Restless Legs Syndrome (RLS)

Restless Legs Syndrome: http://www.nhs.uk/Conditions/Restless-leg-syndrome/Pages/Treatment.aspx

  • Often a side effect of medications (especially psych meds).
  • Ropinerole or Pramipexole (start low dose and titrate up)
    1. Start: Pramipexole (Mirapex)125mg PO at bedtime. Give patient instructions that if her symptoms still continued after 1 week of Pramipexole 0.125mg PO every night that she is to increase this medication to 2 tablets (0.250mg) every night. Maximum dose of Pramipexole is 4 tablets = 0.5mg PO qd, so this patient’s prescription can be increased further if her symptoms persist.
    2. Start: Ropinirole 25mg PO to be taken prior to bedtime. The Ropinirole is started at the lowest dose and will be titrated up until the patient notices a relief of his symptoms.
  • Order Ferritin level to r/o whether low iron is underlying etiology (Tx if Ferritin <50 = optional to correct (or <25 = definitely correct) with Iron Supplements (Ferrous Sulfate).
    1. Tx iron deficiency anemia: Ferrous sulfate/gluconate (either) 325 mg PO qd to tid and Vitamin C 500mg PO qd (helps with the absorption of the iron) – take with food b/c can upset GI.
      1. Consider giving Ferrous gluconate (qd) rather than Ferrous sulfate (tid) if compliance is an issue.
      2. Change the timing of Levothyroxine dose so that the Levothyroxine and ferrous sulfate are not given together because of decreased effectiveness when given together.
    2. The most commonly associated medical condition is iron deficiency anemia (specifically blood ferritin below 50 µg/L[10]), which accounts for 20% of all cases of RLS.
  • Emphasize good sleep hygiene, importance of regular exercise, and avoid caffeine close to bedtime.
  • May need to add Neurotin after trying max doses of Ropinerole and/or Pramipexole.
    1. Gabapentin 300mg PO q PM.

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