In mild cases of RLS, some people find that activities such as taking a hot bath, having a shower, massaging the legs, using a heating pad or ice pack, doing deep knee bends, stretches or other exercises can help alleviate symptoms. Elimination of caffeine drinks and tobacco, as well as minimal consumption of alcohol may also lessen symptoms.
It is important to ask your doctor to check your serum ferritin level to evaluate iron storage status. Establish that you are in the normal range of iron (be wary, if at lower level of normal). Then, if restless sensations persist at an uncomfortable level, especially if causing sleep deprivation, it may be necessary to consider drug therapy. Because Restless Legs Syndrome is a neurological movement disorder you are advised to consult with a Neurologist, who should more likely be familiar with recent treatment practice.
Dopaminergic agents Carbidopa/levodopa, (Sinemet and Madopar) are drugs which add dopamine to the body's system and have been used the longest. Unfortunately, the high rate of "augmentation" of symptoms, around 85%, is a major disadvantage. Augmentation means you may have a better night's sleep, but paradoxically, the symptoms can worsen, developing at an earlier time in the day, often intensifying! A higher dose will only exacerbate RLS. The standard formulation has an effective life of only 2 to 3 hours. Consequently, many doctors now only recommend Sinemet and Madopar to those with mild symptoms, where low doses can be effective.
Pergolide (Permax), a dopamine-receptor agonist, has proven to be a much more effective treatment, with only 10% augmentation and approximately 24 hours therapeutic effect. Researchers internationally, have reported that patients in controlled studies have shown significant improvement in symptoms, with minimal side effects. Nasal congestion, hypotension and nausea can be experienced by some. Patients, who experienced nausea in a German trial, were successfully treated with the add on medication, domperidone (Motilium), during the initial phases.
Two new dopamine-receptor agonists, pramipexole (Mirapex) and ropinerole (Requip), are reported to be producing very effective results in trials overseas. Unfortunately, there are no plans, as yet, to release these drugs in Australia.
Benzodiazepines, sedative agents These work by toning down the central nervous system, enabling sleep, despite some of the movements and sensations continuing. This, of course, can create quite a dilemma for the long suffering bed partner!
The drug most often used in this group is clonazepam (Rivotril), and is mainly only successful with milder cases. Diazepam (Valium) is often reported by patients as a drug prescribed by their doctors ... when they don't know what else to try or they are reluctant to prescribe medication from other drug groups, eg: dopaminergic agents. Drawbacks to the use of these medications include the potential for daytime drowsiness or confusion, especially in older patients. Beware of impaired ability to operate machinery or drive. It is best policy to avoid alcohol. Benzodiazepines may result in unwanted psychological or physical addiction, so medical consultation is essential.
Opioids, narcotic agents Opioids, which are narcotic analgesic (pain killing) drugs, are most often used for people with severe relentless symptoms. Side effects include dizziness, sedation, nausea, vomiting, constipation, hallucinations and headache. The sedative qualities can impair alertness, while narcotic addiction is a concern, although physicians have reported that this is not such a problem at very low doses. Those that try this classification of drugs are usually people who have already tried the other drug groups without success.
Anticonvulsant agents These drugs appear to work by decreasing sensory disturbances and the urge to move. They are particularly effective for some, but not all, patients with marked daytime symptoms, especially those who have pain syndromes associated with their RLS. The most promising of these is gabapentin (Neurontin). Side effects may include dizziness, sleepiness, fatigue, increased appetite and unsteadiness. As with other drugs, the sedative properties may cause mental impairment.
Beware of drug related symptoms It seems that the use of some medications will worsen RLS symptoms. Included in these drugs are the calcium-channel blockers (used to treat high blood pressure and heart conditions), metoclopramide (Reglan), most antinausea medications, some of the cold and allergy medications, major tranquilizers (including haloperidol and phenothiazines), and phenytoin (antiseizure). A recent report indicates that medications used to treat depression can increase RLS symptoms. Ironically, some peoples' symptoms may improve with the use of anti-depressive drugs; however, it is more often the case that they will worsen.
General drug therapy guide All drugs should be started at low doses, increasing slowly if needed, in order to decrease potential side effects. Careful trials are typically necessary, to find the best medication and dosage for each individual. Some patients report that a combination of medications is needed for effective treatment. Others find their drug loses its efficacy after a time and they need to change to another.
It really is vital for you to find an understanding and informed physician.
In mild cases of RLS, some people find that activities such as taking a hot bath, having a shower, massaging the legs, using a heating pad or ice pack, doing deep knee bends, stretches or other exercises can help alleviate symptoms. Elimination of caffeine drinks and tobacco, as well as minimal consumption of alcohol may also lessen symptoms. 
