Pregabalin is Not Recommended for PLMD
There is no established evidence supporting the use of pregabalin for Periodic Limb Movement Disorder (PLMD), and current guidelines do not recommend it for this indication. The most recent American Academy of Sleep Medicine (AASM) clinical practice guideline from 2025 makes no recommendation for pregabalin in PLMD treatment 1.
Key Evidence Against Pregabalin for PLMD
Guideline Recommendations
- The 2025 AASM guideline specifically addresses PLMD treatment but does not include pregabalin among recommended therapies 1.
- The only specific recommendations for PLMD are against valproic acid and triazolam 1.
- The 2009 geriatrics guideline explicitly states: "There is very little evidence to support pharmacologic treatment to suppress PLMS or PLMD, even in the face of insomnia or hypersomnia, particularly in older adults. No agent has been FDA-approved to treat PLMS or PLMD" 1.
Important Distinction: RLS vs PLMD
- Pregabalin is strongly recommended for Restless Legs Syndrome (RLS), with the AASM recommending doses of 150-600 mg/day in divided doses 1.
- However, PLMD is a distinct disorder from RLS, despite their frequent co-occurrence 1.
- Up to 90% of RLS patients have PLMS, but the presence of periodic limb movements alone does not constitute PLMD and does not necessarily require treatment 1.
Clinical Approach to PLMD
When Treatment May Not Be Needed
- PLMS can be reported as a polysomnographic finding without meeting criteria for PLMD diagnosis 1.
- Treatment should only be considered when there is documented clinical sleep disturbance or daytime fatigue attributable to the movements 1.
If Treatment Is Pursued
Since no medications are specifically recommended for PLMD:
- Consider addressing underlying conditions (sleep-disordered breathing, medication effects from antidepressants) 1.
- If RLS coexists with PLMD, treat the RLS with pregabalin 150-600 mg/day, which may secondarily improve PLMS 1.
- Avoid valproic acid, which is specifically recommended against for PLMD 1.
Common Pitfall
Do not extrapolate RLS treatment recommendations to isolated PLMD. While pregabalin is FDA-approved and strongly recommended for RLS 1, this does not extend to PLMD without RLS symptoms 1.