Iron for restless legs syndrome Cochrane

Department of Neurology, Emory University School ofMedicine, Atlanta, USA.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 05/2012; 5(5):CD007834. DOI: 10.1002/14651858.CD007834.pub2
Source: PubMed


Restless legs syndrome (RLS) is a common medical condition that results in uncomfortable urges to move the legs, especially in the evening and at night, and often interferes with sleep. Low blood levels of iron are frequently seen in people who have RLS and the lack of iron may be part of the cause of RLS. Iron can be supplemented either in pill form or through injections into the bloodstream. This review was performed to see if iron supplements are effective in reducing the symptoms of RLS. Six studies of iron were included, which together involved only 192 subjects. Results from the studies were conflicting, with some studies showing that iron was not effective but others showing some help for patients' feelings of restlessness or discomfort. Because of the different ways in which the studies were done, we could not combine results from all of the studies to come up with an overall judgement of whether or not iron is effective. Two of the studies were limited to specific sub-groups of RLS patients, who might be expected to respond to iron differently than would the RLS group as a whole. The study of RLS patients with severe kidney disease showed a benefit of iron therapy. The study of RLS patients with low blood levels of iron did not consistently show a benefit of iron therapy at all time points. Iron did not cause any more side effects than the placebo medication. More studies are needed before we will be able to determine whether iron therapy should be used for patients with RLS.

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    • "In a recent randomized, blinded study, general population patients who met the 2003 IRLSSG criteria for RLS and had low serum ferritin were treated with iron versus placebo and were found to have clinically significant improvement in their RLS symptoms/severity as well as a trend towards improvement in quality of life [37]. Other studies have shown variable benefit of iron replacement therapy in RLS patients [38]. There are no studies to date that have proven this benefit in the RA RLS population. "
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    ABSTRACT: Restless legs syndrome (RLS) is a common neurological disorder of unknown etiology that is managed by therapy directed at relieving its symptoms. Treatment of patients with milder symptoms that occur intermittently may be treated with nonpharmacological therapy but when not successful, drug therapy should be chosen based on the timing of the symptoms and the needs of the patient. Patients with moderate to severe RLS typically require daily medication to control their symptoms. Although the dopamine agonists, ropinirole and pramipexole have been the drugs of choice for patients with moderate to severe RLS, drug emergent problems like augmentation may limit their use for long term therapy. Keeping the dopamine agonist dose as low as possible, using longer acting dopamine agonists such as the rotigotine patch and maintaining a high serum ferritin level may help prevent the development of augmentation. The α2δ anticonvulsants may now also be considered as drugs of choice for moderate to severe RLS patients. Opioids should be considered for RLS patients, especially for those who have failed other therapies since they are very effective for severe cases. When monitored appropriately, they can be very safe and durable for long term therapy. They should also be strongly considered for treating patients with augmentation as they are very effective for relieving the worsening symptoms that occur when decreasing or eliminating dopamine agonists.
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