New Guidelines Issued on Iron Treatment for RLS

AUGUST 16, 2018 What You Should Know about Iron and RLS Iron deficiency is a known contributing factor to RLS, and many find some sy...

AUGUST 16, 2018
What You Should Know about Iron and RLS

Iron deficiency is a known contributing factor to RLS, and many find some symptom relief from supplemental iron in pill form or by intravenous (IV) infusions.

Healthcare providers have new guidance for treating RLS patients whose iron stores are low. A paper published in the January 2018 issue of Sleep Medicine provides information on how to evaluate RLS patients for low iron, when to offer iron therapy as a treatment, and which type of treatment is most likely to be helpful for individual patients, including children.

“Iron treatment, despite its importance, is not well understood,” says co-author Richard P. Allen, PhD, a researcher at the Johns Hopkins Center for Restless Legs Syndrome. “Iron treatment is complicated by current iron status, and the various oral and IV iron treatments available. Understanding the benefits of IV iron in particular for some patients is relatively new, and this paper provides reasonable guidance for its use that is not available elsewhere.”

Past research has shown that iron deficiency in the brain is an underlying abnormality of RLS. “RLS treatments are basically palliative – they reduce symptoms but do not reduce any basic biological abnormality,” Allen says. “Iron treatment differs. It serves to reduce, for some, a biological abnormality in RLS of reduced brain iron.”

The new report was developed on behalf of the International Restless Legs Syndrome Study Group (IRLSSG). In recent years, a number of research studies on iron for RLS and periodic limb movement disorder (PLMD) have been published. To evaluate these findings, the IRLSSG formed a task force of 12 medical experts in RLS, sleep medicine, neuroscience and other fields, to evaluate published research on the topic and develop a set of recommendations for clinical practice.

This group searched the medical literature and examined 299 related articles. The group’s analysis also included clinical recommendations based on expert clinical opinion. The resulting report includes evidence- and consensus-based guidelines that confirm iron should be a first-line treatment option for RLS. The report also recommends treating people with RLS and iron deficiency with oral iron first, unless there is a medical reason why oral iron cannot be used. The article presents updated treatment algorithms for iron use to treat RLS in adults, and both RLS and PLMD in children.

Importantly, the article delves into the differences among five different IV iron formulations available. “Not all IV iron formulations are alike, and some appear to work better than others,” says Dr. Allen. In addition, specific guidance about when and how to use oral iron is presented, including the recommendation that taking oral supplements once a day is preferable to taking them twice a day.

The article, “Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis- Ekbom disease in adults and children: an IRLSSG task force report,” is available online at

This and other clinical publications are the outcome of dedicated work by members of the RLS medical and scientific community to help healthcare providers worldwide offer the best possible medical treatment to RLS patients.

Iron and RLS: What you need to know

Every individual with RLS should have their blood iron levels (serum ferritin) checked, as keeping ferritin levels mid-range – at 75 micrograms per liter and above – correlates to RLS symptom improvement.

If your iron levels are low, your doctor may recommend ways to replenish your iron stores, including:

  • Increased consumption of iron-rich foods, especially meat, fish and liver. Leafy green vegetables also contain iron but may not be broken down adequately by your digestive tract to deliver significant amounts of iron to your body.
  • Oral iron supplements. For best iron absorption, iron pills should be taken at night on an empty stomach with vitamin C. They should not be taken with food, milk, antacids, calcium supplements or medications used to treat acid reflux and thyroid.
  • IV iron therapy. Your RLS doctor should be aware of the potential for IV iron treatment, and if you are an appropriate candidate, can refer you to a hematology center or RLS program that provides iron treatments for RLS.

Iron supplements should only be taken under the supervision and care of a physician to ensure proper monitoring and help prevent iron overload.

Learn more

To learn more about iron and RLS, please view the webcast “Iron and RLS” or see the handout Understanding Iron and Restless Legs Syndrome, available in the Member Portal at

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