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Benzodiazepines to Treat Restless Legs Syndrome

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: March 2023

You may know benzodiazepines, or benzos, as tranquilizers or sedatives. More than a dozen are available by prescription. These drugs can help with the symptoms of restless legs syndrome (RLS). This may be due to their effect on sleep.1,2

Benzodiazepines may be prescribed in small doses and for occasional use to treat mild RLS. They may also be added to other RLS treatments. But the side effects of benzodiazepines mean they are not often prescribed for RLS.1,3

How do benzodiazepines work?

Benzodiazepines act on the benzodiazepine receptors (BZ-R) in the central nervous system. BZ-R is a protein that carries signals (neurotransmitters) in nervous system cells. Benzos suppress BZ-R's normal behavior, which depresses the nervous system. This class of drug is useful for treating the muscle spasms and anxiety of RLS and making it easier to sleep.4

Examples

Klonopin® (clonazepam) is the most-studied benzodiazepine used for RLS. Other benzodiazepines include:5

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  • Valium® (diazepam)
  • Xanax® (alprazolam)
  • Ativan® (lorazepam)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of benzodiazepines are:3

  • Daytime sleepiness or grogginess
  • Rebound insomnia (trouble sleeping the next night after using the drug)

At higher doses, these drugs may affect balance and coordination, which can cause accidents and falls. Higher doses may also impact memory and concentration, especially in older people. This is why doctors may avoid prescribing benzodiazepines to older people.3

People may build up a tolerance after long-term use, and tolerance can lead to abuse.3

Your doctor should not prescribe you benzodiazepines if you are already taking an opioid, Z-drug, or muscle relaxant. Examples of Z-drugs are:6

  • Lunesta® (eszopiclone)
  • Sonata® (zaleplon)
  • Ambien®, Edluar™, or ZolpiMist™ (zolpidem)

Benzodiazepines have a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). They have this warning because they:7

  • Can lead to physical dependency
  • May cause dangerous withdrawal symptoms if the dose is suddenly withdrawn or reduced
  • Carry a risk of abuse, misuse, and addiction
  • Can have life-threatening side effects if taken with alcohol or opioids

These are not all the possible side effects of benzodiazepines. Talk to your doctor about what to expect when taking benzodiazepines. You also should call your doctor if you have any changes that concern you when taking benzodiazepines.

Other things to know

Benzodiazepines should not be used in people with RLS who also have obstructive sleep apnea that is not being treated.3

You should not use clonazepam if you have glaucoma or liver disease.5

Short-acting sleeping pills such as zolpidem should not be prescribed for RLS. This is due to the potential for sleepwalking, sleep eating, and sleep driving that may happen.3

Your doctor may require you to have regular monitoring visits to check on your benzo use.6

Before beginning treatment for RLS, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

Other treatment options

Because of their side effects, benzodiazepines are not commonly prescribed for RLS. Other treatment options include:1

  • Lifestyle changes
  • Devices
  • Other prescription drugs

There are 4 prescription drugs the FDA has approved to treat RLS. However, many other drugs may be prescribed off-label for RLS. Off-label means the drug has been created for a different purpose but may help with some symptoms of another health condition. The drugs prescribed for RLS include:1,3