From the Guidelines
Restless leg syndrome (RLS) can be effectively managed through a combination of lifestyle changes and medications, with the American Academy of Sleep Medicine suggesting the use of ferrous sulfate over no ferrous sulfate in patients with appropriate iron status. For mild RLS, start with regular exercise, maintaining good sleep habits, avoiding caffeine and alcohol, and practicing relaxation techniques like yoga or meditation. If these measures aren't sufficient, medications can help.
Treatment Options
- First-line treatments include dopamine agonists, however, the AASM suggests against the standard use of levodopa, pramipexole, ropinirole, and transdermal rotigotine due to the risk of augmentation with long-term use 1.
- For severe cases or those with pain, gabapentin or pregabalin may be prescribed, but the AASM recommends against the use of bupropion, carbamazepine, clonazepam, and valproic acid 1.
- Iron supplements, such as ferrous sulfate, are recommended if ferritin levels are below a certain threshold, with the AASM suggesting the use of IV iron sucrose over no IV iron sucrose in patients with ferritin < 200 ng/mL and transferrin saturation < 20% 1.
- For intermittent symptoms, low-dose opioids like extended-release oxycodone may be used occasionally, with the AASM suggesting the use of extended-release oxycodone and other opioids over no opioids 1.
- Bilateral high-frequency peroneal nerve stimulation is a new noninvasive nonpharmacological treatment that receives a conditional recommendation from the AASM 1.
Special Considerations
- In adults with RLS and end-stage renal disease (ESRD), the AASM suggests the use of gabapentin, IV iron sucrose, and vitamin C 1.
- In children with RLS, the AASM suggests the use of ferrous sulfate over no ferrous sulfate in patients with appropriate iron status, but notes that there is very little published literature on pediatric RLS treatment 1. It's essential to start with the lowest effective dose to minimize side effects and regularly follow up with your healthcare provider, as medication effectiveness may change over time and dosage adjustments may be necessary 1.
From the FDA Drug Label
The effectiveness of ropinirole in the treatment of RLS was demonstrated in randomized, double-blind, placebo-controlled trials in adults diagnosed with RLS using the International Restless Legs Syndrome Study Group diagnostic criteria Patients were required to have a history of a minimum of 15 RLS episodes/month during the previous month and a total score of ≥15 on the International RLS Rating Scale (IRLS scale) at baseline. All trials employed flexible dosing, with patients initiating therapy at 0.25 mg ropinirole once daily. Patients were titrated based on clinical response and tolerability over 7 weeks to a maximum of 4 mg once daily. In all 3 trials, a statistically significant difference between the treatment group receiving ropinirole and the treatment group receiving placebo was observed at Week 12 for both the mean change from baseline in the IRLS scale total score and the percentage of patients rated as responders (much improved or very much improved) on the CGI-I
Ropinirole is effective in the treatment of Restless Legs Syndrome (RLS). The medication has been shown to significantly reduce symptoms of RLS, as measured by the International RLS Rating Scale (IRLS scale) and the Clinical Global Impression-Global Improvement (CGI-I) scores.
- Key benefits:
- Significant reduction in RLS symptoms
- Improvement in sleep disturbance and daytime somnolence
- Positive impact on activities of daily living and mood
- Dosage: The recommended dosage of ropinirole for RLS is 0.25 mg to 4 mg once daily, taken 1 to 3 hours before bedtime 2 2.
From the Research
Restless Leg Syndrome Treatment Options
- Non-pharmacological interventions such as repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may be beneficial for reducing RLS severity 3
- Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in RLS patients 3
- Mind-body interventions like conventional exercise, yoga, and acupuncture have shown potential in alleviating RLS symptoms, although more research is needed to confirm their effectiveness 4
- Lifestyle interventions such as pneumatic compression devices, light therapy, and cognitive-behavioral therapy may also be considered, but evidence is limited 4
Pharmacological Treatment
- Iron-replacement therapy is recommended for patients with reduced body-iron stores or evidence of iron deficiency 5, 6, 7
- Dopamine agonists like pramipexole, ropinirole, and rotigotine are first-line management options for RLS 5
- Gabapentin or pregabalin may also be prescribed as first-line treatment 5
- Opioids like tramadol, oxycodone, and methadone are considered second-line therapies for intense, severe RLS symptoms 5
Additional Considerations
- Oral iron supplementation should be considered for patients with low ferritin levels, although criteria to identify probable responders and optimal formulations and durations of treatment are needed 4
- Supplementation for low levels of vitamins E, C, and D could be considered, although evidence specifically in RLS is limited 4