Iron Supplementation for Restless Legs Syndrome

Assessment of Iron Status in RLS

Iron studies should be regularly tested in all patients with clinically significant RLS, including ferritin and transferrin saturation, according to the American Academy of Sleep Medicine 2
Testing should ideally be done in the morning, avoiding all iron-containing supplements and foods at least 24 hours prior to blood draw, as recommended by the American Academy of Sleep Medicine 2
The American Academy of Sleep Medicine recommends iron supplementation guidelines for RLS patients with serum ferritin ≤75 ng/mL or transferrin saturation <20% 2

The American Academy of Sleep Medicine recommends oral iron supplementation as first-line therapy for patients with RLS and iron deficiency parameters (low ferritin and low TSAT) 1
The recommended daily dose of oral iron for adults is at least 200 mg of elemental iron, according to the American Journal of Kidney Diseases 3
Intravenous iron formulations should be considered if oral iron is ineffective or poorly tolerated, especially for patients with ferritin between 75-100 ng/mL, as suggested by the American Academy of Sleep Medicine 1, 4

If hemoglobin continues to rise significantly during iron therapy, treatment should be temporarily discontinued and the patient should be evaluated for other causes of polycythemia, as recommended by the American Journal of Kidney Diseases 3
Monitor for adverse effects of oral iron, which commonly include gastrointestinal symptoms such as constipation, according to the American Academy of Sleep Medicine 5

The American Academy of Sleep Medicine recommends addressing potential exacerbating factors for RLS, such as alcohol, caffeine, antihistaminergic, serotonergic, and antidopaminergic medications 2
If iron therapy alone is insufficient, alpha-2-delta ligands are recommended as first-line pharmacologic therapy for RLS, according to the American Academy of Sleep Medicine 2
Dopamine agonists are no longer recommended as first-line therapy due to the risk of augmentation with long-term use, as stated by the American Academy of Sleep Medicine 6