First Line Therapies
Current consensus treatment guidelines recommend:
Iron - Oral and Intravenous iron treatment indications
Alpha-2-Delta Ligands - gabapentin, gabapentin enacarbil or pregabalin
John Winkelman, MD, PhD explains the most current treatment guidelines and management strategies for RLS.
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Second Line Therapies
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. An estimated 5-10% of individuals taking dopaminergic medications experience new onset augmentation each year. Medications in this drug class include ropinirole, pramipexole and the rotigotine patch.
In addition, several drugs approved for treatment of other medical conditions have undergone clinical studies with RLS patients and provide symptom relief when used “off label.” Off label use is the prescribing of approved medications that show success in treating another medical condition other than its intended use, a practice permitted by FDA regulations. The 2021 Mayo Clinic Proceedings Article outlines the treatment algorithm for the care and management of the individual living with restless legs syndrome.