Saturday, April 24, 2021


 Q: Trazodone is a good choice for patients in ICU with complaints of Restless leg syndrome (RLS)?

A) True

B) False

Answer: B

Serotonergic agents i.e., trazodone or mirtazapine makes RLS symptoms worse and should not be used exclusively for this purpose. Similarly, benzodiazepine receptor agonists (BZRAs) like zolpidem can also increase the risk for complex sleep-related behaviors. 

Drugs recommended for RLS are dopamine agonists such as cabergoline, lisuride, pergolide, pramipexole, ropinirole, and rotigotine. Cabergoline and pramipexole are found to be superior to other dopamine agonists. Also, alpha-2-delta ligands i.e. gabapentin and pregabalin are also found to be useful. 



1. Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults--an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep 2012; 35:1039. 

2. Scholz H, Trenkwalder C, Kohnen R, et al. Dopamine agonists for restless legs syndrome. Cochrane Database Syst Rev 2011; :CD006009. 

3. Allen RP, Chen C, Garcia-Borreguero D, et al. Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med 2014; 370:621. 

4. Trenkwalder C, Benes H, Grote L, et al. Cabergoline compared to levodopa in the treatment of patients with severe restless legs syndrome: results from a multi-center, randomized, active controlled trial. Mov Disord 2007; 22:696. 

5. Bassetti CL, Bornatico F, Fuhr P, et al. Pramipexole versus dual release levodopa in restless legs syndrome: a double blind, randomised, cross-over trial. Swiss Med Wkly 2011; 141:w13274.

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