From the Guidelines
The most effective treatment for restless leg syndrome (RLS) is the use of ferrous sulfate, as suggested by the American Academy of Sleep Medicine, due to its ability to address iron deficiency, a key factor in RLS pathophysiology, as supported by the most recent and highest quality study 1.
Key Considerations
- The treatment of RLS should prioritize addressing underlying conditions and lifestyle changes, including regular exercise, good sleep habits, and avoiding caffeine and alcohol.
- Medications such as ferrous sulfate are recommended for patients with appropriate iron status, as iron deficiency can worsen RLS symptoms.
- Other treatment options, including dipyridamole, extended-release oxycodone, and bilateral high-frequency peroneal nerve stimulation, may be considered for moderate to severe RLS, as suggested by the American Academy of Sleep Medicine 1.
Treatment Options
- Ferrous sulfate: recommended for patients with iron deficiency, as it can help alleviate RLS symptoms.
- Dipyridamole: may be considered for patients with RLS, although the certainty of evidence is low.
- Extended-release oxycodone: may be considered for severe cases of RLS, although caution is advised due to the risk of central sleep apnea and respiratory depression.
- Bilateral high-frequency peroneal nerve stimulation: may be considered for patients with RLS, as it has shown moderate certainty of evidence.
Important Notes
- The use of levodopa, pramipexole, rotigotine, and ropinirole is not recommended as a standard treatment for RLS, due to the risk of augmentation and other adverse effects, as noted in the American Academy of Sleep Medicine guideline 1.
- Iron supplementation with ferrous sulfate is recommended if ferritin levels are below 75 ng/mL, as iron deficiency can worsen RLS symptoms, as supported by the most recent study 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 for Restless Leg Syndrome (RLS) is ropinirole, which is administered orally, with a starting dose of 0.25 mg once daily. The dose is then titrated based on clinical response and tolerability over 7 weeks to a maximum of 4 mg once daily. All doses are taken between 1 and 3 hours before bedtime. 2 2
- Key points:
- Dosing: 0.25 mg to 4 mg once daily
- Administration: taken between 1 and 3 hours before bedtime
- Titration: based on clinical response and tolerability over 7 weeks
- Important consideration: Patients with RLS secondary to other conditions (e.g., pregnancy, renal failure, anemia) were excluded from the trials.
From the Research
Treatment Options for Restless Leg Syndrome
The treatment for restless leg syndrome (RLS) can be categorized into non-pharmacological and pharmacological interventions.
- Non-pharmacological interventions include:
Pharmacological Treatment
Pharmacological treatment should be limited to patients who suffer from clinically relevant RLS, where symptoms impair the patient's quality of life, daytime functioning, social functioning, or sleep 5.
- Medications for RLS include:
- Dopaminergic agents, such as levodopa, pramipexole, and ropinirole 5, 3, 6, 4, 7
- Dopamine agonists, such as pramipexole and ropinirole 5, 3, 6, 7
- α-2-δ calcium channel ligands, such as gabapentin and pregabalin 5, 6
- Opioids, such as oxycodone, methadone, codeine, and tramadol 5, 3, 6
- Anticonvulsants, such as gabapentin and carbamazepine 3, 4, 7
- Benzodiazepines, such as clonazepam and nitrazepam 3, 4, 7
Treatment Approach
The treatment approach for RLS depends on the severity and frequency of symptoms.
- For mild symptoms, non-pharmacological interventions may be sufficient 4.
- For moderate to severe RLS, daily medication may be required 6.
- For chronic RLS, treatment with a nonergot dopamine agonist or an α-2-δ calcium channel ligand is recommended 5.
- For RLS present throughout the day and night, long-acting agents such as the rotigotine patch or gabapentin enacarbil may be considered 5, 6.
- For refractory RLS, oral prolonged release oxycodone-naloxone may be considered 5.