🎙️ 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.

Chapters

• 0:28 Introduction to Restless Leg Syndrome
• 0:57 Symptoms and Sleep Impact
• 1:28 Treatment Approaches and Medications
• 2:44 Medication Challenges and Side Effects

Transcript

Speaker 1: 0:18

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, 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 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 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: 1:41

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: 2:08

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 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.