Restless leg syndrome (RLS) is common in patients with cirrhosis; however, its treatment in this cohort remains unclear. A recent study assessed the clinical effectiveness of intravenous iron and a 6-week course of low-dose (75 mg/day) pregabalin for treating RLS in patients with cirrhosis.

The study included adult patients with cirrhosis and RLS and subjected them to serum ferritin measurement. It treated the patients with low serum ferritin (< 75 μg/dL) with intravenous iron. Further, it initiated oral pregabalin, initially 75 mg/day for six weeks, followed by 150 mg/day for six weeks (in case of no response), in those with normal ferritin levels and in those with low levels whose RLS symptoms failed to respond to iron replacement. It assessed the recurrence of symptoms at 6–12 weeks after stopping pregabalin.

The study enrolled 50 patients (52% male patients; median age 48 years; median Child-Pugh–Turcotte score 8 and median Model for End-Stage Liver disease score 17).

It found low ferritin in 58%; among them, 48% responded to intravenous iron alone. 38% of patients with low ferritin and nonresponse to iron and 76% with normal ferritin levels showed a response with low-dose pregabalin. Four out of nine nonresponders who received 150 mg/day of pregabalin discontinued the drug because of adverse effects.

This study indicates that a short course of low-dose (75 mg/day) pregabalin is effective (82%) in alleviating RLS in patients with cirrhosis.

Journal of Gastroenterology and Hepatology. 2022;37(5):933-937. https://doi.org/10.1111/jgh.15803