First-line pharmacologic treatment for Restless Legs Syndrome includes which class of drugs?

• A. Dopamine agonists
• B. SSRIs
• C. Benzodiazepines
• D. Antipsychotics

Answer: (A)

Dopamine agonists are first-line because Restless Legs Syndrome is linked to reduced dopaminergic signaling in the brain. These drugs stimulate dopamine receptors, especially D2-like receptors, to compensate for the underlying dopaminergic dysfunction. By doing so, they effectively reduce the uncomfortable leg sensations and the urge to move, leading to better sleep and daytime function. Examples like pramipexole, ropinirole, and the rotigotine patch have shown reliable symptom relief and are commonly used as initial pharmacologic therapy.

Other drug classes aren’t considered first-line for this condition because they don’t address the core symptoms as directly. SSRIs can worsen RLS symptoms for some people, benzodiazepines may help with sleep but don’t substantially reduce the leg sensations and carry dependency risks, and antipsychotics can worsen symptoms by blocking dopamine. While monitoring for augmentation (symptom worsening with long-term use) is important, initiating treatment with a dopamine agonist remains the standard starting approach.