Restless Legs Syndrome medications & treatments
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Restless legs syndrome (RLS) is a nervous system disorder that causes an overwhelming urge to move the legs. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving can help ease the unpleasant feeling temporarily.
RLS can begin at any age and can worsen as you age. It can disrupt sleep, which may make it difficult to do daily activities and affect your quality of life.
Sometimes self-care activities and lifestyle changes can RLS relieve symptoms. Medications may also be added to help.
What is restless legs syndrome?
Restless legs syndrome, also known as Willis-Ekbom disease, is often labeled as a sleep disorder and is a leading cause of insomnia.
RLS causes an intense, often irresistible urge to move your legs usually because of an uncomfortable sensation. These sensations in your legs are often described as pulling, crawling, throbbing, itching, aching, or burning. They usually occur at night while in bed or when sitting for long periods of time. Walking around or stretching can help stop these uncomfortable sensations.
The symptoms may start at any age, but it becomes more common as people get older. RLS is more common in women than in men and about 10% of people in the US have RLS.
Often, there is no known cause of RLS. Researchers think the condition may be caused by an imbalance of the brain chemical dopamine, which helps to control muscle movement.
Genetics is thought to play a major role as up to 90% of people with RLS have a first-degree relative with RLS. RLS may also be a secondary condition that can be resolved by correcting the underlying problem. Some medical conditions are closely associated with the development of RLS, including:
- Iron deficiency anemia
- Kidney disease
- Parkinson’s disease
- Peripheral neuropathy
- Magnesium deficiency
Some medications can lead to the development of or worsen symptoms of RLS, including anti-nausea meds, antipsychotics, antidepressants, and antihistamines.
How is restless legs syndrome diagnosed?
There’s no single test for diagnosing restless legs syndrome but a doctor may order tests to rule out other conditions or discover a possible cause for the RLS. Blood tests may be ordered to check ferritin (iron), magnesium, and folate levels since any of these deficiencies might lead to RLS. Other substances in the blood may point to other reasons such as diabetes.
Once these can be ruled out, a diagnosis will typically be based on your symptoms although a neurological and physical exam, plus information from the person’s medical and family history and list of current medications, may be helpful.
There are 5 basic symptoms of restless legs syndrome required for a diagnosis of RLS include:
- A strong urge to move the legs that are often associated with uncomfortable sensations such as burning or itching.
- The urge to move the legs starts or gets worse during inactivity.
- The urge to move the legs is partially or completely relieved by movement such as walking.
- Symptoms start or worsen in the evening or at night.
- The symptoms are not caused by any other condition.
Diagnosing RLS in children may be difficult since it can be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long the symptoms last. RLS in children sometimes is misdiagnosed as “growing pains” or ADHD.
What are treatment options for restless legs syndrome?
The treatment of restless legs syndrome depends on the severity of the symptoms and if there is an underlying cause for them. Lifestyle changes, over-the-counter and prescription medications, as well as dietary supplements, can all be used to reduce or relieve symptoms.
If you have an underlying condition that is the cause of the RLS symptoms, treating this condition may help relieve the symptoms. For example, if you have low iron levels, taking iron supplements may get them back to normal and the symptoms may go away.
If you are taking a medication that is the cause, stopping it under the supervision of your doctor may help.
If you have primary RLS, where there is no underlying cause, mild symptoms may be treated with over-the-counter pain medications, or lifestyle changes such as moderate exercise, massages, and stretching may reduce symptoms.
For more severe cases of RLS, prescription medications such as dopamine agonists like pramipexole or anticonvulsants that affect calcium channels like Neurontin are typically used. If these are not helpful opioids such as oxycodone or hydrocodone are sometimes used to treat severe RLS.
Other medications less commonly used are dopaminergic agents like Sinemet (carbidopa/levodopa) as well as benzodiazepines like Klonopin (clonazepam). Sinemet can cause a worsening of symptoms, called augmentation for some people after daily use. Klonopin doesn’t necessarily relieve symptoms but instead helps you sleep through them.
What is the best medication for restless legs syndrome?
The best medication for the treatment of RLS will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with RLS medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most commonly prescribed Food & Drug Administration (FDA) approved RLS medications.
Best medications for restless legs syndrome
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Mirapex (pramipexole)||Dopamine agonist||Oral||0.125mg to 0.5mg 2 to 3 hours before bedtime.||Drowsiness, nausea, impulsive behaviors, daytime sleepiness|
|Requip (ropinirole)||Dopamine agonist||Oral||0.25mg to 4mg 1 to 3 hours before bedtime.||Drowsiness, nausea, impulsive behaviors|
|Neupro (rotigotine)||Dopamine agonist||Transdermal patch||1mg to 3mg/24hrs.||Nausea, vomiting, loss of appetite, insomnia|
|Horizant (gabapentin enacarbil)||Gabapentinoid||Oral||600mg daily in the evening around 5 pm.||Dizziness, drowsiness, headaches, nausea|
|Lyrica (pregabalin)||Gabapentinoid||Oral||50mg to 75mg 3 hours before bedtime.||Nausea, drowsiness, dry mouth|
|Oxycontin (oxycodone hcl)||Opioid||Oral||10mg to 30mg daily in divided doses||Nausea, constipation, drowsiness|
|Tylenol (acetaminophen)||Pain reliever||Oral||325mg to 650mg every 6 hours as needed.||Nausea, stomach pain, loss of appetite|
|Motrin (ibuprofen)||NSAID||Oral||200mg to 400mg every 4 to 6 hours as needed.||Nausea, stomach pain, bleeding|
Your healthcare provider will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.
What are the most common side effects of restless legs syndrome medications?
As with all medications, there are side effects associated with those used to treat RLS. Some of the most common include:
- Dry mouth
Dopamine agonists can cause more serious side effects such as hallucinations, and impulsive behaviors, and cause withdrawal even when slowly tapered.
Opioids and gabapentinoids can also cause withdrawal if stopped suddenly. These are also highly abused drugs that cause overdoses, especially opioids.
What home remedies can help treat restless legs syndrome?
Changes in your lifestyle are one of the most effective treatments for RLS and include:
- Avoid caffeine, nicotine, and alcohol as well as certain medications like antihistamines
- Get regular exercise
- Warm baths
- Apply a heating pad or an ice pack
- Follow a good sleep routine
- Reduce stress
Frequently asked questions about restless legs syndrome
What is the quickest way to get relief from RLS?
Moving or stretching usually provides temporary but quick relief. Massaging your legs may also help.
Is it possible to have RLS symptoms in other parts of your body?
Yes, RLS symptoms can affect other body parts such as your arms, hands, or face.
What should I avoid with RLS?
Some medications, foods, and other substances are known to cause or increase RLS symptoms. Caffeine, alcohol, nicotine as well as some medications such as antidepressants, allergy drugs, and anti-nausea medications can cause or worsen RLS symptoms.
What is the best OTC medication used to treat RLS?
If you have a mild to moderate case of RLS, OTC pain relievers such as acetaminophen or ibuprofen may help.
Related resources for restless legs syndrome
- Restless legs syndrome. MayoClinic.org
- Restless legs syndrome symptoms and causes. ClevelandClinic.org
- Restless legs syndrome overview. WebMD.com
- Restless legs syndrome fact sheet. National Institution of Neurological Disorders and Stroke
- Everything you need to know about restless legs syndrome. Medicalnewstoday.com
- Treatment of restless legs syndrome with pregabalin. Neurology.org