The American Academy of Sleep Medicine (AASM) has updated its clinical practice guidelines for restless legs syndrome (RLS), urging clinicians to transition patients with the condition off dopamine agonists due to the risk of augmentation.
For 30 years, sleep experts have recognized augmentation as a gradual expansion of symptoms in individuals with RLS. However, growing evidence over the past decade showed that dopaminergic medications led to RLS augmentation, occurring in 7-10% of people per year.
According to John Winkelman, MD, PhD, chief of the sleep disorders clinical research program at Massachusetts General Hospital and chair of the AASM committee that revised the guideline, the new guidelines recommend several iron treatments, including intravenous iron and oral iron, as well as three alpha 2 delta calcium channel lignands such as gabapentin, gabapentin enacarbil, and pregabalin.
The guidelines aim to move away from dopamine agonists by focusing on other approaches for managing RLS symptoms. Winkelman emphasized the importance of looking for underlying factors that could be exacerbating the condition, such as serotonergic antidepressants, sleep apnea, regularly taken antihistamines, and alcohol consumption.
To transition patients off dopamine agonists, clinicians should first try to modify these underlying factors before adding alternative medications or approaches. Winkelman notes that this process can take 6-12 months, during which time the dose of the dopamine agonist should be carefully reduced under close supervision.
Source: https://www.hcplive.com/view/rls-guidelines-advise-against-dopamine-agonists-with-john-winkleman-md-phd