Restless Legs Syndrome

Pharmacologic Treatment

With optimization of lifestyle and treatment for comorbid conditions, in combination with removal of exacerbating substances and medications, many patients with RLS avoid the need for pharmacologic intervention; however for those patients whose symptoms negatively impact their ability to actively engage in employment, leisure, and family pursuits and who desire treatment, pharmacologic intervention has been shown to significantly improve quality of life.2,3,112,146,148,149,170-179 No currently available drugs can cure RLS; they aim only at providing symptomatic relief. Because RLS is a chronic condition, therapy must usually be continued indefinitely.

Symptoms of RLS that occur only intermittently, i.e., not daily, can often be managed with medications administered on an as-needed basis. Any of the primary medications in the following sections, with the possible exception of gabapentin, may be used in this manner; however, the onset of action of each drug will determine the timing of the appropriate dose.

Key Points to Achieving Optimal Pharmacologic Treatment of RLS

• Treatment of comorbid conditions may alter the pharmacologic treatment of RLS
• Drugs should be initiated at the lowest possible dose and gradually upwardly titrated
• Onset of action and half-life of medications, in combination with the patient's personal schedule, determine the appropriate timing of treatment
• Drugs are often given at lower doses in the treatment of RLS than in the treatment of the condition for which the drug is indicated
• Intractable RLS may require the use of polytherapy
• Effective long-term therapy may be difficult; when one drug loses its effectiveness, another drug in the same or a different class may prove to be effective