Restless Legs

An uncomfortable urge to move the legs, often with crawling, tingling or aching deep in the calves. It comes on when resting, is worst in the evening and at night, and eases with movement. Common, especially in pregnancy and with low iron, kidney disease or some medicines. It often runs in families.

Treatment options

Ratings show how strong the research is.

• Strong evidenceIronA blood test checks your iron stores (ferritin). People with restless legs benefit from higher iron levels than usual, so treatment is suggested if ferritin is 75 or below. An iron infusion works faster and more reliably than tablets.
• Strong evidenceGabapentin or pregabalinThe preferred medicines when symptoms are frequent. Taken a few hours before symptoms usually start. Can cause drowsiness and dizziness.
• Limited evidenceLow-dose opioidsFor severe restless legs that hasn’t responded to other treatment, under close supervision.
• Not recommendedDopamine medicines as routine treatmentPramipexole, ropinirole, rotigotine and levodopa work well at first, but over time often make symptoms worse and earlier in the day ("augmentation"). A 2024 US guideline no longer advises them for standard use. If you already take one, don’t stop suddenly: talk to your GP.
• Not recommendedClonazepam, magnesium or valerianNo good evidence they help restless legs.

What you can do

• Walk, stretch, massage your legs or have a warm bath when symptoms start.
• Cut back on caffeine and alcohol, and stop smoking.
• Keep your mind busy when sitting (puzzles, reading). Book aisle seats on long trips.
• Get enough sleep, as tiredness worsens symptoms.
• Ask your pharmacist whether any medicine may be a trigger: sedating antihistamines, some antidepressants and some anti-nausea medicines are common culprits.

See your GP if

• Symptoms disturb your sleep more than twice a week
• You’re pregnant, or give blood often (both lower iron)
• Symptoms are getting worse or starting earlier in the day on treatment

See a doctor promptly for leg weakness, numbness that doesn’t go away, or a hot, red, swollen calf. These are not typical of restless legs.

Evidence and more information

• Healthdirect: Restless legs syndrome
• AASM: Summary of the RLS treatment guideline
• AASM: RLS guideline at a glance (2025)

Reviewed October 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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