| Dopaminergic agents |
| Dopamine precursor combinations such as carbidopa-levodopa | Can be used on a “one-time” basis or as circumstances may require. Useful for persons with intermittent RLS because dopamine agonists take longer to have an effect. | As many as 80 percent of patients who take carbidopa-levodopa may develop augmentation.* Therapeutic effect may be reduced if taken with high-protein food. Can cause insomnia, sleepiness and gastrointestinal problems. |
| Dopamine agonists such as pergolide, pramipexole, ropinirole | Useful in moderate to severe RLS. Recent reports indicate high efficacy of dopamine agonists, but the role of their long-term use is unknown.29 | Can cause severe sleepiness,30 which may limit its use during daytime. |
| Agonists can cause nausea. To avoid this, slow dosage increase is important, especially for pergolide. |
| Opioids such as codeine, hydrocodone, oxycodone, propoxyphene, tramadol Benzodiazepines such as clonazepam, temazepam | Can be used on an intermittent basis. Can also be used successfully for daily therapy. Helpful in some patients when other medications are not tolerated and may help improve sleep. | Can cause constipation, urinary retention, sleepiness or cognitive changes. Tolerance and dependence possible with higher doses of stronger agents. Can cause daytime sleepiness and cognitive impairment, particularly in the elderly. |
| Anticonvulsants such as carbamazepine, gabapentin | Can be considered when dopamine agonists have failed. May be useful in those with coexisting peripheral neuropathy and/or when RLS discomfort is described as pain. | Vary, depending on agent. Gastrointestinal disturbance such as nausea, sedation, dizziness. |
| Iron (ferrous sulfate) | Use in patients with serum ferritin levels < 50 ng per mL (< 50 μg per L). | Ideal means of administration has not been established. Oral treatment may take several months to be effective and may be poorly tolerated. |
| Clonidine | May be useful in hypertensive patients. | Has the potential to cause hypotension, dermatitis and sleepiness. |