How is restless legs syndrome (RLS) treated?

Treatment of restless legs syndrome depends on the intensity of the symptoms. Treatment should be considered if quality of life is affected by insomnia and excessive daytime drowsiness. In cases of RLS due to ongoing medical disorders, specific treatment is also necessary.

Non-drug treatments. Non-drug treatments are tried first, especially if symptoms are mild. Non-drug treatments include:

  • Getting regular exercise, such as riding a bike/stationary bike or walking, but avoiding heavy/intense exercise within a few hours of bedtime.
  • Following good sleep habits, including avoiding reading, watching television or being on a computer or phone while lying in bed; getting 7 to 9 hours of sleep and following other healthy sleep habits. Not getting enough sleep can worsen RLS symptoms.
  • Avoiding or limiting caffeinated products (coffees, teas, colas, chocolates, and some medications [check labels]), nicotine, and alcohol.
  • Applying a heating pad, cold compress, or rubbing your legs to provide temporary relief to the leg discomfort. Also consider massage, acupressure, walking, light stretching or other relaxation techniques.
  • Soak in a warm tub.
  • Try magnesium supplements. They may be helpful.
  • Reduce stress as much as possible. Try meditation, yoga, soft music or other options.

Iron supplementation. Iron deficiency is a reversible cause of RLS. If blood tests reveal you have low iron levels, your doctor may recommend taking an iron supplement.

Prescription medications. When RLS symptoms are frequent or severe, your healthcare provider will likely prescribe medications to treat the disorder. Medications options include:

  • Dopamine agonists control the urge to move, sensory symptoms in the legs, and reduce involuntary leg jerks in sleep. Ropinirole (Requip®), pramipexole (Mirapex®) and the rotigotine patch (Neupro®) are the FDA-approved dopamine agonists used for RLS.
  • Anti-seizure medications can slow or block pain signals from nerves in the legs. Examples include gabapentin enacarbil (Horizant®), gabapentin (Neurontin®) and pregabalin (Lyrica®). These drugs are particularly effective in patients with painful RLS due to neuropathy. Gabapentin enacarbil is the only medication in this class that is FDA-approved for RLS. However, the others may be effective.
  • Benzodiazepines, clonazepam (Klonopin®) in particular, are sometimes prescribed for RLS but are usually reserved for more severe cases due to their addictive potential and side effects including daytime drowsiness.
  • Opioids, such as methadone or oxycodone, can be used to relieve symptoms of RLS but because of the risk of addiction, they are usually not prescribed unless the case is severe and other medications have not been effective.

You and your doctor will discuss the treatment that might be best for you.

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