In most cases, restless legs syndrome is a lifelong condition—though some people may go days or months without any symptoms. For those people, or for others whose symptoms do not affect their quality of life, no treatment may be necessary. For people with more severe symptoms, medicines are available. Several medications may be used to treat RLS. Some medications can make restless legs worse. These include some antihypertensive medications (taken for high blood pressure) and antidepressants. Your doctor may recommend stopping these medications, finding alternatives that do not worsen your symptoms, or adding medications to treat RLS.
Although RLS can often worsen—or appear for the first time—during pregnancy, doctors usually don't recommend taking drugs for the condition during pregnancy. If the symptoms of restless legs syndrome are being caused by another disease, such as peripheral neuropathy or diabetes, treating the underlying disease may reduce the symptoms. Similarly, because low blood levels of iron can also cause these disorders, treating anemia or low iron levels may relieve the symptoms.
The medications most commonly prescribed for restless legs syndrome are dopaminergic agents and are normally the first choice for the treatment of RLS. These drugs alter the activity of dopamine, a chemical that carries messages in the central nervous system. Ropinorole (Requip®), pramiprexole (Mirapex®) and rotigotine transdermal (Neupro®) have been approved by the Food and Drug Administration (FDA) for moderate-to-severe RLS. Side effects include dizziness, drowsiness and nausea. Augmentation, in which symptoms appear earlier in the day, is a problem with long-term use of these drugs. The solution to this problem is usually switching to another drug.
The only other medication approved by the FDA for moderate-to-severe RLS is the anticonvulsant gabapentin enacarbil (Horizant®). Other medications that may be used to treat RLS, although not FDA-approved for this purpose, include benzodiazepines and opioids.
Treating Iron Deficiency
In some people, RLS appears to be caused, or worsened, by iron deficiency. If blood tests determine that you are anemic, your doctor may recommend iron supplementation. Oral iron supplements can cause constipation; eating a high-fiber diet may counteract this effect, or your doctor may tell you to take the supplement with a stool softener or to reduce the dose. For some people, intravenous delivery of iron may be necessary.