Diagnosis and management of RLS during pregnancy and lactation

Dashed arrows: Consider medication only after assessment of severity, risks, and benefits by provider and patient, in patients who have significant impact on quality of life.

RLS: restless legs syndrome; TIBC: total iron binding capacity; % saturation: percent iron saturation; IV: intravenous; ER: extended release.
* For more detailed information, refer to UpToDate topics on restless legs syndrome during pregnancy and lactation.
¶ After the first trimester.
Δ Avoid concurrent use with diphenhydramine or antiseizure medications.
◊ Refractory: An inadequate response to at least one nonpharmacologic intervention and iron (if ferritin <75 mcg/L) tried over an adequate period of time.
§ Very severe, very refractory: A score of >30 on the International Restless Legs Syndrome Study Group rating scale and failure to respond to at least one nonpharmacologic treatment, iron (if ferritin <75 mcg/L), and one non-opioid pharmacologic treatment.

Original figure modified for this publication. Picchietti DL, Hensley JG, Bainbridge JL, et al. Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation. Sleep Med Rev 2015; 22:64. Illustration used with the permission of Elsevier Inc. All rights reserved.

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Diagnosis and management of RLS during pregnancy and lactation