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The patients received, in a randomized fashion, gabapentin or placebo for six weeks. The dosage of 600 mg daily could be changed every two weeks to a maximum of 2,400 mg per day. Lee DO, Ziman RB, Perkins AT, et al; XP053 Study Group. A randomized, double-blind, placebo-controlled study to assess the efficacy and tolerability of gabapentin enacarbil in subjects with restless legs syndrome. J Clin Sleep Med. 2011;7(3):282-292. Walters AS, LeBrocq C, Dhar A, et al; International Restless Legs Syndrome Study Group. Initial dose: 300 mg on day one, 300 mg twice daily on day two, and 300 mg three times daily on day three. Maintenance dose: 900-1800 mg per day, divided into three doses. Treatment is typically long-term. Initial dose: 300 mg once daily, with gradual increases as needed. Maintenance dose: 900-3600 mg per day, divided into three doses. The use of gabapentin for restless legs syndrome (RLS) is off-label. Initial dose of 300 mg if the person is under 65 years old and 100 mg if the person is over 65 years old. Maximum recommended dose for RLS is 2700 mg. CKS did not identify any specific guidance on dose titration for use in RLS. This article explains what gabapentin is, its approved and off-label uses, and how the drug works to treat restless legs syndrome and other medical conditions. It also describes the possible side effects and risks and lists other drugs and treatments that may help ease RLS symptoms. Detailed dosage guidelines and administration information for Horizant (gabapentin enacarbil). Includes dose adjustments, warnings and precautions. Keywords: restless legs syndrome, gabapentin, gabapentin enacarbil, treatment. Background. Restless legs syndrome (RLS) is a movement disorder that affects between 5% and 10% of adults [Hening et al. 2004; Phillips et al. 2000; Lavigne and Montplaisir, 1994]. For oral dosage form (extended-release tablets): For restless legs syndrome: Adults—600 milligrams (mg) as a single dose at about 5 PM. Your doctor may adjust your dose as needed and tolerated. Children—Use and dose must be determined by your doctor. For postherpetic neuralgia: Detailed Gabapentin dosage information for adults and children. Includes dosages for Restless Legs Syndrome, Epilepsy and Postherpetic Neuralgia; plus renal, liver and dialysis adjustments. Gabapentin enacarbil available under the trade name Horizant is the only gabapentin product approved for treatment of Restless Legs Syndrome (RLS). A daily dose of 1200 mg provided no additional benefit compared with the 600 mg dose, but caused an increase in adverse reactions. Gabapentin enacarbil may have two distinct therapeutic doses for the treatment of RLS: 600 mg/day or lower doses for the treatment of subjective RLS symptoms and 1,200 mg/day or higher doses for the treatment of both subjective RLS symptoms and associated problems such as severe sleep disturbances. First-line management options include iron-replacement therapy in those with evidence for reduced body-iron stores or, alternatively, with prescribed gabapentin or pregabalin, and dopamine agonists such as pramipexole, ropinirole, and rotigotine. Gabapentin’s effectiveness for RLS may take weeks, with dosage ranging from 300 mg to 3,600 mg daily. It’s initiated at a low dose and increased gradually. Continuity in usage is crucial, as full effects may take up to four weeks. Published concerns about dopaminergic augmentation of RLS symptoms from levodopa date back to the mid-1990s. 29 Heightened awareness of augmentation with long-term dopamine agonist use emerged in the early 2000s as their clinical use became widespread. 29 – 33 Furthermore, the occurrence of impulse control disorders in patients with RLS Gabapentin enacarbil is a prodrug of gabapentin, converted to gabapentin after absorption, and thus avoids the nonlinear pharmacokinetics of gabapentin. It is administered as a single daily dose of 600 mg (300 mg in patients older than 65 years) at 5 pm to target adequate therapeutic levels at bedtime. MINNEAPOLIS—The prodrug gabapentin enacarbil improves sleep, daytime function, and symptoms of restless legs syndrome (RLS), according to two pooled analyses presented at the 28th Annual Meeting of the Associated Professional Sleep Societies. A dose of 600 mg/day provides significant improvement to patients with moderate to severe primary RLS Gabapentin The use of gabapentin for restless legs syndrome (RLS) is off-label. Initial dose: 300 mg if the person is under 65 years old and 100 mg if the person is over 65 years old. Titration: maximum recommended dose for RLS is 2700 mg. CKS did not identify any specific guidance on dose titration for use in RLS. However, for other In moderate to severe primary restless legs syndrome (RLS), clinicians should consider prescribing a pharmacologic agent to reduce RLS symptoms: Strong Evidence Pramipexole, rotigotine, cabergoline*, and gabapentin enacarbil (Level A).
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