Restless legs syndrome therapy reshapes around augmentation avoidance

Restless legs syndrome has been a dopamine-agonist-first category for two decades. The recognition that long-term dopamine agonist use commonly causes augmentation (worsening of symptoms over time) has shifted modern guidelines toward alpha-2-delta ligands (gabapentin enacarbil, pregabalin) as first-line for moderate-severe disease, with low-dose opioids in selected refractory patients. Novel mechanism programs are in late-stage trials. Iron-pathway optimisation is a structural commercial enabler.