From the Guidelines
Restless Leg Syndrome (RLS) treatment should prioritize gabapentin, pregabalin, or IV ferric carboxymaltose for moderate to severe cases, with lifestyle modifications and iron supplementation as first-line approaches for mild cases, as recommended by the American Academy of Sleep Medicine 1.
Symptoms of RLS
- Uncomfortable sensations in the legs with an irresistible urge to move them
- Crawling, tingling, or aching feelings in the legs that temporarily improve with movement
- Symptoms typically occur during periods of rest, especially in the evening or at night
Treatment Options
- Lifestyle modifications: regular exercise, avoiding caffeine and alcohol, maintaining good sleep hygiene, and applying warm or cold compresses
- Iron supplementation (ferrous sulfate 325 mg daily with vitamin C) for patients with ferritin levels below 75 ng/mL
- Medications:
- Gabapentin (300-1200 mg daily) or pregabalin (75-300 mg daily) for moderate to severe cases
- IV ferric carboxymaltose for patients with appropriate iron status
- Bilateral high-frequency peroneal nerve stimulation or extended-release oxycodone and other opioids may be considered for severe cases unresponsive to other treatments
Important Considerations
- Treatment should be monitored regularly for augmentation, a phenomenon where symptoms worsen or begin earlier in the day due to long-term dopaminergic medication use, requiring dose adjustment or medication switching 1
- The American Academy of Sleep Medicine suggests against the standard use of levodopa, pramipexole, ropinirole, and other medications due to concerns about augmentation and adverse effects 1
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 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
- 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 Restless Legs Syndrome (RLS)
- Common adverse events associated with ropinirole hydrochloride tablets in the treatment of RLS 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