What is the recommended dosing of gabapentin (Gabapentin) for restless leg syndrome?

From the Guidelines

For restless leg syndrome, gabapentin is typically started at 300 mg taken orally once daily at bedtime, with gradual titration as needed, as recommended by the American Academy of Sleep Medicine 1. The effective dose usually ranges from 600 to 1,800 mg per day, divided into three doses, with the largest dose taken at night. Most patients find relief at 900-1,200 mg daily. The medication should be taken 1-2 hours before symptoms typically begin in the evening. Gabapentin works by modulating calcium channels and increasing GABA activity in the central nervous system, which helps reduce the abnormal sensations and urge to move associated with restless leg syndrome. Some key points to consider when prescribing gabapentin for restless leg syndrome include:

• Starting with a low dose and gradually increasing as needed to minimize side effects
• Assessing renal function before starting therapy, as dose adjustments are necessary for patients with kidney impairment
• Tapering the medication slowly when discontinuing to avoid withdrawal symptoms
• Being aware of common side effects, such as dizziness, drowsiness, and fatigue, which can be mitigated by starting at a low dose and gradually increasing
• Considering the use of gabapentin in combination with other treatments, such as iron supplementation or other medications, as part of a comprehensive treatment plan for restless leg syndrome, as suggested by the American Academy of Sleep Medicine 1.

From the Research

Dosing of Gabapentin for Restless Leg Syndrome

The recommended dosing of gabapentin for restless leg syndrome (RLS) can vary based on the study and the specific formulation of gabapentin used. Here are some key points regarding gabapentin dosing for RLS:

• In a 2003 study 2, patients with idiopathic RLS were initially treated with 300 mg of gabapentin, and the dose was up-titrated until relief of symptoms was achieved, with a mean dosage of 800 +/- 397 mg and a range of 300-1,200 mg.
• A 2001 study 3 used an initial dose of 300 mg of gabapentin with up-titration until relief of symptoms for 4 weeks, showing significant improvement in subjective symptoms and polysomnographic data.
• For gabapentin enacarbil, a 2011 study 4 administered 1200 mg once daily at 5 pm, with dose adjustments to 600 or 1800 mg permitted based on investigator judgment, demonstrating long-term safety and efficacy in subjects with moderate-to-severe primary RLS.

Key Considerations

When considering the dosing of gabapentin for RLS, it's essential to note the following:

• The dosage may need to be adjusted based on individual patient response and tolerability.
• Gabapentin enacarbil, a prodrug of gabapentin, has been studied for its efficacy and safety in RLS treatment, with dosages ranging from 600 to 1800 mg once daily.
• Other studies, such as those comparing pregabalin with pramipexole 5 or reviewing available literature on RLS treatment 6, may provide additional context but do not directly address gabapentin dosing.

Study Findings

The studies mentioned above provide evidence for the efficacy and safety of gabapentin in treating RLS, with dosages varying across studies:

• The 2003 study 2 found that gabapentin and ropinirole provided similarly well-tolerated and effective treatment of periodic leg movements during sleep and sensorimotor symptoms in patients with idiopathic RLS.
• The 2011 study 4 demonstrated that gabapentin enacarbil was generally safe and well-tolerated and improved RLS symptoms in subjects with moderate-to-severe primary RLS for up to 64 weeks of treatment.