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Tratamiento del síndrome de piernas inquietas: ¿gabapentinoides o agonistas de la dopamina?
Vladimira Vuletić1, Jarosław Sławek2
1Clinical Department of Neurology, Medical Faculty, University in Rijeka, Croatia.
Neurologia i neurochirurgia polska
|February 18, 2026
Resumen
Nuevas guías recomiendan gabapentinoides y hierro IV para el síndrome de piernas inquietas (SPI), relegando los agonistas de la dopamina a uso condicional. Ambas clases de medicamentos tienen posibles efectos secundarios, lo que requiere una cuidadosa consideración para el tratamiento del SPI.
Área de la Ciencia:
- Neurología
- Medicina del Sueño
- Farmacología
Sus antecedentes:
- La patogénesis del síndrome de piernas inquietas (SPI) sigue sin estar clara.
- Los tratamientos actuales para el SPI incluyen agonistas de la dopamina, gabapentinoides, opioides y hierro.
- La Academia Estadounidense de Medicina del Sueño actualizó las guías de tratamiento del SPI en 2025.
Objetivo del estudio:
- Revisar las guías actualizadas de 2025 de la Academia Estadounidense de Medicina del Sueño para el tratamiento del SPI.
- Discutir el cambio en las recomendaciones para los agonistas de la dopamina y los gabapentinoides.
- Presentar una perspectiva clínica sobre la utilidad continua de ambas clases de medicamentos para el SPI.
Principales métodos:
- Revisión de las guías de práctica de 2025 de la Academia Estadounidense de Medicina del Sueño.
- Análisis de datos clínicos sobre la eficacia y los efectos secundarios de los medicamentos para el SPI.
- Opinión de expertos basada en la experiencia clínica y la evidencia disponible.
Principales resultados:
- Los gabapentinoides y el carboximaltosa férrica intravenosa son ahora tratamientos de primera línea para el SPI con una "recomendación fuerte".
- Los agonistas de la dopamina han sido reclasificados a "condicionalmente en contra" debido a posibles efectos secundarios como el aumento y el trastorno del control de impulsos.
- Se recomiendan gabapentinoides en dosis altas, mientras que se sugieren agonistas de la dopamina en dosis bajas; los gabapentinoides pueden tener altas tasas de abstinencia en pacientes mayores.
Conclusiones:
- A pesar de los cambios en las guías, tanto los gabapentinoides como los agonistas de la dopamina siguen siendo valiosos para el manejo del SPI.
- La elección del medicamento requiere una cuidadosa consideración de los factores individuales del paciente, las comorbilidades y los posibles efectos secundarios.
- Ninguna clase de medicamento está completamente libre de riesgos, lo que resalta la necesidad de estrategias de tratamiento personalizadas para el SPI.
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