Can Xanax (alprazolam) cause restless legs syndrome?

Xanax Does Not Cause Restless Legs Syndrome, but May Help Treat It

Alprazolam (Xanax) does not cause restless legs syndrome (RLS) and may actually be beneficial in some cases as a benzodiazepine that can help manage RLS symptoms. While there is no specific evidence linking Xanax to causing RLS, the American Academy of Sleep Medicine (AASM) guidelines suggest benzodiazepines may be considered for treatment in mild cases 1, 2.

Medications That Can Cause or Worsen RLS

The AASM guidelines highlight several medications that can exacerbate RLS symptoms, but benzodiazepines like Xanax are not among them. Instead, the following medications are known to potentially worsen RLS:

• Antipsychotics (particularly olanzapine) 3, 4, 5
• Certain antidepressants
• Dopamine antagonists
• Some antihistamines

Treatment Approach for RLS

According to the most recent AASM guidelines (2025), the recommended treatment approach for RLS includes:

1. First-line treatments:

   • Alpha-2-delta ligands (gabapentin, pregabalin, gabapentin enacarbil) 2
   • Iron supplementation for those with ferritin ≤75 ng/mL or transferrin saturation <20% 2

2. Second-line treatments:

   • Extended-release oxycodone or other opioids for severe cases 2
   • Dopaminergic agents only for short-term use due to risk of augmentation 2

3. Adjunctive therapies:

   • Benzodiazepines like clonazepam (and potentially alprazolam) may be used, especially in mild cases 2, 6
   • Non-pharmacological approaches including exercise and sleep hygiene 2

Role of Benzodiazepines in RLS Management

While benzodiazepines are not first-line therapy for RLS according to current guidelines, they have historically been used in RLS management:

• They may help improve sleep initiation and maintenance in RLS patients 6, 7
• Clonazepam is the most studied benzodiazepine for RLS 6, 7
• Benzodiazepines are more commonly used in mild cases or as adjunctive therapy 2, 6

Important Considerations

• A 2017 Cochrane review found insufficient evidence to definitively establish the effectiveness of benzodiazepines for RLS treatment 7
• When treating RLS, addressing exacerbating factors like caffeine and alcohol consumption is crucial 2
• For patients with medication-induced RLS (such as from olanzapine), discontinuation of the offending medication is the optimal treatment 3, 4, 5

Clinical Pearls

• Always assess iron status in RLS patients before initiating pharmacological treatment 2
• Consider the risk of augmentation with dopaminergic agents, which has led to their demotion from first-line therapy 2
• For patients with comorbid anxiety and RLS, alpha-2-delta ligands may be particularly beneficial as they address both conditions 2
• Regular monitoring for side effects and treatment response is essential for all RLS medications

In conclusion, while Xanax is not known to cause RLS, it belongs to a class of medications (benzodiazepines) that may actually help manage RLS symptoms in certain cases, though they are not considered first-line therapy according to current guidelines.