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SLEEP 2026 | New AASM guidelines for RLS recommend against the use of dopamine agonists
Michael Mak, MD, FRCPC, DRCPSC, FCPA, FAASM, University of Toronto, Toronto, Canada, discusses updates to the American Academy of Sleep Medicine (AASM) guidelines for restless legs syndrome, recommending against the use of dopamine agonists. Dr Mak recommends alpha-2 delta ligands as first-line treatments instead. This interview took place at the 40th annual meeting of the Associated Professional Sleep Societies (APSS) in Baltimore, MD.
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Transcript
Restless legs syndrome, so the ASM released their guidelines on January 1st, 2025. And this was a big change, a big shift compared to the guidelines prior to these ones, in the sense that the dopamine agonists are all fully deprecated. So there’s a recommendation against the use of dopamine agonists, things like pramipexole, ropinirole, transdermal rotigotine, things like that for fear of augmentation, which is a condition where you need escalating doses of these medications...
Restless legs syndrome, so the ASM released their guidelines on January 1st, 2025. And this was a big change, a big shift compared to the guidelines prior to these ones, in the sense that the dopamine agonists are all fully deprecated. So there’s a recommendation against the use of dopamine agonists, things like pramipexole, ropinirole, transdermal rotigotine, things like that for fear of augmentation, which is a condition where you need escalating doses of these medications. And the people that have been taking it for years, they end up having to take greater doses to have the same symptomatic control. And in the absence of the medication, sometimes the restless legs can actually go up the body into the trunk and arms, et cetera. So for those reasons, those medications are discouraged. The first-line treatments are going to be the alpha-2 delta ligands. So gabapentin, gabapentin enacarbil, pregabalin, and then always keeping in mind iron status. So if you’re dealing with a patient that has low ferritin levels, let’s say lower than 75 nanograms per milliliter, then the idea is to do appropriate iron replacement, either by IV means or oral means.
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