First Line Therapies

Current consensus treatment guidelines recommend:
Iron - Oral and Intravenous iron treatment
Alpha-2-Delta Ligands - gabapentin, gabapentin enacarbil or pregabalin

View this video as John Winkelman, MD, PhD explains the most current treatment guidelines and management strategies for RLS.

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.

Diet Considerations

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. That is why we recommend checking ferritin levels to see if you have an iron deficiency and possibly supplementing your diet with iron. Note: Iron supplements should only be taken under the care and supervision of a physician.

You should also identify and avoid habits or factors that may trigger or exacerbate RLS symptoms.

Caffeine has been linked to an increase in RLS symptoms. Many people also find that nicotine, alcohol and refined sugar may lead to an increase in RLS symptoms.

Exercise/Activity Guidelines

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. For those individuals living with RLS, one study suggests that regular exercise reduces severity of the symptoms by an average of 40 percent.

A few guidelines:

• Daily is best! Make 30-60 minutes of enjoyable, physical activity a daily lifetime habit.
• Emphasize activities involving the legs, including both aerobic and high-load (resistance) exercise.
• Exercise in moderation. Avoid exercising to the point that muscles or joints ache or become painful as this will very likely make the RLS symptoms and your sleep worse.
• Do not engage in any activity or workload that a doctor has told you to avoid.
• In addition to planned sessions, increase “incidental” activities such as taking the stairs, using easy-to-find, distant parking places, performing physical chores with force and energy, etc.
• Determine for yourself when to exercise for optimal relief from RLS symptoms. However, avoid significant exertion within an hour or so of bedtime.

Please note: the information provided on these pages is for informational purposes only. It should not be considered a substitute for the advice of a healthcare provider.