What are the recommended first-line pharmacological treatments for adults diagnosed with Restless Legs Syndrome?

First-line pharmacological treatments for adults diagnosed with Restless Legs Syndrome (RLS) are alpha-2-delta ligands, specifically pregabalin or gabapentin, used off-label. These are preferred due to a lower risk of augmentation and impulse control disorders compared to dopamine agonists.

Dopamine agonists, previously first-line, are now generally second-line options due to risks of augmentation and impulse control disorders, but may be considered in specific cases such as short-term use or patient preference, with careful monitoring.

Iron supplementation should be considered if serum ferritin is below 50–75 micrograms/L, even without overt anaemia, as iron deficiency can exacerbate RLS symptoms.

Opioids (e.g., codeine or tramadol) may be used as alternatives, particularly for painful RLS symptoms, but with caution due to dependence risk.