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Published Online, 1 April 2008, www.theannals.com, DOI 10.1345/aph.1K667.
 The Annals of Pharmacotherapy: Vol. 42, No. 5, pp. 627-632. DOI 10.1345/aph.1K667
© 2008 Harvey Whitney Books Company.
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NEUROLOGY

Appropriate Use of Dopamine Agonists and Levodopa in Restless Legs Syndrome in an Ambulatory Care Setting

Ogochukwu Chidozie Molokwu, PharmD

Clinical Pharmacist—Ambulatory Care and Department of Pharmacy, Community Medical Centers, Fresno, CA; Assistant Clinical Professor, School of Pharmacy, University of California at San Francisco

Reprints: Dr. Molokwu, 3837 N. Clark St., Fresno, CA 93726, fax 559/459-1060, omolokwu{at}communitymedical.org

BACKGROUND: Dopaminergic agents are the mainstay therapy for the management of restless legs syndrome (RLS). There are no clear guidelines on RLS management, and no study has evaluated the appropriate use of dopaminergic agents in RLS.

OBJECTIVE: To evaluate the appropriateness of use of dopaminergic agents in RLS management in an ambulatory care setting based on the most current scientific evidence.

METHODS: A retrospective drug utilization evaluation was conducted in patients who received levodopa or dopamine agonist for RLS from July 1, 2006, to July 31, 2007. Patients' medical records were reviewed and data were collected on demographics; comorbidities; laboratory values; doses of levodopa or dopamine agonists; prescribing physician's specialty; and use of alcohol, tobacco, and caffeine.

RESULTS: A total of 27 patients were included in the study for data collection and analysis. Twenty-two (81%) patients were on levodopa and 5 (19%) were on ropinirole. RLS severity was documented in only 2 (7%) patients. Serum ferritin levels and transferrin-iron saturation (Tsat) percentages were not obtained in 18 (67%) and 20 (74%) of the patients, respectively. Two (7%) patients had ferritin levels less than 50 ng/mL, and 7 (26%) patients had ferritin levels greater than 50 ng/mL. Fourteen (52%) patients were taking concurrent antidepressants and 6 (22%) were taking sedating antihistamines. Alcohol and tobacco use was documented in 2 (7%) and 8 (30%) patients, respectively. Twenty-six (96%) of the prescribing physicians were primary care providers.

CONCLUSIONS: The findings of this study confirm the need for provider education about the appropriate use of levodopa and dopamine agonists in patients with RLS. Appropriate use of these drugs may help decrease unnecessary adverse effects, complications, and costs.

Key Words: dopamine agonists, iron, levodopa, restless legs syndrome

Published Online, April 1, 2008. www.theannals.com, DOI 10.1345/aph.1K667




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