Iron More Effective Than Requip for Restless Leg Syndrome

Published: October 23, 2012

Here is another study confirming what we have known for years — that addressing low iron (even with normal iron tests) is critical for addressing Restless Leg Syndrome (RLS) — and I find it to be more effective than the medication Requip.

In this study, patients with RLS with a mean ferritin of ~ 40 (which interestingly is the same cut off we use as our measure for low iron, despite "normal" being over ~ 9) were given iron or placebo, and had a marked improvement in their RLS symptoms vs. placebo.

To put it in perspective, in a recently completed U.S. trial, patients taking Requip decreased RLS symptoms by less than 4 points more than the placebo did. Iron lowered RLS symptoms by more than 9 points more than placebo. This makes iron more than twice as effective as Requip!

For addressing Restless Leg Syndrome, I give iron once a day on an empty stomach and at least 6 hours away from any thyroid hormone. I also add a good multivitamin powder, as this has many other nutrients that can help. If medications are needed, I add Neurontin at bedtime, and will sometimes add Klonopin if Fibromyalgia is also present (though the Klonopin may be addictive). I almost never recommend Requip.

To paraphrase, RLS is not a Requip deficiency!

Efficacy of oral iron in patients with restless legs syndrome and a low-normal ferritin: A randomized, double-blind, placebo-controlled study

Background and Purpose

Restless Legs Syndrome (RLS) is a primary disorder of sensation that affects sleep and has been associated with iron deficiency. The purpose of this study was to determine if symptomatic RLS patients with low-normal serum ferritin levels benefit from oral iron replacement.

Patients and Methods

This was a randomized, placebo-controlled, double-blinded study. Eligible patients were randomized to oral iron therapy vs. appearance-matched placebo and followed over a 12-week period.


Baseline International Restless Leg Scale scores for the therapy (24.8+/-5.72) and placebo (23.0+/-5.03) groups were similar. Baseline ferritin levels for the therapy (40.6+/-15.3ng/ml) and placebo (36.7+/-20.8ng/ml) groups were also similar.

After 12 weeks, International Restless Leg Scale (IRLS) scores decreased more in the therapy arm (10.3+/-7.40) than in the placebo arm (1.14+/-5.64), (p=0.01). Ferritin levels increased more in the therapy arm (25.1+/-20.3ng/ml) than in the placebo arm (7.5+/-13.7ng/ml), (p=0.04). We observed a nonsignificant trend toward improved quality of life in the treated patients, (p=0.07).


This is the first double-blinded, placebo-controlled study to demonstrate statistically significant improvement in RLS symptoms using oral iron therapy in patients with low-normal ferritin. The findings from this study suggest that additional larger randomized placebo-controlled trials of iron as therapy for patients with low-normal ferritin are warranted.


Sleep Medicine, Feb 16, 2009. PMID: 19230757, by Wang J, O'Reilly B, Venkataraman R, Mysliwiec V, Mysliwiec A. Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.

e-mail icon
Facebook icon
Twitter icon
Google icon
LinkedIn icon