How should a patient take 900mg of gabapentin (Neurontin) for Restless Legs Syndrome (RLS)?

How to Take 900mg Gabapentin for Restless Legs Syndrome

For RLS, 900mg gabapentin should be taken as a single dose at 5 PM with food, though this represents a suboptimal intermediate dose that may require titration to either 600mg daily (for mild symptoms) or 1200-2400mg daily divided into multiple doses (for moderate-to-severe symptoms with sleep disturbance). 1

Optimal Dosing Strategy

The 900mg dose is problematic because it falls between validated therapeutic ranges:

• 600mg once daily (taken at 5 PM with food) is FDA-approved for subjective RLS symptoms with lower rates of somnolence and dizziness 2
• 1200mg once daily (taken at 5 PM with food) is the most validated dose for both RLS symptoms AND associated severe sleep disturbances 2, 3
• 900mg daily failed to show significant improvement in clinical trials, with higher early discontinuation rates due to adverse effects without sufficient therapeutic benefit 2

Recommended Titration Approach

Start with 300mg at bedtime, then titrate based on response: 1

• Begin with 300mg taken at bedtime with food 1
• If symptoms persist after 3-7 days, increase by 300mg every few days 1
• Target maintenance dose: 1800-2400mg/day divided three times daily for optimal 24-hour symptom control 1
• Single nighttime dosing fails to address daytime RLS symptoms and provides suboptimal coverage 1

Critical Timing and Administration

• Take with food to optimize absorption 3
• Timing matters: For once-daily dosing, take at 5 PM; for divided dosing, space throughout the day to maintain 24-hour coverage 1, 3
• Evening/nighttime symptoms are most pronounced, but daytime symptoms require adequate dosing 1

Before Starting Gabapentin

Check iron status first—this is non-negotiable: 1

• Measure morning fasting ferritin and transferrin saturation 1
• Supplement if ferritin ≤75 ng/mL or transferrin saturation <20% 1
• Iron supplementation can significantly improve RLS independent of gabapentin 1

Common Side Effects to Monitor

• Somnolence and dizziness are most common but typically transient and mild 1, 3
• These side effects are dose-dependent—higher doses (>600mg) increase risk 2
• Monitor for altered mental status, particularly in elderly or renally impaired patients 1

Critical Pitfalls to Avoid

• Do not use 900mg as a long-term maintenance dose—it represents a "half-landing" that causes more adverse effects than benefits 2
• Do not use single nighttime dosing for moderate-to-severe RLS—symptoms occur throughout the day and require divided dosing 1
• Do not skip iron assessment—correcting iron deficiency may reduce or eliminate need for higher gabapentin doses 1
• Avoid dopamine agonists (pramipexole, ropinirole) as they cause augmentation—paradoxical worsening of symptoms with long-term use 1, 4

Alternative Formulation

Consider gabapentin enacarbil (a prodrug with superior bioavailability) which allows once-daily dosing at 600mg or 1200mg and maintains efficacy for up to 9 months 1, 3