Restless legs syndrome
Sensorimotor disorder with irresistible urge to move legs at rest, worse in evenings and nights. Foundation: iron repletion (ferritin below 75 µg/L); for pronounced symptoms — gabapentinoids or dopamine agonists.
ICD-10 G25.813 drugs
Also known as: RLS
Drugs used for this condition
- AGabapentinFirst line · Gabapentinoids (antiepileptics)Per the updated AASM 2025 guideline, the first line for restless legs syndrome is the alpha-2-delta ligands (gabapentin, gabapentin enacarbil, pregabalin); they are preferred over dopamine agonists, which cause augmentation (symptom worsening) over time. Plain gabapentin is used off-label, usually 300 mg 1–2 hours before bed, titrated to 1200–1800 mg/day; gabapentin enacarbil (Horizant) has more direct trial evidence and a different regimen (600 mg once in the evening). The effect develops over 1–2 weeks. It suits patients with coexisting pain or anxiety; use caution in reduced kidney function (lower the dose) and because of sedation, dizziness, and abuse potential.
- BPramipexoleSecond line · Non-ergot dopamine D2/D3 receptor agonistSecond-line for moderate-to-severe restless legs syndrome per AASM 2024 and EFNS/ENS 2012. First-line is iron supplementation in ferritin deficiency (under 75 ng/mL) and α2δ ligands (gabapentin, pregabalin). Pramipexole 0.125–0.5 mg 2–3 hours before bed. Long-term use is linked to augmentation phenomenon – symptom worsening with daytime spread; when augmentation appears, switch the drug.
- BRopiniroleSecond line · Non-ergot dopamine D2/D3 receptor agonistSecond-line for moderate-to-severe restless legs syndrome per AASM 2024. First-line is iron supplementation in ferritin deficiency and α2δ ligands (gabapentin, pregabalin). Ropinirole 0.25–4 mg 2–3 hours before bed. Long-term use is linked to augmentation – switch the drug when augmentation appears.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit