An Updated Algorithm for the Management of Restless Legs Syndrome

Restless legs syndrome (RLS), a common disorder, is largely managed by primary care providers. Much has changed in its management since the last version of this algorithm was published in 2021. The Scientific and Medical Advisory Board of the RLS Foundation has written this new paper as a practical algorithmic guide to current treatment based on a review of the literature published since 2020 and consensus expert opinion. This updated algorithm includes management of intermittent RLS, with behavioral approaches; new indications for oral and intravenous iron therapy; the role of medications in exacerbating RLS; gabapentinoids as first-line pharmacologic therapy for chronic persistent RLS; the risks of dopamine agonists and the precautions needed if they are used; the management of dopamine agonist augmentation; the important role of low-dose opioids in management and how to safely use them; novel therapies including peroneal nerve stimulation and buprenorphine; and RLS in children, during pregnancy and lactation, in end-stage renal failure, and in the perioperative period. Alternative, investigative, and potential future approaches are addressed.