What is the treatment for restless legs syndrome?

From the Guidelines

Restless legs syndrome (RLS) treatment should prioritize the use of ferrous sulfate over no ferrous sulfate in patients with appropriate iron status, as suggested by the American Academy of Sleep Medicine (AASM) with a conditional recommendation and moderate certainty of evidence 1. The treatment of RLS typically begins with lifestyle changes and addressing underlying conditions. Regular exercise, maintaining a consistent sleep schedule, avoiding caffeine and alcohol, and practicing relaxation techniques can help manage mild symptoms. Some key points to consider in the treatment of RLS include:

• The use of ferrous sulfate is recommended for patients with low ferritin levels, as iron deficiency is a common underlying cause of RLS 1.
• Dopamine agonists such as pramipexole and ropinirole are not recommended as first-line treatments due to the risk of augmentation and other adverse effects 1.
• Alpha-2-delta calcium channel ligands like gabapentin and pregabalin may be effective for patients with pain or sleep disturbances, but their use should be individualized based on symptom severity and coexisting conditions 1.
• Opioids such as oxycodone may be considered for severe cases unresponsive to other treatments, but they carry addiction risks and should be used with caution 1.
• IV ferric carboxymaltose is recommended for adults with RLS, especially those with low ferritin levels, as it has been shown to improve symptoms and quality of life 1. It's essential to individualize treatment based on symptom severity, timing, and coexisting conditions, and to regularly monitor patients for potential side effects and treatment efficacy.

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 for Restless Legs Syndrome (RLS) is ropinirole, which is administered orally, with a starting dose of 0.25 mg once daily, and can be titrated up to a maximum of 4 mg once daily based on clinical response and tolerability. The dose is typically taken 1 to 3 hours before bedtime.

• Key points:
  • Ropinirole has been shown to be effective in reducing RLS symptoms in clinical trials.
  • The medication is initiated at a low dose and gradually increased as needed and tolerated.
  • The goal of treatment is to alleviate symptoms and improve quality of life for patients with RLS. 2 2

From the Research

Treatment Options for Restless Legs Syndrome

The treatment for restless legs syndrome (RLS) can vary depending on the severity of symptoms and the individual's response to different therapies. Some of the treatment options include:

• Dopaminergic agents, such as ropinirole, which are considered the drugs of first choice in treating RLS 3, 4, 5
• Dopamine agonists, such as pergolide, pramipexole, and cabergoline, which have been shown to alleviate RLS symptoms in 70-90% of patients 4
• Gabapentin, a structural analogue of gamma-aminobutyric acid, which has been shown to improve sensorimotor symptoms in RLS 3
• Opioids, such as oxycodone-naloxone prolonged-release, which may be considered for severe RLS that is inadequately controlled by other treatments 6
• Iron replacement therapy, which may be beneficial for individuals with iron deficiency 7
• Anticonvulsants, benzodiazepines, and other pharmacologic therapies, which may also be used to treat RLS 7

Non-Pharmacologic Therapies

In addition to pharmacologic therapies, non-pharmacologic therapies may also be beneficial for RLS, including:

• Good sleep hygiene 7
• Avoidance of alcohol, caffeine, and nicotine 7
• Regular exercise and physical activity
• Stress management techniques, such as meditation and yoga

Treatment Goals

The goals of RLS treatment include improving symptoms and the patient's quality of life 7. Treatment should be individualized based on the severity of symptoms, the presence of any underlying medical conditions, and the patient's response to different therapies.