinine, ferritin, thyroid function test were conducted along with electroencephalogram. All these investigations came out to be normal.\nThe patients were started on ropinirole 0.75 mg/day. Two of them improved with in next 2 days and the third patient required dose escalation to 1.5 mg/day to have clinical improvement. BZDs were tapered off successfully, but ropinirole was continued for next 1 month then was tapered of over 2 weeks uneventfully.