Re: RLS--Dr. Levin--Two questions

[Guest guest]

Hal White wrote:

>

> From: halwhite@... (Hal White)

>

> Dick:

>

> I'd like to follow up on a couple of responses you recently made, if I

> might.

>

> You mentioned to Tina that, " Drug holidays for Mirapex are not

> necessary. " Am I correct in inferring from that reply that rebound and

> augmentation are not a problem with Mirapex? Or did you just mean that

> holidays aren't helpful in preventing them insofar as Mirapex is

> concerned?

>

> In a different message, you said to that, " Vistaril (also marketed

> as

> Atarax) is pretty safe and typically does not bother RLS patients even

> though it has antihistaminic actions. " Should I infer from this that

> most antihistamines frequently exacerbate RLS symptoms? I knew that

> benedryl and its brethren had this reputation, but I wasn't aware this

> was true for most, if not all, antihistamines. Assuming this is so, is

> there an antihistamine (Allegra? Claritin?) that's preferred for RLS

> sufferers?

>

Hal

The function of a drug holiday is to reduce the incidence of drug

tolerance. Rebound and augmentation are affected very little by taking

drug holidays, if the same dosage is returned to. You can sometimes get

around rebound and augmentation by taking a real vacation from the

offending drug for several weeks or longer and then starting up again

with a lower dose that doesn't promote R & A. The incidence of tolerance

to Mirapex appears to be very small. You might have to increase the

dosage occasionally to get relief but you can often decrease it after a

while and continue at the original dosage. For me, once I increased the

dosage of Sinemet or Permax, there was no going back, unless I stopped

them completely for several weeks.

Antihistamine aggravation of RLS is an individual thing. Some people can

take any of them with no problem, while others have to hunt to find one

that doesn't cause aggravation of symptoms. Benadryl took the biggest

rap because it is the commonest antihistamine around and is found in so

many OTC products. The only way I know of to determine whether your RLS

will react to an antihistamine is to try it. Not very scientific, but

that's life.

Happy Holidays

Dick