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.

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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