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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MTRAC Reviews

The Midlands Therapeutic Review and Advisory Committee (MTRAC) has published reviews covering ropinirole (Adartrel®) and pramipexole (Mirapexin®) for restless leg syndrome.

has been assessed as a Q3 drug having stronger evidence but a lower place in therapy. Pramipexole has been assessed as a Q4 drug having weaker evidence and a lower place in therapy. Both drugs have a lower place in therapy as use is recommended only after potential causes of secondary restless leg syndrome such as iron deficiency anaemia and peripheral neuropathy had been excluded.

Both treatments are licensed for the treatment of moderate to severe restless leg syndrome (RLS). Assessment of the severity of RLS is possible using the Restless Leg Syndrome Rating Scale. This scale rates a patients assessment of their symptoms over 10 questions and allows examiners to rate RLS severity to guide treatment decisions.

Action: Clinicians should use the RLS rating scale to guide treatment decisions. In patients with moderate to severe RLS ropinirole appears to be the most effective treatment option but patients should be warned about potential side effects (nausea and vomiting occur in more than 10% of cases) and there is also a possibility for paradoxical worsening of symptoms with treatment.

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