Management of Leg Muscle Spasms

First-Line Treatment Options

• The American College of Physicians recommends alpha-2-delta ligands, such as gabapentin, gabapentin enacarbil, or pregabalin, as first-line treatment for patients with leg muscle spasms due to their efficacy and lower risk of adverse effects, with moderate certainty of evidence 1
• Alpha-2-delta ligands are effective for muscle spasms related to restless legs syndrome and have a better safety profile than dopaminergic agents 1

Second-Line Treatment Options

• Tizanidine can be considered for chronic muscle spasticity, particularly in patients with spasticity following stroke 2
• Baclofen may be used for spasticity resulting in pain, poor skin hygiene, or decreased function 2
• Dantrolene sodium is another option for spasticity but has limited trial data to support its use 2

Medications to Avoid

• Diazepam and other benzodiazepines should be avoided during stroke recovery due to possible deleterious effects on recovery and sedation side effects 2
• Valproic acid is not recommended for treating muscle spasms related to periodic limb movement disorder 3
• Long-term use of dopaminergic agents should be avoided due to risk of augmentation 1, 4

Special Considerations

• For patients with end-stage renal disease and muscle spasms, gabapentin is suggested as an effective treatment option 1
• For patients with restless legs syndrome, checking serum iron studies is recommended as iron deficiency can exacerbate symptoms 1