Materiały źródłowe

• #1 Treatment of Restless Legs Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899490/

  Restless legs syndrome (RLS) is a common disorder diagnosed by the clinical characteristics of restlessness in the legs associated often with abnormal sensations that start at rest and are improved by activity, occurring with a diurnal pattern of worsened symptoms at night and improvement in the morning. […] Treatment of RLS has undergone considerable change over the last few years. Several classes of medications have demonstrated efficacy, including the dopaminergic agents and the alpha-2-delta ligands. […] Levodopa was the first dopaminergic agent found to be successful. […] The direct dopamine agonists, including ropinirole, pramipexole, and rotigotine patch, are also effective, although side effects, including daytime sleepiness, impulse control disorders, and augmentation, may limit usefulness.

• #2 Management of restless legs syndrome and periodic limb movement disorder in adults – UpToDate

  https://www.uptodate.com/contents/treatment-of-restless-legs-syndrome-and-periodic-limb-movement-disorder-in-adults

  Management of restless legs syndrome and periodic limb movement disorder in adults […] RLS is a manageable condition that generally responds well to pharmacologic therapy. A variety of treatments have been studied in randomized, controlled trials; the major classes of drugs used include alpha-2-delta voltage-gated calcium channel ligands, dopaminergic agents, opioids, and benzodiazepines. […] The selection of therapy depends upon a number of factors, including disease severity, patient age, comorbidities (eg, pain, depression, anxiety, history of impulse control disorders), drug side effects, and patient preferences. The goals of therapy are to reduce or eliminate symptoms of RLS and improve daytime function, sleep, and quality of life. […] Iron replacement is suggested in patients with restless legs syndrome (RLS) whose fasting serum ferritin level is ≤75 ng/mL.

• #3 Restless Leg Syndrome: Causes, Home Remedies, and More

  https://www.healthline.com/health/restless-leg-syndrome

  Home remedies such as exercise or stretching and medications are among treatments for restless legs syndrome. While these treatments may help reduce symptoms, they wont cure RLS. […] RLS is a lifelong condition with no cure, but medication can help manage symptoms. […] Medication wont cure RLS, but it can help manage symptoms. Some options are: […] It may take several attempts before you find the right medication. Your doctor will adjust the medication and dosage as your symptoms change. […] If necessary, medications that affect dopamine, benzodiazepines, and anticonvulsants may be prescribed.

• #4 Restless Legs Syndrome (RLS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9497-restless-legs-syndrome

  Restless legs syndrome (RLS) is a movement condition that causes a strong urge to move your legs when you’re resting. […] There isn’t a cure for RLS, but treatment is available. […] Treatment for RLS may include taking medications or changing your routine at home to help relieve your symptoms. […] Certain medications can help relieve your symptoms of RLS. Your healthcare provider may recommend or prescribe the following: Iron supplements, taken with vitamin C. Antiseizure medications (gabapentin, pregabalin). Dopamine agonists (pramipexole, ropinirole). Dopamine precursors or medications that turn into dopamine (levodopa). […] Certain medications like benzodiazepines (clonazepam), hypnotics (zolpidem) or opioids (methadone, buprenorphine) may help with severe cases if all other forms of treatment are ineffective.

• #5

  https://www.nhs.uk/conditions/restless-legs-syndrome/treatment/

  Mild restless legs syndrome that isn’t linked to an underlying health condition can be managed with just a few lifestyle changes. […] If symptoms are more severe, medication may be needed. […] Restless legs syndrome caused by an underlying health condition can often be cured by treating that condition. […] For example, iron deficiency anaemia can be treated by taking iron supplements. […] Dopamine agonists may be recommended if you’re experiencing frequent symptoms of restless legs syndrome. […] They work by increasing dopamine levels, which are often low. […] A mild opiate-based painkiller, such as codeine, may be prescribed to relieve pain associated with restless legs syndrome. […] Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome. […] If restless legs syndrome is badly disrupting your sleep, a short-term course of medicine may be recommended to help you sleep.

• #6

  https://www.nhs.uk/conditions/restless-legs-syndrome/

  Mild cases of restless legs syndrome that are not linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes. […] If your symptoms are more severe, you may need medication to regulate the levels of dopamine and iron in your body. […] If restless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all that’s needed to treat the symptoms.

• #7 You are not alone

  https://www.rls.org/diagnosis-treatment

  Current consensus treatment guidelines recommend: Iron – Oral and Intravenous iron treatment Alpha-2-Delta Ligands – gabapentin, gabapentin enacarbil or pregabalin. […] Although once considered a first line therapy, dopaminergic medications are now second line therapy due to augmentation. Augmentation is the worsening of RLS symptoms over time from drugs that act on the dopaminergic system. […] There are many non-drug therapies that can help relieve symptoms of restless legs syndrome (RLS). […] Review your diet to ensure it is healthy and balanced. […] Iron deficiency without anemia has been associated with increased fatigue, depression, cognitive impairment, decreased work capacity, and also RLS. […] Research demonstrates that an active lifestyle can prevent and/or treat RLS. […] Regular exercisers are 3.3 times less likely to have RLS than non-exercisers.

• #8 RLS Remedies : Home Care for Better Sleep

  https://www.webmd.com/brain/restless-legs-syndrome/ss/slideshow-rls-remedies

  Stress makes RLS symptoms worse. Release the tension by taking slow, deep breaths. It also helps to dim the lights and listen to soothing music before you go to bed. […] A calf massage before bed might calm your RLS symptoms and help you get to sleep. You can do it yourself or trade mini-massages with a family member. Give your partner a 10-minute shoulder rub, then stretch out for a leg massage and relax deeply. […] Yoga combines three remedies that can reduce mild RLS symptoms: stretching, deep breathing, and relaxation. Try a class or video to learn the right posture and pace for each move. Once you know the poses, you can do them on your own. A podcast can lead you through the moves and include an eyes-closed, guided relaxation at the end. […] Alcohol and cigarettes can bring on the symptoms of RLS and harm your sleep in other ways, too. A drink may make you drowsy at first, but you’re more likely to wake up during the night or have poor sleep that doesn’t leave you feeling rested. The nicotine in cigarettes is what triggers RLS symptoms, so avoid cigars, „chew,” and any other tobacco products.

• #9 Restless Legs Syndrome Treatments & Medications

  https://www.webmd.com/brain/restless-legs-syndrome/restless-leg-syndrome-treatment

  There are no cures for primary restless legs syndrome, or RLS, although various treatments often can help relieve symptoms. Treatment for secondary restless legs syndrome (RLS caused by another medical problem) involves treating the underlying cause. […] The first line of defense against restless legs syndrome (RLS) is to avoid substances or foods that may aggravate or worsen the problem. Stay away from alcohol, caffeine, and nicotine. This may help relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem. […] Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinson’s disease, should be treated. Dietary supplements to correct an iron, vitamin or mineral deficiency may relieve or even cure the RLS.

• #10 RLS Remedies : Home Care for Better Sleep

  https://www.webmd.com/brain/restless-legs-syndrome/ss/slideshow-rls-remedies

  Restless legs syndrome, also called RLS, makes it hard to sleep. Your legs may ache, burn, tingle, twitch, or jerk. To get the deep sleep you need, try going to bed a little later and sleeping later in the morning. Those morning hours may be some of your best rest. […] Going to sleep and waking up at the about the same time every day helps just about everyone sleep better. When you have RLS, it may stop a bad cycle where fatigue makes your symptoms worse, and then the twitching and tingling ruins your sleep for another night. Pay attention to how much sleep you need to feel your best. Most adults need seven to nine hours each night. […] Gentle stretching before bed might help. For a calf stretch, step forward and bend your front leg while keeping your back leg straight, in a small lunge. You can put your hand on a wall for support. Repeat on the other side. Stretching also helps if you’ve been sitting for a long time.

• #11 Restless Legs Syndrome (RLS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9497-restless-legs-syndrome

  If you have mild RLS symptoms, a healthcare provider may recommend the following at-home therapies to help you feel more comfortable and fall asleep with restless legs. These may include: Getting regular exercise, such as aerobics, riding a bike/stationary bike or walking. […] Soaking your legs in a warm tub, and applying a heating pad or cold compress to your legs. These may provide temporary relief for your discomfort. […] Moving your legs can temporarily relieve restless legs immediately, but your symptoms often return when you stop moving. […] There’s no known way to prevent restless legs syndrome. You can reduce your risk of experiencing worsening symptoms by treating any underlying health conditions or avoiding triggers like caffeine and alcohol. […] There’s no cure available for RLS, but treatment can help manage your symptoms.

• #12 Restless legs syndrome and related disorders Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/restless-legs-syndrome-and-related-disorders

  Long-term treatment with dopaminergic agonists can lead to tolerance (reduced response over time) and augmentation (worsening of symptoms with ongoing treatment). […] Treatment for complaints of sleeplessness and RLS focuses on improving sleep and eliminating possible causes of RLS. Initially, doctors normally try to achieve these goals without the use of drugs. A non-drug approach is a particularly important first step for older people. […] Some people report that making the following changes help control RLS: Taking hot baths or using cold compresses. Quitting smoking. Getting enough exercise during the day. Doing calf stretching exercises at bedtime. Using ergonomic measures. For example, working at a high stool where legs can dangle helps some people. Also, sitting in an aisle seat during meetings or airplane travel can allow for more leg movement. Changing sleep patterns. Some people report that symptoms do not occur when they sleep in the late morning. Therefore, people may consider changing their sleep patterns if feasible. Avoiding caffeine, alcohol, and nicotine also improves some cases of RLS. Foot wraps have been shown to help some people with RLS in preliminary studies.

• #13 RLS Remedies : Home Care for Better Sleep

  https://www.webmd.com/brain/restless-legs-syndrome/ss/slideshow-rls-remedies

  Stress makes RLS symptoms worse. Release the tension by taking slow, deep breaths. It also helps to dim the lights and listen to soothing music before you go to bed. […] A calf massage before bed might calm your RLS symptoms and help you get to sleep. You can do it yourself or trade mini-massages with a family member. Give your partner a 10-minute shoulder rub, then stretch out for a leg massage and relax deeply. […] Yoga combines three remedies that can reduce mild RLS symptoms: stretching, deep breathing, and relaxation. Try a class or video to learn the right posture and pace for each move. Once you know the poses, you can do them on your own. A podcast can lead you through the moves and include an eyes-closed, guided relaxation at the end. […] Alcohol and cigarettes can bring on the symptoms of RLS and harm your sleep in other ways, too. A drink may make you drowsy at first, but you’re more likely to wake up during the night or have poor sleep that doesn’t leave you feeling rested. The nicotine in cigarettes is what triggers RLS symptoms, so avoid cigars, „chew,” and any other tobacco products.

• #14 RLS Remedies : Home Care for Better Sleep

  https://www.webmd.com/brain/restless-legs-syndrome/ss/slideshow-rls-remedies

  Restless legs syndrome, also called RLS, makes it hard to sleep. Your legs may ache, burn, tingle, twitch, or jerk. To get the deep sleep you need, try going to bed a little later and sleeping later in the morning. Those morning hours may be some of your best rest. […] Going to sleep and waking up at the about the same time every day helps just about everyone sleep better. When you have RLS, it may stop a bad cycle where fatigue makes your symptoms worse, and then the twitching and tingling ruins your sleep for another night. Pay attention to how much sleep you need to feel your best. Most adults need seven to nine hours each night. […] Gentle stretching before bed might help. For a calf stretch, step forward and bend your front leg while keeping your back leg straight, in a small lunge. You can put your hand on a wall for support. Repeat on the other side. Stretching also helps if you’ve been sitting for a long time.

• #15 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  Symptoms of restless legs syndrome sometimes go away after treating an underlying condition, such as iron deficiency. Correcting an iron deficiency may involve taking an iron supplement by mouth. Or you may be given an iron supplement through a vein in your arm. Take iron supplements only with medical supervision and after having your blood-iron level checked. […] Electrical stimulation of a nerve on the side of your knee may help RLS symptoms. Devices for electrical stimulation require a prescription from a healthcare professional. […] If you have RLS without an associated condition, treatment focuses on lifestyle changes. If those aren’t effective, your healthcare professional may prescribe medicines. […] Several prescription medicines are available to reduce the restlessness in the legs. Many of the medicines were developed to treat other diseases, but they may help with RLS. They include:

• #16 Restless Leg Syndrome

  https://www.rwjbh.org/trinitas-regional-medical-center/treatment-care/sleep-disorders/restless-leg-syndrome/

  If your RLS is mild, taking a hot bath, massaging your legs, exercising, eliminating caffeine, and using an ice pack and/or a heating pad may be suggested as options to help alleviate your symptoms. […] Medication may be prescribed to control symptoms for people with more severe cases of RLS. Some medications may lose their effectiveness when used nightly, so your doctor may want to alternate different medications to prevent them from giving you diminishing relief from your symptoms. […] One other non-drug approach, which is the use of Transcutaneous Electrical Nerve Stimulation, or TENS, may help reduce the symptoms in those with both RLS and PLMS. Applied to an area of the legs or feet, for about 15-30 minutes before bedtime, this electrical stimulation can be helpful in some cases.

• #17 Restless legs syndrome and related disorders Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/restless-legs-syndrome-and-related-disorders

  Long-term treatment with dopaminergic agonists can lead to tolerance (reduced response over time) and augmentation (worsening of symptoms with ongoing treatment). […] Treatment for complaints of sleeplessness and RLS focuses on improving sleep and eliminating possible causes of RLS. Initially, doctors normally try to achieve these goals without the use of drugs. A non-drug approach is a particularly important first step for older people. […] Some people report that making the following changes help control RLS: Taking hot baths or using cold compresses. Quitting smoking. Getting enough exercise during the day. Doing calf stretching exercises at bedtime. Using ergonomic measures. For example, working at a high stool where legs can dangle helps some people. Also, sitting in an aisle seat during meetings or airplane travel can allow for more leg movement. Changing sleep patterns. Some people report that symptoms do not occur when they sleep in the late morning. Therefore, people may consider changing their sleep patterns if feasible. Avoiding caffeine, alcohol, and nicotine also improves some cases of RLS. Foot wraps have been shown to help some people with RLS in preliminary studies.

• #18 Restless Legs Syndrome – Harvard Health

  https://www.health.harvard.edu/a_to_z/restless-legs-syndrome-a-to-z

  Treatment of restless legs syndrome depends on the severity of your symptoms. If your symptoms are mild, simply exercising, stretching, massaging your legs, or taking a hot bath may bring relief. Lifestyle changes also may help, especially following a balanced diet and avoiding caffeine, alcohol, and cigarette smoking. […] Iron treatment may be helpful even in the absence of iron deficiency (because too much iron can be harmful, monitoring of blood iron levels is important). […] Many experts also recommend mentally challenging activities, such as crossword puzzles or video games, to reduce symptoms (perhaps by distraction). […] A number of medications, taken individually or in combination, may be effective to treat restless legs syndrome. Drugs called alpha-2-delta ligands are recommended as the first choice. They include gabapentin (Neurontin), gabapentin enacarbil (Horizant), and pregabalin (Lyrica). Examples of other drugs that may be useful are clonidine (Catapres), amantadine (Symadine, Symmetrel), and propranolol (Inderal).

• #19

• #20 Restless Legs Syndrome Treatments & Medications

  https://www.webmd.com/brain/restless-legs-syndrome/restless-leg-syndrome-treatment

  There are no cures for primary restless legs syndrome, or RLS, although various treatments often can help relieve symptoms. Treatment for secondary restless legs syndrome (RLS caused by another medical problem) involves treating the underlying cause. […] The first line of defense against restless legs syndrome (RLS) is to avoid substances or foods that may aggravate or worsen the problem. Stay away from alcohol, caffeine, and nicotine. This may help relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem. […] Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinson’s disease, should be treated. Dietary supplements to correct an iron, vitamin or mineral deficiency may relieve or even cure the RLS.

• #21 Treatment of Restless Legs Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899490/

  The alpha-2-delta ligands, including gabapentin, gabapentin enacarbil, and pregabalin, are effective for RLS without known occurrence of augmentation or impulse control disorders, although sedation and dizziness can occur. […] The treatment of RLS must be individualized to each patient. […] In patients with mild symptoms, no treatment may be required, although all patients should be screened for iron deficiency. […] Following a diagnosis of RLS, the first step in designing a treatment strategy is to evaluate for secondary causes. […] The most reliable indicator of body stores of iron is the serum ferritin, transferrin, and transferrin saturation. […] The current recommendation is that all patients diagnosed with RLS be evaluated for iron deficiency. […] Those with low or low-to-normal ferritin levels, as determined by the specific values of the testing laboratory, should undergo iron replacement therapy, which can be done orally or parenterally.

• #22 Management of restless legs syndrome and periodic limb movement disorder in adults – UpToDate

  https://www.uptodate.com/contents/treatment-of-restless-legs-syndrome-and-periodic-limb-movement-disorder-in-adults

  Management of restless legs syndrome and periodic limb movement disorder in adults […] RLS is a manageable condition that generally responds well to pharmacologic therapy. A variety of treatments have been studied in randomized, controlled trials; the major classes of drugs used include alpha-2-delta voltage-gated calcium channel ligands, dopaminergic agents, opioids, and benzodiazepines. […] The selection of therapy depends upon a number of factors, including disease severity, patient age, comorbidities (eg, pain, depression, anxiety, history of impulse control disorders), drug side effects, and patient preferences. The goals of therapy are to reduce or eliminate symptoms of RLS and improve daytime function, sleep, and quality of life. […] Iron replacement is suggested in patients with restless legs syndrome (RLS) whose fasting serum ferritin level is ≤75 ng/mL.

• #23 New guideline provides treatment recommendations for RLS

  https://aasm.org/new-guideline-provides-treatment-recommendations-for-restless-legs-syndrome/

  New guideline provides treatment recommendations for restless legs syndrome. A new clinical practice guideline developed by the American Academy of Sleep Medicine provides updated recommendations for the treatment of restless legs syndrome. The guideline reflects the latest scientific evidence and recommends significant changes in the standard treatment of RLS in adults. […] One of the significant changes in the new guideline is that it elevates the importance of iron evaluation in everyone with RLS and, depending on iron indices, recommends iron supplementation. These recommendations reflect evidence suggesting that low brain iron is an important underlying cause of RLS. For adults with RLS, the guideline provides a strong recommendation for intravenous ferric carboxymaltose and conditional recommendations for two other formulations of intravenous iron and one formulation of oral iron — ferrous sulfate. For children with RLS, ferrous sulfate received a conditional recommendation, making it the only treatment recommended for pediatric patients.

• #24 Restless Legs Syndrome Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/1188327-treatment

  All patients with low iron levels (ferritin 50 ng/mL) should receive supplemental iron therapy. […] In iron deficiency, 325 mg of ferrous sulfate may be given with 250 mg of vitamin C. […] Anecdotal evidence from Japan suggests that yokukansan (an herbal remedy) may be effective in the treatment of RLS. […] Oral corticosteroids have also been used to treat RLS in exceptional circumstances. […] Sleep hygiene measures should be recommended to all patients. […] Moreover, patients with mild restless legs syndrome (RLS) who are sensitive to caffeine, alcohol, or nicotine should avoid these substances. […] Nonpharmacologic management and sleep hygiene measures are the treatments of choice in children.

• #25 Restless Legs Syndrome Treatments & Medications

  https://www.webmd.com/brain/restless-legs-syndrome/restless-leg-syndrome-treatment

  There are no cures for primary restless legs syndrome, or RLS, although various treatments often can help relieve symptoms. Treatment for secondary restless legs syndrome (RLS caused by another medical problem) involves treating the underlying cause. […] The first line of defense against restless legs syndrome (RLS) is to avoid substances or foods that may aggravate or worsen the problem. Stay away from alcohol, caffeine, and nicotine. This may help relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem. […] Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinson’s disease, should be treated. Dietary supplements to correct an iron, vitamin or mineral deficiency may relieve or even cure the RLS.

• #26

  https://www.nhs.uk/conditions/restless-legs-syndrome/treatment/

  Mild restless legs syndrome that isn’t linked to an underlying health condition can be managed with just a few lifestyle changes. […] If symptoms are more severe, medication may be needed. […] Restless legs syndrome caused by an underlying health condition can often be cured by treating that condition. […] For example, iron deficiency anaemia can be treated by taking iron supplements. […] Dopamine agonists may be recommended if you’re experiencing frequent symptoms of restless legs syndrome. […] They work by increasing dopamine levels, which are often low. […] A mild opiate-based painkiller, such as codeine, may be prescribed to relieve pain associated with restless legs syndrome. […] Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome. […] If restless legs syndrome is badly disrupting your sleep, a short-term course of medicine may be recommended to help you sleep.

• #27 Management of restless legs syndrome and periodic limb movement disorder in adults – UpToDate

  https://www.uptodate.com/contents/treatment-of-restless-legs-syndrome-and-periodic-limb-movement-disorder-in-adults

  Management of restless legs syndrome and periodic limb movement disorder in adults […] RLS is a manageable condition that generally responds well to pharmacologic therapy. A variety of treatments have been studied in randomized, controlled trials; the major classes of drugs used include alpha-2-delta voltage-gated calcium channel ligands, dopaminergic agents, opioids, and benzodiazepines. […] The selection of therapy depends upon a number of factors, including disease severity, patient age, comorbidities (eg, pain, depression, anxiety, history of impulse control disorders), drug side effects, and patient preferences. The goals of therapy are to reduce or eliminate symptoms of RLS and improve daytime function, sleep, and quality of life. […] Iron replacement is suggested in patients with restless legs syndrome (RLS) whose fasting serum ferritin level is ≤75 ng/mL.

• #28 Updated Guidelines for the Treatment of Restless Leg Syndrome: New Research Prompts a Significant Shift in Recommendations – MGH Psychiatry News

  https://mghpsychnews.org/updated-guidelines-for-the-treatment-of-rls/

  This update from the American Academy of Sleep Medicine presents a significant change in recommendations for the treatment of RLS, discouraging the use of commonly prescribed dopamine agonists. The American Academy of Sleep Medicine (AASM) has published new clinical practice guidelines for the treatment of restless leg syndrome (RLS). The updated guidelines include several important changes in the treatment of RLS: […] The new guidelines recommend against the use of the dopamine agonists, pramipexole and ropinirole. […] New evidence supports the strong recommendation for the use of three alpha-2-delta ligand calcium channel blockers gabapentin enacarbil, gabapentin, and pregabalin for the treatment of RLS. […] The use of low-dose, extended-release oxycodone and other low-dose opioids have demonstrated efficacy for RLS; however, opioids carry risks that require cautious use and clinical oversight. […] This is an innovative treatment developed that has received a conditional recommendation of support for the treatment of RLS.

• #29 Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorderlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na58166/2024/12/26/treatment-restless-legs-syndrome-and-periodic-limb

  Updated guidelines from the American Academy of Sleep downgrade the use of dopamine agonists to treat RLS. […] Alpha-2-delta ligands (gabapentin, gabapentin encarbil, and pregabalin) are strongly recommended for those without contraindications. […] There are conditional recommendations against the long-term use of levodopa and dopamine agonists (pramipexole, ropinirole, and transdermal rotigotine), as well as bupropion, carbamazepine, clonazepam, valerian root, and valproic acid. There is also a strong recommendation against cabergoline. […] On the basis of these updated guidelines, alpha-2-delta ligands can be considered as first-line treatment for RLS. […] Implementation of good practice recommendations is essential in the management of all patients with RLS.

• #30

  https://bpac.org.nz/bpj/2012/december/restlesslegs.aspx

  Dopaminergic medicines such as ropinirole and levodopa should never be abruptly stopped, as this can precipitate neuroleptic malignant syndrome, particularly if the medicine has been used for a long time. […] There is some evidence that gabapentin is an effective treatment for restless legs syndrome, and is useful where pain is a significant symptom. […] Iron supplementation should be considered for patients with a serum ferritin level below 50 micrograms/L. […] Clonazepam may be considered for patients who have significant sleep disturbance as a result of restless legs syndrome, particularly difficulty falling asleep. […] Reassurance and advice about lifestyle measures is usually sufficient for most women who are pregnant and experiencing restless legs syndrome. Pharmacological treatment should be a last resort.

• #31 Treatment of Restless Legs Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899490/

  A second class of drugs that has demonstrated efficacy for RLS and PLMS is the alpha-2-delta ligands, including gabapentin, gabapentin enacarbil, and pregabalin. […] Gabapentin enacarbil is a pro-drug of gabapentin that is absorbed by active transport in the gut and converted to gabapentin. […] Early studies suggested that opioid compounds improved RLS symptoms. […] However, the possibility of addiction to opioids and exacerbation of sleep apnea have limited the use of this class of drugs as a first-line therapy. […] A variety of other medications has been used for the treatment of RLS. […] At this time, there is little evidence to support the use of these agents as a primary treatment for RLS. […] Several agents have sufficient evidence to be considered as effective for the treatment of RLS, including those approved by the FDA for RLS: ropinirole, pramipexole, rotigotine, and gabapentin enacarbil.

• #32

  https://www.scielo.br/j/anp/a/jYm4fP6CvFmQrYf67WHFHFL/

  Levodopa is effective, in the short term, to treat Restless Legs Syndrome (RLS), improving symptoms, quality of sleep and quality of life. However, dopamine agonists are superior to levodopa in improving symptoms related to quality of life and sleep duration. […] Dopamine agonists are the most studied agents used to treat RLS. The largest quantity and quality of clinical studies has led to an increasing body of scientific evidence regarding the use of these drugs. […] Gabapentin is traditionally used to treat epilepsy and neuropathic pain. […] Pregabalin has also been studied in recent years to treat RLS with more robust results than gabapentin. […] For several decades, opioids have been used empirically as an alternative for the treatment of RLS. […] Although there are data suggesting that iron is associated with the pathophysiology of RLS and various data in the literature reporting the benefits of replacing oral or parenteral iron in patients with RLS, there are no good-quality studies that give scientific support decisions about their effectiveness and safety.

• #33

  https://www.e-jsm.org/journal/view.php?number=383

  Treatment with DAs has sometimes other serious side effects (regardless of the treatment duration): 1) excessive daytime sleepiness with sleep attacks, with harmful consequences like drowsiness when driving and motor vehicle collisions, and 2) impulse-control disorder symptoms, including a spectrum of undesirable behaviors such as compulsive and financially destructive shopping, gambling, punding (repetitive, aimless hand movements, such as the disassembly and reassembly of watches or other gadgets), and other quasi-addictive behaviors, with sometimes disastrous medical and legal consequences. […] Considering the potential side effects of DA, first-line treatment of RLS with this drug class—the only currently authorized treatment for this indication in France—should no longer be the rule. Among the alpha2delta ligands, gabapentin demonstrates improvement in RLS symptoms with level A evidence and presents advantages in terms of sleep quality.

• #34 Restless legs syndrome

  https://www1.racgp.org.au/ajgp/2023/september/restless-legs-syndrome

  Levodopa plus a DOPA decarboxylase inhibitor (either carbidopa or benserazide) is a reasonable option to treat intermittent RLS symptoms (ie symptoms occurring less than once or twice a week) but is not recommended as a chronic treatment due to the high risk of tolerance and augmentation (drug-induced worsening of RLS; discussed later). […] Dopamine agonists (Table 3) are effective in managing chronic persistent RLS, defined as symptoms occurring at least twice weekly and causing moderate to severe distress, thus justifying consideration of daily therapy. […] Alpha-2-delta ligands (pregabalin, gabapentin and gabapentin enacarbil; Table 3) are recognised as the first-line treatment for chronic persistent RLS due to their comparable clinical efficacy coupled with a lack of augmentation and impulse control disorder.

• #35 Do You Have Restless Legs Syndrome (RLS)? Treatment Advice Has Changed > News > Yale Medicine

  https://www.yalemedicine.org/news/restless-legs-syndrome-advice-has-changed

  Recent guidelines advise against standard drugs, highlight iron’s importance. […] The new guidelines downgrade a previous strong recommendation for dopamine agonists and conditionally recommend against their use. […] Other new advice for RLS covers existing treatments that help many people manage symptoms. These include iron infusions for people found to have low levels of iron in the brain, a problem that has been linked to RLS and is suspected when blood tests show low iron levels in the body. Other therapies are a device that provides electronic stimulation for the legs and medications that ease RLS symptoms but do not cause augmentation. […] The new guidelines include conditional recommendations against treating RLS with dopamine agonists, which were considered breakthrough drugs for severe RLS when they were approved by the Food and Drug Administration (FDA) in the 2000s to treat the condition.

• #36 SLEEP

  https://www.healio.com/news/neurology/20230607/video-dopamine-no-longer-firstline-treatment-for-restless-legs-syndrome

  INDIANAPOLIS The guidelines for restless legs syndrome treatment no longer indicate dopamine agonists as a first-line choice, John Winkelman, MD, PhD, says in this Healio video from SLEEP 2023. […] First-line treatments now include iron, alpha2-delta agents or long-acting opioids, Winkelman, chief of the sleep disorders clinical research program at Massachusetts General Hospital, said. […] We have good options in restless legs syndrome, but be very clear, dopamine agonists are not first-line therapy because of the high incidence of augmentation, he said.

• #37 Restless Legs Syndrome Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/1188327-treatment

  Medications used in the treatment of restless legs syndrome (RLS) include the following: Dopaminergic agents (eg, pramipexole, ropinirole, bromocriptine, levodopa-carbidopa, and rotigotine), Benzodiazepines (eg, clonazepam), Opioids (eg, codeine), Anticonvulsants (eg, gabapentin and pregabalin), Presynaptic alpha2-adrenergic agonists (eg, clonidine), Iron salt. […] A Task Force of the International Restless Legs Syndrome Study Group (IRLSSG) developed evidence-based guidelines for long-term pharmacologic treatment of RLS. […] The IRLSSG Task Force recommends either a dopamine-receptor agonist or an alpha2-delta calcium-channel ligand as first-line treatment therapy for RLS in most patients, with the choice of medication depending on symptom severity, cognitive status, history, and comorbid conditions.

• #38 Treatment of Restless Legs Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899490/

  A variety of medications are reported to exacerbate or trigger RLS symptoms. […] For most patients with RLS, the standard recommendation is to avoid tricyclic antidepressants, selective serotonergic reuptake inhibitors, and serotoninnorepinepherine reuptake inhibitors, and to consider buproprion for the treatment of depression. […] The first direct dopamine agonists used for RLS were ergoline compounds. […] There are 3 non-ergoline, direct dopamine agonists approved by the US Food and Drug Administration (FDA) for the treatment of RLS: ropinirole, pramipexole, and transdermal rotigotine. […] Ropinirole is available in an immediate release (IR) and extended-release (ER) formulation. […] Pramipexole is a non-ergoline compound approved for use in RLS by the FDA in 2006. […] Rotigotine is a direct dopamine agonist with activity predominantly at the D2 receptor, but also at D1 and D3 receptors.

• #39 Treatment of Restless Legs Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899490/

  A variety of medications are reported to exacerbate or trigger RLS symptoms. […] For most patients with RLS, the standard recommendation is to avoid tricyclic antidepressants, selective serotonergic reuptake inhibitors, and serotoninnorepinepherine reuptake inhibitors, and to consider buproprion for the treatment of depression. […] The first direct dopamine agonists used for RLS were ergoline compounds. […] There are 3 non-ergoline, direct dopamine agonists approved by the US Food and Drug Administration (FDA) for the treatment of RLS: ropinirole, pramipexole, and transdermal rotigotine. […] Ropinirole is available in an immediate release (IR) and extended-release (ER) formulation. […] Pramipexole is a non-ergoline compound approved for use in RLS by the FDA in 2006. […] Rotigotine is a direct dopamine agonist with activity predominantly at the D2 receptor, but also at D1 and D3 receptors.

• #40 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #41 Restless legs syndrome

  https://www1.racgp.org.au/ajgp/2023/september/restless-legs-syndrome

  Levodopa plus a DOPA decarboxylase inhibitor (either carbidopa or benserazide) is a reasonable option to treat intermittent RLS symptoms (ie symptoms occurring less than once or twice a week) but is not recommended as a chronic treatment due to the high risk of tolerance and augmentation (drug-induced worsening of RLS; discussed later). […] Dopamine agonists (Table 3) are effective in managing chronic persistent RLS, defined as symptoms occurring at least twice weekly and causing moderate to severe distress, thus justifying consideration of daily therapy. […] Alpha-2-delta ligands (pregabalin, gabapentin and gabapentin enacarbil; Table 3) are recognised as the first-line treatment for chronic persistent RLS due to their comparable clinical efficacy coupled with a lack of augmentation and impulse control disorder.

• #42

  https://www.e-jsm.org/journal/view.php?number=383

  Treatment with DAs has sometimes other serious side effects (regardless of the treatment duration): 1) excessive daytime sleepiness with sleep attacks, with harmful consequences like drowsiness when driving and motor vehicle collisions, and 2) impulse-control disorder symptoms, including a spectrum of undesirable behaviors such as compulsive and financially destructive shopping, gambling, punding (repetitive, aimless hand movements, such as the disassembly and reassembly of watches or other gadgets), and other quasi-addictive behaviors, with sometimes disastrous medical and legal consequences. […] Considering the potential side effects of DA, first-line treatment of RLS with this drug class—the only currently authorized treatment for this indication in France—should no longer be the rule. Among the alpha2delta ligands, gabapentin demonstrates improvement in RLS symptoms with level A evidence and presents advantages in terms of sleep quality.

• #43 Medical Treatments | RLS-UK | Restless Leg Syndrome

  https://www.rls-uk.org/medical-treatments

  Other medications such as levodopa and benzodiazepines can be helpful for intermittent RLS but come with side effects which normally make them unsuitable for chronic persistent RLS or long term use. […] Clinical research indicates that patients with RLS may have lower than normal iron stores in the brain and that iron therapy can be beneficial even if patients are not considered anaemic by normal standards. […] Also known as gabapentinoids, this a class of drug which includes pregabalin and gabapentin and is used to treat epilepsy, neuropathic pain and anxiety, and can be used off label as a first line treatment for chronic persistent or refractory RLS. […] For refractory RLS, where first line treatments have failed due to adverse effects or augmentation, low dose opioids can be highly effective and do not generally lead to addiction or tolerance if patients are adequately screened and monitored.

• #44 New guideline provides treatment recommendations for RLS

  https://aasm.org/new-guideline-provides-treatment-recommendations-for-restless-legs-syndrome/

  Another important change is that the new guideline includes conditional recommendations against the standard use of pramipexole and ropinirole, both of which were supported by strong recommendations in the 2012 guidance. […] In contrast, new evidence supporting three alpha-2-delta ligand calcium channel blockers — gabapentin enacarbil, gabapentin, and pregabalin — led the task force to support them as strong recommendations for RLS treatment. […] Bilateral high-frequency peroneal nerve stimulation, an innovative treatment developed in the years since the previous guidance was published, received a conditional recommendation of support. […] The use of low-dose, extended-release oxycodone and other low-dose opioids also received conditional recommendations of support. […] The authors advised that the first step in the management of RLS should be to address exacerbating factors including alcohol, caffeine, certain antidepressant and antihistamine medications, and untreated obstructive sleep apnea.

• #45 The Treatment and Management of Restless Legs Syndrome

  https://www.medscape.org/viewarticle/522010_6

  Levodopa can improve sensory symptoms and PLMS in RLS. For symptoms that start before sleep, one 25-mg/100-mg carbidopa-levodopa tablet can be taken 1-2 hours before bedtime. […] The most commonly prescribed dopamine agonists for RLS are pramipexole and ropinirole. Both are nonergots, and have been determined to be effective in double-blind, placebo-controlled studies. […] Clonazepam can alleviate sensory symptoms and PLMS in RLS patients. […] Low-potency opioids, such as codeine and propoxyphene, can be of benefit for those with mild and intermittent symptoms, whereas higher potency agents, such as oxycodone, methadone, or levorphanol, may be useful in refractory cases. […] Carbamazepine has been shown to be effective in reducing RLS sensory symptoms, especially among young patients with recent-onset and severe symptoms. […] Clonidine, a presynaptic alpha2-adrenergic agonist, is effective in idiopathic and secondary RLS. […] In PD patients with RLS, subthalamic deep brain stimulation has been noted to improve not only the motor symptoms of PD but also RLS.

• #46 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #47 Treatment of Restless Legs Syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899490/

  A second class of drugs that has demonstrated efficacy for RLS and PLMS is the alpha-2-delta ligands, including gabapentin, gabapentin enacarbil, and pregabalin. […] Gabapentin enacarbil is a pro-drug of gabapentin that is absorbed by active transport in the gut and converted to gabapentin. […] Early studies suggested that opioid compounds improved RLS symptoms. […] However, the possibility of addiction to opioids and exacerbation of sleep apnea have limited the use of this class of drugs as a first-line therapy. […] A variety of other medications has been used for the treatment of RLS. […] At this time, there is little evidence to support the use of these agents as a primary treatment for RLS. […] Several agents have sufficient evidence to be considered as effective for the treatment of RLS, including those approved by the FDA for RLS: ropinirole, pramipexole, rotigotine, and gabapentin enacarbil.

• #48 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #49 The Treatment and Management of Restless Legs Syndrome

  https://www.medscape.org/viewarticle/522010_6

  Levodopa can improve sensory symptoms and PLMS in RLS. For symptoms that start before sleep, one 25-mg/100-mg carbidopa-levodopa tablet can be taken 1-2 hours before bedtime. […] The most commonly prescribed dopamine agonists for RLS are pramipexole and ropinirole. Both are nonergots, and have been determined to be effective in double-blind, placebo-controlled studies. […] Clonazepam can alleviate sensory symptoms and PLMS in RLS patients. […] Low-potency opioids, such as codeine and propoxyphene, can be of benefit for those with mild and intermittent symptoms, whereas higher potency agents, such as oxycodone, methadone, or levorphanol, may be useful in refractory cases. […] Carbamazepine has been shown to be effective in reducing RLS sensory symptoms, especially among young patients with recent-onset and severe symptoms. […] Clonidine, a presynaptic alpha2-adrenergic agonist, is effective in idiopathic and secondary RLS. […] In PD patients with RLS, subthalamic deep brain stimulation has been noted to improve not only the motor symptoms of PD but also RLS.

• #50 The Treatment and Management of Restless Legs Syndrome

  https://www.medscape.org/viewarticle/522010_6

  Levodopa can improve sensory symptoms and PLMS in RLS. For symptoms that start before sleep, one 25-mg/100-mg carbidopa-levodopa tablet can be taken 1-2 hours before bedtime. […] The most commonly prescribed dopamine agonists for RLS are pramipexole and ropinirole. Both are nonergots, and have been determined to be effective in double-blind, placebo-controlled studies. […] Clonazepam can alleviate sensory symptoms and PLMS in RLS patients. […] Low-potency opioids, such as codeine and propoxyphene, can be of benefit for those with mild and intermittent symptoms, whereas higher potency agents, such as oxycodone, methadone, or levorphanol, may be useful in refractory cases. […] Carbamazepine has been shown to be effective in reducing RLS sensory symptoms, especially among young patients with recent-onset and severe symptoms. […] Clonidine, a presynaptic alpha2-adrenergic agonist, is effective in idiopathic and secondary RLS. […] In PD patients with RLS, subthalamic deep brain stimulation has been noted to improve not only the motor symptoms of PD but also RLS.

• #51 A Narrative Review of the Lesser Known Medications for Treatment of Restless Legs Syndrome and Pathogenetic Implications for Their Use | Tremor and Other Hyperkinetic Movements

  https://tremorjournal.org/articles/10.5334/tohm.739

  There are several well-known treatments for Restless Legs Syndrome (RLS), including dopamine agonists (pramipexole, ropinirole, rotigotine), anticonvulsants (gabapentin and its analogs, pregabalin), oral or intravenous iron, opioids and benzodiazepines. However, in clinical practice, treatment is sometimes limited due to incomplete response or side effects and it is necessary to be aware of other treatment options for RLS, which is the purpose of this review. […] Alternative pharmacological agents include clonidine which reduces adrenergic transmission, adenosinergic agents such as dipyridamole, glutamate AMPA receptor blocking agents such as perampanel, glutamate NMDA receptor blocking agents such as amantadine and ketamine, various anticonvulsants (carbamazepine/oxcarbazepine, lamotrigine, topiramate, valproic acid, levetiracetam), anti-inflammatory agents such as steroids, as well as cannabis. Bupropion is also a good choice for the treatment of co-existent depression in RLS because of its pro-dopaminergic properties.

• #52 A Narrative Review of the Lesser Known Medications for Treatment of Restless Legs Syndrome and Pathogenetic Implications for Their Use | Tremor and Other Hyperkinetic Movements

  https://tremorjournal.org/articles/10.5334/tohm.739

  There are several well-known treatments for Restless Legs Syndrome (RLS), including dopamine agonists (pramipexole, ropinirole, rotigotine), anticonvulsants (gabapentin and its analogs, pregabalin), oral or intravenous iron, opioids and benzodiazepines. However, in clinical practice, treatment is sometimes limited due to incomplete response or side effects and it is necessary to be aware of other treatment options for RLS, which is the purpose of this review. […] Alternative pharmacological agents include clonidine which reduces adrenergic transmission, adenosinergic agents such as dipyridamole, glutamate AMPA receptor blocking agents such as perampanel, glutamate NMDA receptor blocking agents such as amantadine and ketamine, various anticonvulsants (carbamazepine/oxcarbazepine, lamotrigine, topiramate, valproic acid, levetiracetam), anti-inflammatory agents such as steroids, as well as cannabis. Bupropion is also a good choice for the treatment of co-existent depression in RLS because of its pro-dopaminergic properties.

• #53 Treatment Options for Idiopathic Restless Legs Syndrome – touchNEUROLOGY

  https://touchneurology.com/movement-disorders/journal-articles/treatment-options-for-idiopathic-restless-legs-syndrome/

  Gabapentin should be considered, as with dopamine agonists, as a first-line therapy for iRLS, with a similar degree of efficacy to ropinirole, pramipexole and rotigotine. […] The possible role of valerian (a herb having a good profile of side effects), which has shown short-term improvement of RLS symptoms in a triple-blinded, placebo-controlled study with a low sample size, seems to be promising, though it awaits confirmation with long-term studies involving greater numbers of patients. […] Among non-pharmacological therapies, preliminary studies on exercise, yoga, traction straight leg raise techniques and repetitive transcranial stimulation have shown possible efficacy.

• #54 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #55 Restless Legs Syndrome Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/restless-legs-syndrome/

  If your symptoms are caused by another medical problem like diabetes or iron deficiency anemia, you will be treated for that problem first. For example, you’ll take iron supplements if you aren’t getting enough iron. […] If RLS starts during pregnancy, your doctor may just recommend exercise and stretching. […] If your symptoms don’t improve, you may try medicines. These include: […] In some cases, your doctor may recommend an opioid pain medicine. […] Over time, a dopamine medicine may not work as well. […] Your doctor may recommend different medicines. Or your doctor may recommend a combination of medicines. Follow up with your doctor if your symptoms don’t improve. […] Your doctor may have you try other treatments. These include: […] There are ways to improve your symptoms of restless legs syndrome at home. Here are some things to consider. […] See your doctor if your symptoms do not improve, if they become worse, or if they significantly interfere with your sleep and daily functioning.

• #56 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #57 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #58 Restless Legs Syndrome (RLS): Symptoms, Causes, & Treatment – Elite Vein Clinic

  https://eliteveinclinic.com/blog/restless-legs-syndrome/

  Doctors may suggest dietary changes for those with specific vitamin or mineral deficiencies. […] For pregnant women suffering from RLS, time is the best answer. Symptoms often improve after delivery. […] Many medications can provide relief for restless legs syndrome patients. Medical professionals can provide recommendations based on a patient’s individual RLS experience. […] The FDA has also approved ropinirole, pramipexole, and rotigotine to treat moderate to severe RLS. […] Long-term use of dopaminergic agents is not recommended as they can worsen symptoms. Stopping the medication can reverse the progression. […] In extreme cases, doctors may prescribe certain opioids in low doses. […] Sometimes benzodiazepines are generally prescribed to treat anxiety, muscle spasms, and insomnia.

• #59 Treatments for Restless Legs Syndrome (RLS) | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/sleep/restless-legs-syndrome/treatments.html

  For children, regular exercise and sleep routines are usually tried first. If those don’t work, the doctor may prescribe medicine. […] If your symptoms don’t improve, you may try medicines. These include: Dopamine agonists, such as ropinirole (for example, Requip). Anticonvulsants, such as gabapentin (for example, Neurontin) or gabapentin enacarbil (for example, Horizant). […] In some cases, your doctor may recommend an opioid pain medicine. […] If your doctor recommends medicine, be sure to talk about the possible benefits and risks. Let your doctor know about all of the other medicines you take. Medicines for other conditions sometimes help cause RLS. For example, antidepressants may improve symptoms. Or they may make them worse. […] Over time, a dopamine medicine may not work as well.

• #60

  https://www.scielo.br/j/anp/a/jYm4fP6CvFmQrYf67WHFHFL/

  The conclusion of this consensus on the use of iron in the treatment of RLS is that there is no robust evidence to indicate or contraindication of their use. Thus, the use of iron in the treatment of RLS should be decided by the physician involved in patient care, considering the studies currently available. […] The treatment for Pediatric RLS is also divided into non-pharmacological and pharmacological. However, it is noteworthy that there are no studies with level I evidence to guide therapeutic choices of RLS in children.

• #61 Treatments for Restless Legs Syndrome (RLS) | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/sleep/restless-legs-syndrome/treatments.html

  For children, regular exercise and sleep routines are usually tried first. If those don’t work, the doctor may prescribe medicine. […] If your symptoms don’t improve, you may try medicines. These include: Dopamine agonists, such as ropinirole (for example, Requip). Anticonvulsants, such as gabapentin (for example, Neurontin) or gabapentin enacarbil (for example, Horizant). […] In some cases, your doctor may recommend an opioid pain medicine. […] If your doctor recommends medicine, be sure to talk about the possible benefits and risks. Let your doctor know about all of the other medicines you take. Medicines for other conditions sometimes help cause RLS. For example, antidepressants may improve symptoms. Or they may make them worse. […] Over time, a dopamine medicine may not work as well.

• #62 Restless Legs Syndrome | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/restless-legs-syndrome

  In patients with medically-refractory (malignant) RLS injections of botulinum toxin into the leg muscles that are particularly involved in the discomfort may be an effective treatment. […] Sometimes, combinations of these different types of drugs are needed to control severe symptoms, and often medicines may work for a period of time before needing to be replaced by other medications. The dose of medication and the time at which they are given depend on the duration and intensity of symptoms. In all cases, patients should take the lowest dose that controls their individual symptoms. In severe cases associated with low blood iron and refractory to other medications, intravenous iron might be considered but carries a risk of a severe allergic reaction (anaphylactic shock). […] Other, yet unproven treatments in patients who are refractory to medical therapy include deep brain stimulation (DBS), spinal cord stimulation, and transcranial magnetic stimulation.

• #63 Restless Legs Syndrome | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/restless-legs-syndrome

  In patients with medically-refractory (malignant) RLS injections of botulinum toxin into the leg muscles that are particularly involved in the discomfort may be an effective treatment. […] Sometimes, combinations of these different types of drugs are needed to control severe symptoms, and often medicines may work for a period of time before needing to be replaced by other medications. The dose of medication and the time at which they are given depend on the duration and intensity of symptoms. In all cases, patients should take the lowest dose that controls their individual symptoms. In severe cases associated with low blood iron and refractory to other medications, intravenous iron might be considered but carries a risk of a severe allergic reaction (anaphylactic shock). […] Other, yet unproven treatments in patients who are refractory to medical therapy include deep brain stimulation (DBS), spinal cord stimulation, and transcranial magnetic stimulation.

• #64 Restless Legs Syndrome | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/restless-legs-syndrome

  In patients with medically-refractory (malignant) RLS injections of botulinum toxin into the leg muscles that are particularly involved in the discomfort may be an effective treatment. […] Sometimes, combinations of these different types of drugs are needed to control severe symptoms, and often medicines may work for a period of time before needing to be replaced by other medications. The dose of medication and the time at which they are given depend on the duration and intensity of symptoms. In all cases, patients should take the lowest dose that controls their individual symptoms. In severe cases associated with low blood iron and refractory to other medications, intravenous iron might be considered but carries a risk of a severe allergic reaction (anaphylactic shock). […] Other, yet unproven treatments in patients who are refractory to medical therapy include deep brain stimulation (DBS), spinal cord stimulation, and transcranial magnetic stimulation.

• #65 The Treatment and Management of Restless Legs Syndrome

  https://www.medscape.org/viewarticle/522010_6

  Levodopa can improve sensory symptoms and PLMS in RLS. For symptoms that start before sleep, one 25-mg/100-mg carbidopa-levodopa tablet can be taken 1-2 hours before bedtime. […] The most commonly prescribed dopamine agonists for RLS are pramipexole and ropinirole. Both are nonergots, and have been determined to be effective in double-blind, placebo-controlled studies. […] Clonazepam can alleviate sensory symptoms and PLMS in RLS patients. […] Low-potency opioids, such as codeine and propoxyphene, can be of benefit for those with mild and intermittent symptoms, whereas higher potency agents, such as oxycodone, methadone, or levorphanol, may be useful in refractory cases. […] Carbamazepine has been shown to be effective in reducing RLS sensory symptoms, especially among young patients with recent-onset and severe symptoms. […] Clonidine, a presynaptic alpha2-adrenergic agonist, is effective in idiopathic and secondary RLS. […] In PD patients with RLS, subthalamic deep brain stimulation has been noted to improve not only the motor symptoms of PD but also RLS.

• #66 New Treatment Guidelines for Restless Legs Syndrome Improve Clinical Safety | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/new-treatment-guidelines-restless-legs-syndrome-improve-clinical-safety

  The American Academy of Sleep Medicine recently published new clinical practice guidelines for restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) in adults and pediatric patients. The new guidelines advise against using dopamine agonists to treat RLS the standard of care for the last 20 years due to valid concerns about the drugs physiological and psychological adverse effects. […] A select number of RLS specialists have avoided these drugs for years, but now the guidelines have caught up with clinical practice, says Spector. […] Duke’s experts manage hard-to-treat cases of RLS and other sleep disorders. The multidisciplinary team collaborates to create personalized treatment plans using the latest evidence-based guidelines. […] The new guidelines recommend it as a first-line treatment, says Spector.

• #67 New guideline provides treatment recommendations for RLS

  https://aasm.org/new-guideline-provides-treatment-recommendations-for-restless-legs-syndrome/

  Another important change is that the new guideline includes conditional recommendations against the standard use of pramipexole and ropinirole, both of which were supported by strong recommendations in the 2012 guidance. […] In contrast, new evidence supporting three alpha-2-delta ligand calcium channel blockers — gabapentin enacarbil, gabapentin, and pregabalin — led the task force to support them as strong recommendations for RLS treatment. […] Bilateral high-frequency peroneal nerve stimulation, an innovative treatment developed in the years since the previous guidance was published, received a conditional recommendation of support. […] The use of low-dose, extended-release oxycodone and other low-dose opioids also received conditional recommendations of support. […] The authors advised that the first step in the management of RLS should be to address exacerbating factors including alcohol, caffeine, certain antidepressant and antihistamine medications, and untreated obstructive sleep apnea.

• #68 Restless Legs Syndrome Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/1188327-treatment

  Treatment for restless legs syndrome (RLS) may not be necessary for patients with mild or sporadic symptoms or for those without significant impairment. […] Treatment should be tailored to the patients specific symptoms and may involve pharmacotherapy and nonpharmacologic measures. […] Patients should be monitored by a neurologist or their primary care provider for development of adverse events, augmentation, or rebound. […] Drug therapy for primary restless legs syndrome (RLS) is largely symptomatic; cure is possible only for secondary RLS. In some patients, RLS symptoms occur sporadically, with spontaneous remissions lasting weeks or months. The use of pharmacotherapy on an irregular basis is warranted in such cases. Continuous pharmacologic treatment should be considered if patients complain of having RLS symptoms at least 3 nights each week.

• #69 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation. […] Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine. […] It may take several trials to find the right medicine or combination of medicines that work best for you. […] And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS. […] Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

• #70 Restless Legs Syndrome Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/restless-legs-syndrome/

  If your symptoms are caused by another medical problem like diabetes or iron deficiency anemia, you will be treated for that problem first. For example, you’ll take iron supplements if you aren’t getting enough iron. […] If RLS starts during pregnancy, your doctor may just recommend exercise and stretching. […] If your symptoms don’t improve, you may try medicines. These include: […] In some cases, your doctor may recommend an opioid pain medicine. […] Over time, a dopamine medicine may not work as well. […] Your doctor may recommend different medicines. Or your doctor may recommend a combination of medicines. Follow up with your doctor if your symptoms don’t improve. […] Your doctor may have you try other treatments. These include: […] There are ways to improve your symptoms of restless legs syndrome at home. Here are some things to consider. […] See your doctor if your symptoms do not improve, if they become worse, or if they significantly interfere with your sleep and daily functioning.

• #71 You are not alone

  https://www.rls.org/diagnosis-treatment

  One of the most common and least understood problems encountered with RLS treatment as a result of dopaminergic medications, Augmentation is defined as the worsening of RLS symptoms over time from drugs that act on the dopaminergic system. […] Download this research study for a more comprehensive understanding of the cause, result and treatment of augmentation.

• #72 Restless legs syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/diagnosis-treatment/drc-20377174

  Medicines affecting calcium channels. Medicines such as gabapentin, gabapentin enacarbil and pregabalin are the first line of treatment for most people with RLS. These medicines can cause side effects such as dizziness, unsteadiness, mental fog and weight gain. […] Medicines that increase dopamine in the brain. These medicines affect levels of the chemical messenger dopamine in the brain. Rotigotine, pramipexole and ropinirole work at first. But in many people taking these medicines, RLS gets worse over time. The medicines may cause symptoms to return earlier in the day. Some people taking these medicines find that symptoms spread to the arms. This is called augmentation. The medicines also can make it hard to manage impulses, such as compulsive gambling. Because of these risks, dopamine drugs are only used if medicines affecting calcium channels don’t work or cause side effects.

• #73

  https://bpac.org.nz/bpj/2012/december/restlesslegs.aspx

  Dopaminergic medicines such as ropinirole and levodopa should never be abruptly stopped, as this can precipitate neuroleptic malignant syndrome, particularly if the medicine has been used for a long time. […] There is some evidence that gabapentin is an effective treatment for restless legs syndrome, and is useful where pain is a significant symptom. […] Iron supplementation should be considered for patients with a serum ferritin level below 50 micrograms/L. […] Clonazepam may be considered for patients who have significant sleep disturbance as a result of restless legs syndrome, particularly difficulty falling asleep. […] Reassurance and advice about lifestyle measures is usually sufficient for most women who are pregnant and experiencing restless legs syndrome. Pharmacological treatment should be a last resort.

• #74 Updated Guidelines for the Treatment of Restless Leg Syndrome: New Research Prompts a Significant Shift in Recommendations – MGH Psychiatry News

  https://mghpsychnews.org/updated-guidelines-for-the-treatment-of-rls/

  This update from the American Academy of Sleep Medicine presents a significant change in recommendations for the treatment of RLS, discouraging the use of commonly prescribed dopamine agonists. The American Academy of Sleep Medicine (AASM) has published new clinical practice guidelines for the treatment of restless leg syndrome (RLS). The updated guidelines include several important changes in the treatment of RLS: […] The new guidelines recommend against the use of the dopamine agonists, pramipexole and ropinirole. […] New evidence supports the strong recommendation for the use of three alpha-2-delta ligand calcium channel blockers gabapentin enacarbil, gabapentin, and pregabalin for the treatment of RLS. […] The use of low-dose, extended-release oxycodone and other low-dose opioids have demonstrated efficacy for RLS; however, opioids carry risks that require cautious use and clinical oversight. […] This is an innovative treatment developed that has received a conditional recommendation of support for the treatment of RLS.

• #75 New guideline provides treatment recommendations for RLS

  https://aasm.org/new-guideline-provides-treatment-recommendations-for-restless-legs-syndrome/

  New guideline provides treatment recommendations for restless legs syndrome. A new clinical practice guideline developed by the American Academy of Sleep Medicine provides updated recommendations for the treatment of restless legs syndrome. The guideline reflects the latest scientific evidence and recommends significant changes in the standard treatment of RLS in adults. […] One of the significant changes in the new guideline is that it elevates the importance of iron evaluation in everyone with RLS and, depending on iron indices, recommends iron supplementation. These recommendations reflect evidence suggesting that low brain iron is an important underlying cause of RLS. For adults with RLS, the guideline provides a strong recommendation for intravenous ferric carboxymaltose and conditional recommendations for two other formulations of intravenous iron and one formulation of oral iron — ferrous sulfate. For children with RLS, ferrous sulfate received a conditional recommendation, making it the only treatment recommended for pediatric patients.

• #76

  https://www.e-jsm.org/journal/view.php?number=383

  Restless legs syndrome is a prevalent sensorimotor sleep disorder that worsens the quality of life. Dopamine agonists are widely used to relieve the symptoms of restless legs syndrome, even though these patients are in a hyperdopaminergic state. This treatment paradox inevitably leads to augmentation syndrome. Here, we review the pathophysiological basis of this deterioration in patients treated with dopamine agonists. Other treatment options are required with a focus on the neuromodulation of dopaminergic or non-dopaminergic pathways. […] DAs such as pramipexole, ropinirole, and rotigotine have been the mainstays of RLS treatment. […] However, the vast majority of clinical and brain imaging studies carried out over the last decade have revealed a paradoxical, presynaptic, and hyperdopaminergic state. This realization explains why DAs are highly effective for short-term pain relief in patients with RLS but have mid-term and long-term side effects: the most significant of which are augmentation syndrome (AS), characterized by an increase in both symptom severity and intensity, and a temporal and spatial progression of RLS symptoms; the latter starts earlier in the afternoon and spreads to previously unaffected parts of the body, especially the arms.

• #77 Critical Updates to the Treatment of Restless Legs Syndrome: John Winkelman, MD, PhD

  https://www.neurologylive.com/view/critical-updates-treatment-of-restless-legs-syndrome-john-winkelman

  The chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital provided insight on new updates to the management of restless legs syndrome, including removing dopamine agonists as first line treatments. […] „Dopamine agonists are not first line treatments. The reason for that is theres substantial evidence that dopamine agonists when used for restless legs syndrome are associated with an augmentation of symptoms, a worsening of the underlying disorder.” […] some of the topline highlights from the updated recommendations included the need to assess iron status and consider appropriate oral or intravenous iron therapy. Other than for iron, there was no evidence that supplemental minerals or vitamins relieve idiopathic RLS. Additionally, unless contraindicated, the recommendations stated that alpha2-delta ligands should be first-line agents for chronic persistent RLS, with dopamine agonists considered more second-line drugs. Furthermore, low-dose opioid therapy can be an effective approach for refractory RLS, with appropriate precautions.

• #78 Restless Legs Syndrome | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/restless-legs-syndrome

  No two patients respond identically to treatments for RLS. All treatments are felt to provide only symptom relief, rather than a permanent cure for RLS. Therefore, treatment should only be started when the benefits are felt to justify any potential side effects and costs. RLS is a chronic condition and, therefore, treatment decisions should take into account potential long-term issues and be individualized to the particular needs of the patient. Both dosing and medication changes are often required to maximize benefit and minimize the risk of tolerance and side effects over time. […] By far, the most consistently effective treatments for RLS are prescription medications. No medication has been specifically developed for RLS, but fortunately, medications developed for other conditions often help RLS symptoms.

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