Are You Having painful leg cramps?

Some studies suggest that more than two-thirds of older persons have experienced painful night-time leg cramps.  These cramps typically affect the calf muscles, but you may also get them in the feet or thighs.  This article, written by Dr. Armon B. Neel, Jr, and published in AARP’s “Ask the Pharmacist” lists 8 types of drugs that can cause leg cramps:

  1. Short-acting loop diuretics (water pills) help the body get rid of excess fluid by moving it into the urine.  These diuretics also known as Bumex or Lasix may also increase the body’s excretion of some electrolytes including sodium, chloride, and potassium through the urine.  Alternative:  A low dose of a long-acting loop diuretic, such as Demadex or Torsemide may reduce the risk of electrolyte loss.  You might consider cutting back on salt, exercise more, and watch your fluid intake.  And be sure to consult a health care professional before beginning a new exercise regimen.
  2. Thiazide diuretics are mostly used to treat high blood pressure, CHF, edema, and other conditions.  Otherwise known as chlorothiazide, hydrochlorothiazide, indapamide, and metolazone they can deplete key electrolytes, causing leg cramps and other muscle problems.  Alternative: Speak with your health care provider about switching to a low dose or a long-acting loop diuretic such as Torsemide (Demadex), which can significantly reduce the risk of electrolyte loss, or to another hypertension medication.  It may be helpful to cut back on salt, exercise more, and control your fluid intake but be careful with salt substitutes because they may contain potassium chloride which can also cause electrolyte imbalances.  Consult a healthcare professional before beginning a new exercise regimen.
  3. Beta-Blockers are typically prescribed to treat high blood pressure and arrhythmias.  They may slow the heart rate and lower blood pressure by blocking the effect of adrenaline.  Beta-blockers are also used to treat angina, migranes, tremors, and some kinds of glaucoma (in eye drop form). Examples of these beta-blockers are also known as: Atenolol, carvedilol, Metroprolol, Propranolol, Sotalol, Timolol and some other drugs whose chemical names end with “olol.”  Alternatives: benothiazepine or calcium channel blockers are often safer and more effective than beta-blockers.
  4. Statins and fibrates are used to treat high cholesterol.  Also known as Lipitor, Crestor, Zocor, or Tricor.  Statins may inhibit the production of satellite cells in the muscle, interfering with muscle growth.  Alternatives:  If you’re among the many of older Americans who don’t have known heart disease but are taking these drugs to lower a slightly elevated cholesterol, ask your doctor or other heart care provider about trying to lower your cholesterol by changing your diet.  Taking a combination of sublingual (under-the-tongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily) and vitamin B6 (200 mg daily) may help lower your blood levels of hemocystene which is linked to high cholesterol.
  5. Beta2-agonists are brochodilator drugs that relax the smooth muscles surrounding the bronchial tubes, making it easier to breathe.  They are frequently prescribed to relieve the symptoms of COPD and are typically given through an inhaler, delivering a measured dose of the drug as a fine mist.  Sometimes they are given in pill or injectable form to patients who can’t use inhalers and include albuterol, Symbicort, Xopenex, Maxair, or Advair.  It is not well known why these beta2-agonists cause leg cramps.  Alternatives:  If using these drugs for a condition other than pulmonary disease talk with your doctor about possibly switching medications or types of treatment.  Studies have found that these drug types do not provide significant relief to non-COPD patients with acute bronchitis or cough.  If you do have pulmonary disease speak with your physician about switching to Spiriva, a different type of long acting bronchodilator, used once daily.
  6. ACE inhibitors are used to treat high blood pressure, congestive heart failure and other conditions.  They help relax blood vessels.  Examples include: Lotensin, Capoten, enalapril (Vasotec), Lisinopril, Accuprilm, and Altace – among others.  These ACE inhibitors can cause potassium to build up in the body which can lead to leg cramps and achy joints, bones and muscles.  Alternatives:  If you are taking ACE inhibitors for a cardiovascular problem, talk with your doctor about switching to a benzothiazepine calcium channel blocker, another blood pressure medication that is often better tolerated by older adults.  If your condition is accompanied by fluid retention, your doctor may consider adding a low dose long-acting loop diuretic such as torsemide.
  7. Angiotensin II-receptor blockers (ARBs) are often prescribed to treat coronary artery disease or heart failure in patients who can’t tolerate ACE inhibitors or who have type 2 diabetes or kidney disease from diabetes.  Examples are Atacand, Avapro, Cozaar, Micardis, and Diovan.  Like ACE inhibitors, ARBs may lead to potassium overload in the body which can cause leg cramps and achy joints, bones and muscles.  Alternatives:  Consult with your health care provider about the advisability of switching to a benzothiazepine calcium channel blocker, which is often better tolerated by older adults.  A low dose of a long-acting loop diuretic such as torsemide may also be desirable.

Any advice or information provided should not be followed in lieu of a personal consultation with a trained medical consultation.  

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Practical Information for Family Members

If you’ve ever agonized over care decisions for a loved one, below are some practical tips that might help you get started.  As this blog is new we plan to use our expertise in elder care to present more tips.  Here are some beginning thoughts on preparations that may be needed right now :

  • Organize Your Parent’s Personal Health Record
  • It is never too late for End of Life Planning
  • Managing Medications
  • Finding Professionals who can help
  • Advocating for the Older Adult
  • Do you know how to Prevent falls in the home?
  • Finding independence through technology
  • Keeping the Older Adult in Their Home which is where they want to be
  • Mobility Equipment and other Assistive Equipment
  • To drive or Not to Drive?
  • Family Communications and Responsibilities
  • Encouraging the Older Adult’s Well-Being
  • Dealing With Dementia
  • When is Hospice needed?
  • Choosing a Residential Facility if there is no other alternative
  • Taking Care of the Caregiver
  • Providing Personal Care to Your Loved One

Please feel free to add your comments below if there is another topic you’d like for us to feature in the near future.  Thank you.