Lyrica for Restless Legs Syndrome

Lyrica® (pregabalin) is one of three medications in the class of drugs known as alpha-2-delta ligands along with its cousins gabapentin (Neurontin®) and gabapentin enarcarbil (Horizant®) that are the consensus first-line drugs for the treatment of restless legs syndrome (RLS). Andy Berkowski, MD of ReLACS Health analyzes the use of this medication in this video.

To read in more depth about RLS and other sleep disorders, follow A ReLACSing Blog:

For more information on gabapentin and Horizant, this video explains the differences:

Lyrica works by reducing the transmission of the abnormal signal from one brain cell to another that is telling the brain that one has to move the legs. It affects a calcium channel in these nerve cells and essentially quiets down that loud voice creating the urge to move and the discomfort caused by this disease. Originally and still occasionally used a drug to prevent seizures by this same mechanism, Lyrica has become popular for a variety of nerve or nerve pain conditions including Shingles, neuropathic pain in the feet, and fibromyalgia. It turns out to work fairly well for RLS in the majority of cases. For RLS, it can be dosed once or twice in the evening and/or at night when typical RLS symptoms take place. The main side effects can be dizziness and drowsiness, which people may adapt to after a few days. Rarely people can gain a few pounds on Lyrica, possible due to increase in body fluid rather than eating more or more fat accumulation, but this is unclear.

There is a Black Box warning about suicide risk with this medication in those with depression, and though this is very rare, it should be noted. Lyrica can slow down breathing in some circumstances when combined with other drugs that also affect breathing like opioids (narcotics, pain medications), hypnotics (benzodiazepines, prescription sleeping pills), and muscle relaxants. This is particularly important to know for those with untreated obstructive sleep apnea (OSA), significant obesity, COPD or lung disease, or anyone that may have reasons for difficulty breathing at night. Lyrica can be quite effective for RLS, but it is not always tolerated or effective. It is often less effective in those exposed to dopamine agonists (ropinirole/Requip®, pramipexole/Mirapex®, rotigotine/Neupro®) or those with the inevitable augmentation from these medications.

For more information on what is augmentation, see here:

Arguably the most impression clinical trial for RLS in the New England Journal of Medicine was done on Lyrica a few years back so there is strong evidence in research and extensive experience among doctors treating RLS.

Generally, clinicians start patients on either gabapentin or Lyrica, and if one does not work they try the other as there could be fewer side effects or better effects on RLS of one versus the other even if they are cousins from the same drug class. Lyrica seems to be better absorbed on an empty stomach than gabapentin or Horizant which are best taken with a meal.

[liamporter]

Thanks for sharing. RLS patients need all the help they can get 🙏🙏🙏.