Medication		Starting dose	Adverse effects	Comments
Non-ergotamine dopamine agonists			Nausea, orthostasis, daytime somnolence; augmentation occurs, but less so than with carbidopa/levodopa(Sinemet)	Drugs of choice in most patients with moderate to severe daily RLS; pramipexole and ropinirole are FDA-indicated for the treatment of moderate to severe RLS Pramipexole: increase dose by 0.25 mg after four to seven days, up to 0.5 mg per day Ropinirole: increase to 0.5 mg on day three and to1.0 mg on day eight; increase by 0.5 mg every week if needed to maximum of 4 mg per day
	Pramipexole (Mirapex)	0.125 mg
	Ropinirole (Requip)	0.25 mg
Carbidopa/levodopa		25/100 mg	Gastrointestinal upset and headache; augmentation common with daily dosing	Rapid onset of action, usually with first dose; beneficial for individuals requiring medications for intermittent symptoms
Gabapentin (Neurontin)		100 to 300 mg	Sedation, gastrointestinal discomfort	An appropriate first choice in individuals with RLS associated with neuropathic pain; consider use for daily RLS if dopamine agonist not effective; may be used with dopamine agonist in patients with refractory RLS
Opioids		Nightly dose varies by choice of opioid	Nausea, constipation; potential for abuse	Limited studies of effectiveness, but a reasonable choice in individuals with RLS associated with pain; may be used with dopamine agonist in patients with refractory RLS
Benzodiazepines			Daytime sleepiness; increased risk of falls at night; potential for abuse	Can be useful in intermittent RLS, particularly when insomnia is significant; may be used with dopamine agonist in patients with refractory RLS
	Clonazepam (Klonopin)	0.5 mg
	Zolpidem (Ambien)	5 mg
Ergotamine dopamine agonists			Same as for non-ergotamine agonists; also have additional risk of cardiac valvulopathy	Effective in the treatment of moderate to severe RLS, but non-ergotamine dopamine agonists are preferred because of safety profile; neither cabergoline nor pergolide is FDA-indicated for treatment of RLS; pergolide recently removed from the U.S. market
	Cabergoline (Dostinex)	0.5 mg
	Pergolide (Permax)	0.05 mg