Restless Legs Syndrome

Finding The Right Treatment

Treatment

There are both medication and behavioral options for the treatment of RLS.

Determining whether medication will play a role in treatment

The Food and Drug Administration (FDA) has approved four medications for the treatment of RLS, including ropinirole (Requip), pramipexole (Mirapex), gabapentin enacarbil (Horizant) and rotigotine (Neupro). These medications fall into different categories of drugs; ropinirole, pramipexole, and rotigotine are all dopamine agonists, while gabapentin enacarbil is an antiseizure drug. Dopamine agonists are also used to treat people with Parkinson’s disease.

Several other medications are prescribed for RLS, including gabapentin (Neurotin), and pregabalin (Lyrica). These medications are often used by neurologists to treat seizures and epilepsy but have been found to be effective in the treatment of RLS, as well.

Some doctors choose sedating medications to treat RLS, such as benzodiazepines, including clonazepam (Klonopin). These medications cause drowsiness. Although they are effective, they are prescribed with caution due to their potential for dependency.

Benzodiazepines have addictive potential, so individuals with a history of substance abuse should avoid these medications. However, taken as prescribed, these medications can provide rapid relief from acute anxiety. It is best not to take benzodiazepines for long periods of time because of the risk of psychological and physical dependency. Benzodiazepines should never be taken with opioid medications or when alcohol is consumed.

Restless leg syndrome is the leading cause of Insomnia

Because of this, conventional treatments to improve sleep are used for RLS. Although these medications can cause sedation, they do not address the underlying restlessness that is a core part of RLS. For this reason, many patients find that Ambien, Trazodone, and Lunesta are not fully effective for the full range of RLS symptoms.

Medical device and related solutions

One prescribed medical device has been approved by the FDA to treat restless legs syndrome: The Restiffic foot wraps are composed of two compression loops & hooks placed around the bottom center of the feet. These devices start at about $200 but may be covered by health insurance, depending on an individual's health plan.

Some individuals experience improved RLS symptoms with the use of compression socks, which improve blood flow and raise oxygen levels in the legs. Weighted blankets, nerve stimulators, leg massagers, and heating pads are additional comfort measures.

Medications to avoid

In some cases, opiate medications have been prescribed, including hydrocodone, Vicodin, Lortab, codeine (Tylenol with codeine), tramadol (Ultram, Tramal), or oxycodone XR formulations, such as Tylox or Percodan, as well as methadone or morphine. Important warning: Never take an opioid at the same time as taking a benzodiazepine or any other sedating drug. This includes alcohol. Such a combination is extremely dangerous and can lead to an unintentional overdose.

Note that people with restless legs syndrome should generally NOT take other medications that increase their blood levels of the neurochemical serotonin. These include medications that are serotonin reuptake inhibitors (SRIs) such as fluoxetine (Prozac) or sertraline (Zoloft). In addition, they should not take medications in the medication category of serotonin norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.

Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.