What is the treatment for restless leg syndrome?

From the Guidelines

The most effective treatment for restless leg syndrome (RLS) is the use of gabapentin enacarbil, gabapentin, or pregabalin, as recommended by the American Academy of Sleep Medicine (1). These medications are alpha-2-delta calcium channel ligands that have been shown to be effective in managing RLS symptoms, especially for patients with pain or sleep disturbances. For adults with RLS, the American Academy of Sleep Medicine suggests the use of ferrous sulfate over no ferrous sulfate in patients with appropriate iron status (1). Additionally, IV ferric carboxymaltose is recommended for adults with RLS, particularly those with low ferritin levels (1). Some key points to consider when treating RLS include:

• Regular exercise and maintaining a consistent sleep schedule can help manage symptoms
• Avoiding caffeine and alcohol, and practicing relaxation techniques can also be beneficial
• Dopamine agonists such as pramipexole or ropinirole may be effective, but can sometimes lead to augmentation (worsening symptoms) with long-term use (1)
• Low-dose opioids, such as extended-release oxycodone, may be considered for severe cases, but should be used with caution due to the risk of central sleep apnea and respiratory depression (1)
• Bilateral high-frequency peroneal nerve stimulation is a new noninvasive nonpharmacological treatment that has shown promise in initial studies (1) It's essential to note that the treatment of RLS should be individualized, and patients should be regularly monitored to adjust treatment as needed. The American Academy of Sleep Medicine provides guidelines for the treatment of RLS, including recommendations for special populations such as adults with end-stage renal disease (ESRD) (1). Overall, the goal of treatment is to manage symptoms, improve quality of life, and reduce morbidity and mortality associated with RLS.

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 can be initiated at a dosage of 0.25 mg once daily and titrated up to a maximum of 4 mg once daily based on clinical response and tolerability. The dosage should be taken between 1 and 3 hours before bedtime. 2 2

• Key points:
  • Ropinirole is effective in the treatment of RLS.
  • The initial dosage is 0.25 mg once daily.
  • The maximum dosage is 4 mg once daily.
  • Dosage should be taken before bedtime.

From the Research

Treatment Options for Restless Leg Syndrome

The treatment for restless leg syndrome (RLS) can be divided into non-pharmacological and pharmacological interventions.

• Non-pharmacological interventions include:
  • Good sleep hygiene 3
  • Massaging the affected legs, taking hot baths, and performing mentally demanding tasks 3
  • Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture 4
  • Yoga and vibration pads may improve some sleep-related outcomes 4
• Pharmacological interventions include:
  • Dopaminergic agents, such as pramipexole, ropinirole, and rotigotine transdermal patch 5, 3, 6, 7
  • Opioids, such as oxycodone, methadone, codeine, and tramadol 5, 3, 6, 7
  • Anticonvulsants, such as gabapentin, gabapentin enacarbil, and pregabalin 3, 6, 7
  • α-2-δ calcium channel ligands, such as gabapentin and pregabalin 5

Considerations for Treatment

When selecting a treatment, it is essential to consider the severity of RLS, the presence of comorbidities, and the potential for augmentation 5, 6, 7.

• Dopamine agonists are generally considered first-line treatment, but may cause augmentation, particularly if the dose is too high 6, 7.
• Opioids may be effective for severe cases, but should be used with caution and monitored closely due to the risk of dependence and other side effects 6, 7.
• Iron deficiency should be identified and treated, as it may improve RLS symptoms and reduce the risk of augmentation 7.