From the Guidelines
Restless Leg Syndrome (RLS) is a condition characterized by uncomfortable sensations in the legs with an irresistible urge to move them, and the most effective treatment approach involves a combination of lifestyle modifications and pharmacological interventions, with ferrous sulfate suggested for use over no ferrous sulfate in patients with appropriate iron status, as recommended by the American Academy of Sleep Medicine 1.
Symptoms of RLS
The symptoms of RLS include:
- Uncomfortable sensations in the legs, such as crawling, tingling, or aching feelings
- Irresistible urge to move the legs, typically occurring during periods of rest, especially in the evening or at night
- Symptoms that are partially or totally relieved by movement, such as walking or stretching
Treatment Options for RLS
For mild RLS, lifestyle modifications are the first approach, including:
- Regular exercise
- Avoiding caffeine and alcohol
- Maintaining good sleep hygiene
- Applying warm or cold compresses For moderate to severe cases, medication is necessary, with options including:
- Ferrous sulfate, suggested for use over no ferrous sulfate in patients with appropriate iron status 1
- Dipyridamole, suggested for use over no dipyridamole, although with low certainty of evidence 1
- Extended-release oxycodone and other opioids, suggested for use over no opioids, with moderate certainty of evidence 1
- Bilateral high-frequency peroneal nerve stimulation, suggested for use over no peroneal nerve stimulation, with moderate certainty of evidence 1 It is essential to note that the treatment should address both symptom relief and any underlying causes, with medication adjustments based on efficacy and side effects. Iron supplementation is crucial if ferritin levels are below 75 ng/mL, as iron deficiency often underlies RLS.
From the FDA Drug Label
Restless Legs Syndrome: Ropinirole hydrochloride tablets are indicated for the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) Key diagnostic criteria for RLS are: an urge to move the legs usually accompanied or caused by uncomfortable and unpleasant leg sensations; symptoms begin or worsen during periods of rest or inactivity such as lying or sitting; symptoms are partially or totally relieved by movement such as walking or stretching at least as long as the activity continues; and symptoms are worse or occur only in the evening or night. The most commonly observed adverse events (>5%) in the 12-week double-blind, placebo-controlled trials in the treatment of Restless Legs Syndrome with ropinirole hydrochloride (n = 496) and at least twice the rate for placebo-treated patients (n = 500) were, in order of decreasing incidence: nausea, somnolence, vomiting, dizziness, and fatigue
The symptoms of Restless Leg Syndrome (RLS) include:
- An urge to move the legs usually accompanied or caused by uncomfortable and unpleasant leg sensations
- Symptoms begin or worsen during periods of rest or inactivity
- Symptoms are partially or totally relieved by movement
- Symptoms are worse or occur only in the evening or night
The treatment options for RLS include ropinirole hydrochloride tablets, which are indicated for the treatment of moderate-to-severe primary RLS. Common adverse events associated with ropinirole hydrochloride for RLS treatment include:
- Nausea
- Somnolence
- Vomiting
- Dizziness
- Fatigue 2
From the Research
Symptoms of Restless Leg Syndrome (RLS)
- Restless legs syndrome (RLS) is a sensory-motor neurologic disorder characterized by an uncomfortable urge to move the legs, particularly at nighttime 3, 4
- Symptoms can include increasing severity, as well as temporal and anatomic extension of symptoms 3
- RLS can dramatically affect sleep and quality of life 3
Treatment Options for RLS
- Medications such as alpha2-delta calcium channel ligands (A2Ds) gabapentin, pregabalin, and gabapentin enacarbil can be effective in treating RLS 3, 4, 5
- Dopamine agonists (DAs) pramipexole, ropinirole, or rotigotine can also be used to treat RLS, but may produce augmentation, a progressive, long-term, iatrogenic worsening of RLS symptoms 3, 4, 5
- Oral or IV iron supplementation can be efficacious as initial treatment in patients with low normal serum indexes 3, 4
- 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 and enhancing sleep 6
- Alternative pharmacological agents such as clonidine, adenosinergic agents, glutamate AMPA receptor blocking agents, glutamate NMDA receptor blocking agents, various anticonvulsants, anti-inflammatory agents, and cannabis may be considered for treatment of RLS 7
- Opioids can be effective for severe cases of RLS, especially for those who have failed other therapies 5, 7
Considerations for Treatment
- Treatment should be based on the severity of RLS and the effectiveness of medication for the short-term or long-term treatment of RLS 4
- Doses of dopamine agonists should be kept to the minimum required for acceptable symptom reduction 4
- Iron deficiency must be identified at diagnosis, and treatment may improve RLS symptoms and potentially lower the risk of augmentation 3, 4
- Clinicians should first follow evidence-based review recommendations for the treatment of RLS, but when the clinical response is either incomplete or side effects are intolerable, other options can be considered 7