A 52-year-old woman with a history of iron deficiency anemia presents with an uncomfortable sensation in her legs that occurs primarily in the evenings when she is trying to relax or sleep. She describes an irresistible urge to move her legs, which is temporarily relieved by walking around. These symptoms are causing significant sleep disturbance. Her neurologic examination is normal. Her ferritin level is 25 ng/mL (normal >50 ng/mL).
Which of the following is the most appropriate initial management for this patient?
- Pramipexole
- Gabapentin
- Oral iron supplementation (correct answer)
- Clonazepam
Explanation: This patient has restless legs syndrome (RLS). An important secondary cause of RLS is iron deficiency. Before initiating symptomatic treatment with dopamine agonists (e.g., pramipexole) or alpha-2-delta ligands (e.g., gabapentin), it is essential to check iron stores and replete them if low. In patients with RLS and a serum ferritin level <75 ng/mL, oral iron supplementation is recommended as the initial management, as it can significantly improve or resolve symptoms.