Medicines for Restless legs syndrome

What it is

Restless legs syndrome (RLS) is a common condition that creates an overwhelming need to move the legs, usually accompanied by an unpleasant crawling, tingling or aching sensation deep in the limbs. Three features are typical: the symptoms build up when you are at rest, they are worse in the evening and at night, and they are relieved, at least briefly, by moving — walking, stretching or rubbing the legs. Because it disrupts settling and staying asleep, RLS can be a major cause of poor sleep and daytime tiredness. It can occur on its own or be linked to other factors, the most important being low iron stores; it is also more common in pregnancy and in people with kidney disease. Severity ranges widely, from an occasional nuisance to a nightly problem that significantly affects quality of life.

How it is treated

The first step is to look for and treat anything that may be driving the symptoms — most importantly checking iron stores, because correcting low iron can resolve or greatly improve RLS, and reviewing medicines or substances that can worsen it. Many people need no drug treatment at all once aggravating factors are addressed and simple measures are in place. When symptoms are frequent and distressing enough to need medication, the options work in different ways: gabapentinoids are often preferred, while dopamine agonists are also used. A particular long-term concern with dopamine agonists is "augmentation", where the symptoms gradually become more intense, start earlier in the day or spread — which is why these medicines are used thoughtfully, reviewed regularly and not simply increased over time. Treatment is individualised and adjusted to keep symptoms controlled with the least medication needed.