From the Guidelines
The pharmacological treatment for Restless Leg Syndrome (RLS) should prioritize the use of gabapentin, gabapentin enacarbil, or pregabalin as first-line options, as recommended by the American Academy of Sleep Medicine (AASM) with strong evidence 1. The treatment of RLS involves a range of pharmacological options, but the most recent and highest quality evidence supports the use of alpha-2-delta calcium channel ligands as the primary treatment approach.
- Gabapentin, gabapentin enacarbil, and pregabalin are recommended over no treatment, with strong recommendations and moderate certainty of evidence 1.
- Iron supplementation, such as IV ferric carboxymaltose, is also recommended for patients with appropriate iron status, with strong evidence 1.
- Dopamine agonists, such as pramipexole, ropinirole, and rotigotine, may be considered in certain cases, but their use is not recommended as a standard treatment due to concerns about augmentation and other side effects 1.
- Opioids, such as oxycodone, may be used in severe or refractory cases, but with caution due to addiction potential 1. It is essential to consider the individual patient's symptoms, comorbidities, and preferences when selecting a treatment, and to regularly assess efficacy and adjust dosing as needed.
- The treatment should be taken 1-2 hours before symptoms typically begin, and patients should be aware of potential side effects, including augmentation, daytime sleepiness, and impulse control disorders.
- The AASM recommendations provide a framework for guiding treatment decisions, but clinical judgment and patient-centered care are crucial in managing RLS effectively 1.
From the FDA Drug Label
The effectiveness of ropinirole in the treatment of RLS was demonstrated in randomized, double-blind, placebo-controlled trials in adults diagnosed with RLS using the International Restless Legs Syndrome Study Group diagnostic criteria Patients were required to have a history of a minimum of 15 RLS episodes/month during the previous month and a total score of ≥15 on the International RLS Rating Scale (IRLS scale) at baseline. All trials employed flexible dosing, with patients initiating therapy at 0. 25 mg ropinirole once daily. Patients were titrated based on clinical response and tolerability over 7 weeks to a maximum of 4 mg once daily.
The pharmacological treatment for Restless Leg Syndrome (RLS) is ropinirole, which is administered orally, with a dosage of 0.25 mg once daily, titrated based on clinical response and tolerability to a maximum of 4 mg once daily. The treatment is typically taken 1 to 3 hours before bedtime. 2 2
- Key points:
- Ropinirole is effective in treating RLS
- Flexible dosing is used, with a starting dose of 0.25 mg once daily
- Maximum dose is 4 mg once daily
- Treatment is taken 1 to 3 hours before bedtime
From the Research
Pharmacological Treatment for Restless Leg Syndrome (RLS)
The pharmacological treatment for RLS involves various medications, including:
- Dopaminergic agents, such as levodopa, pramipexole, and ropinirole, which are considered first-line treatment for RLS 3, 4
- α2δ ligands, such as pregabalin, which may be considered for initial RLS treatment to prevent augmentation 5, 6
- Opioids, which may be considered for severe cases of RLS or for patients who have failed other therapies 7, 6
- Rotigotine, a dopamine agonist that may be used for moderate to severe RLS, but may also produce augmentation at higher doses with long-term use 5, 7
Prevention of Augmentation
To prevent augmentation, the following strategies may be employed:
- Using α2δ ligands, such as pregabalin, as initial treatment 5
- Keeping the dopamine agonist dose as low as possible 5, 7
- Using longer-acting dopamine agonists, such as rotigotine 7
- Maintaining a high serum ferritin level 7
Treatment of Existing Augmentation
For existing augmentation, the following treatment options may be considered:
- Elimination or correction of extrinsic exacerbating factors, such as iron levels, antidepressants, and antihistamines 5
- Dividing or advancing the dose of dopamine agonists, or increasing the dose if there are breakthrough night-time symptoms 5
- Switching to an α2δ ligand or rotigotine 5, 7
- Using opioids, which may be effective for severe cases of augmentation 7