Initial daily dose | Minimum interval to assess effect before increasing dose | Usual effective daily dose range* | Metabolism and clearance | |
Gabapentinoids (alpha-2-delta calcium channel ligands) | ||||
Gabapentin (IR) | 100 to 300 mg 2 hours before bedtime | 5 to 7 days | 900 to 2400 mg as a single dose or in two divided doses (eg, one-third an hour before symptoms start and two-thirds before bed) |
|
Gabapentin enacarbil (ER) | 300 to 600 mg in early evening (eg, ~5 PM) | 5 to 7 days | 600 mgΔ |
|
Pregabalin (IR) | 50 to 75 mg 1 to 3 hours before bedtime | 5 to 7 days | 150 to 450 mg |
|
Dopamine agonists | ||||
Pramipexole (IR) | 0.125 mg 2 to 3 hours before bedtime | 2 to 3 days | 0.25 to 0.50 mg |
|
Ropinirole (IR) | 0.25 mg 1 to 3 hours before bedtime | 2 to 3 days | 0.25 to 2 mg |
|
Rotigotine transdermal patch | 1 mg per 24 hour patch | 5 to 7 days | 2 to 3 mg per 24 hour patch |
|
ER: extended release; FDA: US Food and Drug Administration; IR: immediate release.
* Long-term use of dopaminergic drugs for RLS can result in augmentation. To decrease risk, use lowest effective dose and do not exceed upper dose range. Refer to UpToDate topic review for details.
¶ Specific dose adjustment recommendations for patients with impaired kidney function are provided in the drug specific monographs included within UpToDate.
Δ Doses up to 1200 mg have been used, although doses ≥600 mg provided no additional benefit in clinical trial for RLS.Do you want to add Medilib to your home screen?