🎙️ Episode 29: Restless Leg SOS: Gabapentin and Friends to the Rescue

🧠 Problem:

RLS causes chronic sleep disruption, often worsens in hospital or peri-op settings.

💊 Management:

First-line: Gabapentin or Pregabalin (per American Academy of Sleep Medicine).

Avoid long-term dopamine agonists — cause augmentation and impulse control disorders.

🩸 Bonus Tip:

Check ferritin — keep it >75 ng/mL.

Oral or IV iron can help symptom control.

🧩 Clinical Takeaway:

Treat aggressively; it’s more than “just annoying.”

Avoid benzos and older agents unless no better option.

Transcript

Speaker 1 0:01

Now let's talk about restless leg syndrome . Now it may not seem like a big deal and you're like , well , no one's going to die of restless leg syndrome , but your patients feel like they're going to die , especially if they have to withhold their medication

Introduction to Restless Leg Syndrome

Speaker 1 0:12

, when they're in a special situation , when they're MPO , or maybe they have their medications , they're having side effects from them . Please be aware , the patients and the families are going to be inflamed and you're going to have to try to figure out alternatives , and there's not great alternatives . So what is restless leg syndrome ? It's a movement condition in which people are forced to move their legs all night long to get relief from the symptoms and obviously they're not getting good sleep , and we all

Symptoms and Sleep Impact

Speaker 1 0:41

know that not getting good sleep is not a good thing , not healthy , and they'll describe it to you when you talk to them and say their legs just feel uncomfortable . They can have sensations , everything from aching , throbbing , pulling , itching , crawling or creeping , and it creates this environment where they just can't get sleep and it's almost like a downward spiral . They can't get sleep , they don't get healthy and things just spiral downwards . So what do you need to do ? You need to avoid caffeine and things just spiral downwards . So what do you need to do ? You need to avoid caffeine , alcohol , antihistamines , antidepressants . If they have OSA , you need to treat it Now . Iron supplementation

Treatment Approaches and Medications

Speaker 1 1:12

you'll have to determine if IV or oral , based on what's going on . If the ferritin is less than 75 , I know that's higher than other numbers , but this is specific for restless leg syndrome .

Speaker 1 1:24

Now the American Academy of Sleep Medicine recommends these two . Now we know these have side effects , but these are what they're calling their frontline agent either gabapentin or pregabalin . What's the side effects ? Well , 6% to 8% get low-stress edema , dizziness . Also , you need to watch in people with COPD because it can cause problems with breathing . Those are just a few and then also can cause confusion . So none of these medications are great . Now they recommend against the long-term use .

Speaker 1 1:51

Now these are medications that people have been taking for years in most cases , and man to try to taper them off . These medications , I can imagine , will be very difficult . Premiplexal , rupinol and transdermal rotaginine Also recommend against bupropion , carbamazepine , clonazepam , valerian root , which is over-the-counter supplement valproic acid and carbogoline . So very difficult to treat and then , once the patient gets on , steady state is these are the medications a lot of people are given and you need to kind of watch

Medication Challenges and Side Effects

Speaker 1 2:28

and you may need to taper them off . Man , that's going to be difficult . Remember , gabapentin and pregabalin are first line per the American Academy of Sleep Medicine , but remember we know that these have side effects .