Restless Legs Syndrome (RLS) - Treatment Overview

Treatment Overview

Treatment for restless legs syndrome is based on the type of symptoms you have and how bad your symptoms are. Getting regular exercise and enough sleep may relieve mild symptoms. Medicines may be tried when symptoms are severe and interfere with sleep and daily functioning. If your symptoms are being caused by another medical condition (such as iron deficiency anemia), that condition can be treated first.

Initial treatment

Changing your daily routine is sometimes enough to control your symptoms. Stretching, walking, exercising regularly, taking a hot or cold bath, using massage, and avoiding smoking and caffeine may reduce or control your symptoms.

If your symptoms are caused by another medical condition such as diabetes or iron deficiency anemia, you will be treated for that condition first. For example, if iron deficiency is causing restless legs syndrome, you will be prescribed iron supplements.

Restless legs syndrome that starts during pregnancy usually goes away soon after the baby is born, most often within days. Your doctor may recommend conservative treatment, such as regular exercise and stretching, to relieve symptoms. Your condition may be reevaluated if it doesn't go away after you have given birth.

Children with restless legs syndrome are not usually treated with drugs right away. Instead, regular, moderate exercise and regular sleep routines are tried first. If this treatment is not effective, the doctor may prescribe drugs—such as levodopa or dopamine agonists—that help increase a chemical in the brain called dopamine. These medicines can reduce symptoms as well as involuntary leg movements at night. Clonidine, a drug that is usually used to treat high blood pressure, has also been used to treat restless legs syndrome in children.

Ongoing treatment

If your symptoms are mild, you will probably be able to control the uncomfortable sensations and urges to move your legs through regular exercise, stretching, walking, losing weight if you are overweight, and by avoiding smoking and caffeine. Sometimes a hot or cold bath or massage can help. If your doctor determines that your restless legs syndrome is caused by another condition (such as diabetes or iron deficiency anemia), treating that condition will usually resolve your symptoms.

If your symptoms do not improve, drugs may be used to control involuntary leg movements and help you sleep, such as:¹

• Dopamine agonists, such as ropinirole (Requip), pramipexole (Mirapex), or the dopamine precursor, levodopa (Sinemet).
• Anticonvulsants, such as gabapentin (Neurontin).
• Opioids, such as oxycodone (Percocet), hydrocodone (Lortab), and tramadol (Ultram).

In addition, your doctor may prescribe sedative-hypnotics (including benzodiazepines and the newer non-benzodiazepine drugs like zolpidem [Ambien], zaleplon [Sonata], and eszopiclone [Lunesta]), alone or in combination with dopamine agonists, opioids, or anticonvulsants.

Medicines are started at the lowest effective dose. Sometimes doses are split, although both are usually taken in the evening. Sometimes drugs are combined to better control symptoms and manage side effects.

If your doctor recommends medicine, make sure that you discuss expectations and understand the potential benefits and risks of the drug. Let your doctor know about all of the other drugs you are taking. Drugs taken for other conditions sometimes contribute to restless legs syndrome. For example, antidepressants improve restless legs syndrome in some people, but make it worse in others.

Treatment if the condition gets worse

If you continue to have symptoms even though you are receiving treatment with drugs and are exercising regularly, eating right, and not smoking or using caffeine, your symptoms may need to be reevaluated. Many other conditions can cause the sensations found in restless legs syndrome, including several vitamin and mineral deficiencies.

Your doctor may recommend different drugs or a combination of drugs. Follow up with your doctor if your symptoms do not improve.