This handout is for restless legs syndrome / willis–ekbom disease. Your care team identified this based on: urge to move the legs, usually with/caused by an uncomfortable or unpleasant leg sensation (irlssg essential criterion 1; aasm 2025 pmid 39324694).
Other reasons your team may use this plan: symptoms begin or worsen during rest or inactivity (sitting, lying — criterion 2); partial or total relief by movement (walking, stretching) at least as long as the activity continues (criterion 3); worse in the evening/night than during the day, or only occurs in evening/night (criterion 4).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ferrous sulfate | 325 mg (≈65 mg elemental iron) + vitamin C 100-200 mg, alternate-day single dose (maximises fractional absorption — cross-ref heme.iron-deficiency-anemia.core.v1) | PO | every other day | IRLSSG iron consensus PMID 29425576 — oral iron when ferritin ≤75 ng/mL & TSAT >20%; AAN 2016 Level B (ferrous sulfate + vitamin C) PMID 27856776; alternate-day dosing blunts hepcidin (cross-ref heme.iron-deficiency-anemia.core.v1) |
| ferric carboxymaltose | 750-1000 mg IV (per weight/regimen); recheck ferritin/TSAT before re-dosing | IV | single/two-dose course | FCM RCT IRLS decrease 8.9 vs 4.0, CGI-I much/very-much improved 48.3% vs 14.3% (corroborated PMID 28643901); IRLSSG iron consensus PMID 29425576 — IV iron when oral inappropriate / ferritin ≤100; strong evidence; preferred in CKD |
| iron sucrose | 200 mg IV per session, multiple sessions to target dose | IV | multiple sessions | Alternative IV iron — IRLSSG iron consensus PMID 29425576; often the dialysis-unit formulary IV iron |
| IV iron infusion procedure + premedication/monitoring | — | — | — | Infusion-reaction monitoring; hypophosphataemia surveillance with repeated FCM (cross-ref heme.iron-deficiency-anemia.core.v1) |
| sleep hygiene + moderate exercise + avoid evening caffeine/alcohol/nicotine | — | — | — | Foundational non-pharmacologic measures (AASM 2025 PMID 39324694; Silber 2021 PMID 34218864) |
| withdraw RLS-aggravating drugs | — | — | — | Antihistamines, dopamine antagonists/antiemetics, mirtazapine/SSRI/SNRI, antipsychotics, alcohol/caffeine/nicotine worsen RLS; switch antidepressant to bupropion (RxCUI 42347; RLS-neutral/beneficial) |
| pneumatic compression device | — | — | — | AAN 2016 Level B (PMID 27856776) — consider when a non-pharmacologic approach is desired; NIRS / rTMS Level C |
Plan: RLS/WED chronic management — iron repletion → alpha-2-delta first-line → dopamine agonist limited → low-dose opioid refractory (AASM 2025 PMID 39324694; IRLSSG iron PMID 29425576; Garcia-Borreguero 2016 PMID 27448465)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Iron recheck 8-12 wk after repletion (and before re-dosing IV iron); titrate alpha-2-delta to effect; pregnancy RLS usually remits postpartum (de-prescribe); periodic aggravator review; long-term opioid stewardship; re-evaluate diagnosis if refractory despite repletion + adequate first-line therapy
Guideline: 2025 AASM Clinical Practice Guideline — Treatment of RLS and PLMD (Winkelman, JCSM 2025; NEWEST — primary floor) + AASM 2025 systematic review/meta-analysis/GRADE + AAN 2016 practice guideline + IRLSSG iron-treatment consensus (Allen 2018) + IRLSSG/EURLSSG/RLS-F first-line + augmentation guideline (Garcia-Borreguero 2016) + Silber Mayo updated algorithm 2021