Restless Legs Treatment Update 2025: Dopamine Agonists No Longer First Choice
New 2025 guidelines move beyond dopamine drugs for restless legs — here's my story, and why it's important to follow them.
When I was first diagnosed with restless legs, my doctor prescribed a dopamine agonist. Over time I tried many different types of medication. At the beginning, it felt like a miracle — my nights were calmer, and I could finally sleep again.
But after a couple of years, things started to change. The pain in my legs grew worse and didn't stop when the sun came up. My legs burned, ached, and felt on fire — it was exhausting and frightening.
On top of that, new symptoms crept in. I felt dizzy, my memory wasn't the same, and I often felt distant from myself. I became apathetic, and life started to feel very heavy. I was terrified and desperate to understand why all this was happening.
Ragnahild's experience is not unique. Many patients with Restless Legs Syndrome (RLS) face similar struggles, especially when treated long-term with dopamine agonists. That's why the new 2025 guidelines from the American Academy of Sleep Medicine (AASM) represent such an important shift in treatment.
Why the 2025 Guidelines Matter
For years, dopamine agonists — drugs like pramipexole, ropinirole, and rotigotine — were the standard treatment. But in January 2025, the AASM issued new guidelines: dopamine agonists are no longer recommended as a first-choice long-term treatment.
The reason? A troubling side effect called augmentation, where medication meant to help actually makes symptoms worse over time.
What Is Augmentation?
Augmentation can cause:
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Earlier onset of symptoms during the day
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More intense leg discomfort
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Symptoms spreading to the arms
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Shorter relief from medication
This means that, for many patients, the treatment worsens the very condition it was meant to control.