Non-Medication Treatment Of RLS (Restless Legs Syndrome)
The pharmacist discusses what a patient should do who has run out of medication for treatment of RLS (Restless Legs Syndrome).
I ran out of ropinirole and can’t get a refil until 4/28. I take 2 tab. 4mg per day. I suffer from sever restless leg, am under a Doctors care and am in good. Is there anything I can take to help?
Since you are running out of medication too soon, this should be discussed with the doctor to best titrate the dose to your needs.
According to the prescribing information for this medication, it is important that this medication is titrated up slowly to avoid side effects and to find the best dose to treat your restless leg syndrome (RLS) symptoms.
When coming off this medication, it is typically tapered down as well. Since you may be out of the medication before you intended, it is important to watch for symptoms of withdrawal, which include:
- Rigid muscles
- Confusion or agitation
- Low blood pressure
The above symptoms can happen because the medication is impacting the dopamine in your body and the body needs time to properly adjust to either the addition of the medication or the discontinuation of it.
Due to the nature of this medication and needing titrating and tapered, it should be discussed with the doctor the best dosing to last you until your next refill. Your doctor may want to titrate the dosing up again depending on how much time has lapsed between your last dose and when you pick up the next fill.
There are no non-prescription medications or supplements that have sufficient evidence they help with restless leg syndrome.
There have been small studies on vitamins and iron, but these have been inconclusive and have appeared more helpful in those with end-stage kidney disease or on hemodialysis. There are also limited studies regarding non-medication methods of helping with restless leg syndrome. These small studies focused on pneumatic compression devices, exercise, and sleep hygiene.
Ferrous Sulfate and Vitamin C
Low iron levels may be associated with increased severity of RLS symptoms. However, this may not be helpful if iron levels are not equal to or less than 75 micrograms/L. Ferrous sulfate 325 mg can be bought over-the-counter and dosed as one tablet twice a day. Taking these with vitamin C (200 mg) or orange juice can help increase the absorption of the ferrous sulfate.
Ferrous sulfate should not be taken at the same time as calcium supplements or dairy products because it decreases the absorption. Multivitamins also contain iron and it is important not to take the iron sulfate on top of a multivitamin, as it is possible to get too much. Ferrous sulfate can interact with other medications as well, such as agents for Parkinson's disease, certain antibiotics, certain HIV medications, and levothyroxine.
It is important to discuss taking ferrous sulfate with the doctor or check to see if this will interact with any other medications.
Pneumatic Compression Devices
Patients in a study wore a compression device for at least 1 hour per day for 1-3 months. These patients reported a significant decrease in RLS symptoms. Pneumatic compression devices may be a good non-medication therapy to try along with medication therapy. However, a doctor typically has to be consulted for pneumatic compression devices.
The link between RLS and exercise is still unclear. There have been studies suggesting exercise close to bedtime can make RLS symptoms worse, but there have been other studies suggesting that lack of exercise can increase the risk of RLS. A small study showed RLS symptoms significantly decreased when patients exercised using aerobic and lower-body resistance training for 3 days of the week compared to those who did not. RLS symptoms started to improve as early as 6 weeks after starting the 3 days/week exercise regimen in some patients.
Sleep hygiene is particularly important if RLS symptoms are affecting your sleep. Although sleep hygiene is not directed toward reducing RLS symptoms, it may still help improve sleep.
Important sleep hygiene practices are:
- Exercising regularly
- Avoiding caffeine/nicotine/other stimulants and high-fat foods close to bedtime
- Limiting daytime napping to 20-30 minutes
- Getting enough exposure to light during the day and having a dark environment when going to bed, establishing a relaxing before-bedtime routine, and having a pleasant sleeping environment (regarding temperature, light, noise, etc.)
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