From the Guidelines
Treatment for restless leg syndrome (RLS) should prioritize non-medication approaches, including regular exercise, maintaining good sleep habits, avoiding caffeine and alcohol, and applying heat or cold to the legs, before considering medication options, as recommended by the American Academy of Sleep Medicine (1).
Non-Medication Treatments
- Regular exercise
- Maintaining good sleep habits
- Avoiding caffeine and alcohol
- Applying heat or cold to the legs
Medication Treatments
- Ferrous sulfate is suggested for use in adults with RLS, particularly those with appropriate iron status (1)
- Dopamine agonists, such as pramipexole or ropinirole, may be considered, but with caution due to the risk of augmentation (1)
- Alpha-2-delta calcium channel ligands, like gabapentin, may be effective, but the evidence is not as strong (1)
- Opioids, such as extended-release oxycodone, may be used in severe or refractory cases, but with caution due to addiction potential (1)
- Bilateral high-frequency peroneal nerve stimulation is a new non-invasive non-pharmacological treatment that may be considered (1)
Special Considerations
- In adults with RLS and end-stage renal disease (ESRD), gabapentin, IV iron sucrose, and vitamin C may be considered (1)
- In children with RLS, oral iron supplementation may be used, particularly in cases of iron deficiency (1)
Important Notes
- Treatment should be individualized based on symptom severity, timing, and comorbidities, with medication adjustments made as needed to balance symptom control and side effects (1)
- Regular monitoring is necessary to assess the effectiveness of treatment and potential side effects, particularly with dopamine medications (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.
The treatment options for Restless Leg Syndrome (RLS) include ropinirole, which has been shown to be effective in reducing symptoms of RLS. The recommended dosage is to start with 0.25 mg once daily and titrate up to a maximum of 4 mg once daily, taken 1-3 hours before bedtime. Key benefits of ropinirole for RLS treatment include:
- Significant reduction in RLS symptoms, as measured by the International RLS Rating Scale (IRLS scale)
- Improvement in sleep disturbance and daytime somnolence
- Long-term maintenance of efficacy in RLS treatment, as demonstrated in a 36-week trial 2 2
From the Research
Treatment Options for Restless Leg Syndrome
The treatment options for restless leg syndrome (RLS) can be categorized into pharmacological and non-pharmacological interventions.
- Pharmacological Treatment:
- Dopaminergic medications, such as pramipexole, ropinirole, and levodopa, are considered first-line treatments for RLS 3, 4, 5.
- Nonergot dopamine agonists, such as pramipexole and ropinirole, are preferred over ergot dopamine agonists due to a lower risk of augmentation 3.
- α-2-δ calcium channel ligands, such as gabapentin and pregabalin, can be used as alternative treatments, especially in patients with chronic pain, anxiety, or insomnia 3, 4.
- Opioids, such as oxycodone and tramadol, can be used as second-line treatments or for breakthrough symptoms 3, 4.
- Non-Pharmacological Interventions:
- Regular physical activity, such as exercise, can help alleviate RLS symptoms 6, 7.
- Oral iron supplementation may be beneficial for patients with low ferritin levels 6.
- Repetitive transcranial magnetic stimulation, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce RLS severity 7.
- Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve sleep-related outcomes in RLS patients 7.
- Lifestyle Modifications: