Numerous medicines can cause cramps. In less than five minutes the cramps are gone. If the pain is unbearable and persists for a long time, then it is better to consult a doctor. Harvard Health Publishing. The longer the cramp lasts the more likely the muscle will be sore for a prolonged p… Food sources of potassium include potatoes, bananas, prunes, oranges, raisins and tomatoes. Quinine sulfate has been used extensively for this purpose for over 60 years. Rest medications that can cause muscle cramps include: * furosemide (lasix), hydrochlorothiazide (microzide), and other diuretics … In fact, the Physicians’ Desk Reference lists “muscle cramps or spasms” as an adverse effect with an incidence of ≥5% for indapamide, a thiazide-like indoline diuretic. Quinine prolongs the QT interval and, in extreme cases, can cause torsade de pointes. can any docs explain? Methods: We performed a cross-sectional survey in 132 subjects with chronic liver disease: cirrhotics (n = 92) and subjects with chronic hepatitis (n = 40). Cramps commonly occur in healthy people (usually middle-aged and elderly people), sometimes during rest, but particularly during or after exercise or at night (including during sleep). Muscle Cramps and Diuretic Therapy Muscle Cramps and Diuretic Therapy Mosenkis, Ari; Townsend, Raymond R. 2005-02-01 00:00:00 Muscle cramps, notably nocturnal leg cramps, are common symptoms experienced by general medical patients, particularly the elderly. Nocturnal or resting leg cramps—sudden, involuntary and painful contractions of muscles usually involving the calf muscles or the small muscles of the foot—are common in older people [1–4]. This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp. Working off-campus? agents, diuretics are most often associated with cramps. Dominate leg cramps, diuretic therapy, and resistant hypertension. Glomerulus = basket filter; Proximal tubule = “big dumb reabsorption”; loop of henle = “engine of the kidney” dilutes fluid, and concentrates medullary interstitium; distal convoluted tubule = “intelligent”, finely controlled reabsorption of sodium and water; medullary collecting duct = “brains of the kidney” for fine tuning, potassium and hydrogen secreted Diuretics get secreted into proximal tubule before acting, thus if low renal blood flow, higher doses needed to achieve effect (thus the “lasix threshold” dose) —Se Won O… There always is the sensation of a tense or tight muscle that feels very hard compared to other relaxed muscles. Your doctor can show you stretching exercises that can help you reduce your chances of getting muscle cramps. Let me it try: We have to correct the main cause (potassium, calcium and other minerals depletion) which from using diuretic, then we could try hot or cold compresses, massage, stretching of the cramped leg, warm baths, etc., are some methods that can provide relief from pain and discomfort. Muscle cramps may occur during exercise, at rest, or at night, depending upon the exact cause. Our guest, Dr. Joel Topf, is a clinical nephrologist, pioneer in the use of social media for medical education, and Assistant Clinical Professor at Oakland University William Beaumont School of Medicine, best known for his blog, Precious Bodily Fluids, and hilarious/informative Twitter feed @kidney_boy. If your feet are cramping, it’s possible that your shoes could be too tight. She has a bachelor's degree in public health as well as a master's degree in English. Muscle cramps typically start in the leg—often in the calf muscles … The University of Maryland Medical Center reports that some evidence exists connecting low potassium to high blood pressure, although more research is needed in this area. Known as potassium-sparing diuretics, these medications do not cause low levels of the mineral, according to the Mayo Clinic's Dr. Sheldon G. Sheps. If your potassium level is deficient, you can experience not only cramps but also muscle weakness and fatigue, according to the Linus Pauling Institute at Oregon State University. Their etiology is unclear, and an association with diuretic agents is possible. For recurrent cramps that disturb your sleep, your doctor might prescribe a medication to relax your muscles. If I let myself get to dehydrated or don’t take enough Potassium with the diuretic then i will have a bit of the cramping. Kamel KS, Halperin ML. Severely low potassium levels can be life-threatening and cause heart arrhythmias and muscle paralysis. Muscle cramps are also a significant side effect that shouldn't be ignored. Having a low potassium level can have serious health consequences. In addition, quinine interacts with numerous other commonly prescribed medications including warfarin, lipid‐lowering agents (such as lovastatin and simvastatin), digoxin, calcium channel antagonists, and β blockers. Journal of the Korean Geriatrics Society. Though leg cramps at night can be intensely painful, they aren’t typically serious. Their etiology is varied; most commonly, these cramps are idiopathic. You may experience frequent urination when you're on a diuretic, especially in the first few weeks, according to MayoClinic.com. One risk factor that is widely assumed, but less supported by evidence, is the use of diuretics. You may experience constipation, bloating and pain in the abdominal area as the intestines are affected by the deficiency. Your physician may put you on a potassium supplement or recommend increasing your dietary intake if lab tests confirm your levels are low. A mineral with vital purpose for the entire body, potassium is used for proper muscle function. If your potassium level is deficient, you can experience not only cramps but also muscle weakness and fatigue… Updated January 23, 2017. Dr. Bennett Werner answered. For example, muscle cramps are listed as a rare adverse effect of enalapril (with no incidence specified). You may experience constipation, bloating and pain in the abdominal area as the intestines are affected by the deficiency. 43 years experience Cardiology. Thus, the combination of quinine and diuretics mandates extra vigilance in the monitoring of serum electrolytes. The cramping is so bad that I am forced to use Spirivia instead. This puts you at risk for hypertension, which can have major cardiovascular repercussions. Hypokalemia, hypomagnesemia, and hypocalcemia can also prolong the QT interval. The mechanism of diuretic‐associated cramping (if such an entity truly exists) is likely related to hypokalemia, hypomagnesemia, or volume contraction (with or without metabolic alkalosis). A muscle cramp (charley horse) is a sudden, brief, involuntary, painful contraction of a muscle or group of muscles. Although they are used to treat several other conditions as well, diuretics are commonly prescribed as a treatment for high blood pressure. Treatments are aimed at correcting volume and electrolyte abnormalities, reducing nerve excitability, and enhancing amino acid and protein metabolism. Interestingly, potassium‐sparing diuretics, such as amiloride, are also associated with cramping. ; Sheldon G. Sheps, M.D. can high dose diuretics cause severe muscle cramps, low iron and low iron saturation? Hypocalcemia is a possible cause during therapy with loop‐diuretics such as furosemide, but is unlikely with the hypocalciuric thiazide‐type diuretics. Journal of the American Geriatrics Society. Apple Cider Vinegar. The other drug I take that causes rib cramping for me is a diuretic. 62. Salt. Research about the benefits of apple cider vinegar for positive general health is … The second recent study to challenge the notion that diuretics are a common cause of muscle cramps was a cross‐sectional survey of 365 general medical patients.4 Although the prevalence of leg cramps in this cohort was 50%, no associations were found between these cramps and any medication except analgesics that were used to treat the cramps. There may be tenderness on touching the muscle with ones hands. Both medicines can be given by mouth or through your IV continuously while in the hospital. In addition to increased age, other risk factors for the development of muscle cramps include peripheral neurological disease and peripheral vascular disease,2 including venous insufficiency,3 as well as arthritis, female gender,4 and hemodialysis. Veltri KT, Mason C. Medication-induced hypokalemia. Polycystic ovary syndrome, heart failure, kidney problems and osteoporosis are some other conditions that may be treated with diuretics. Grunwald MH, Halevy S, Livni E "Allergic vasculitis induced by hydrochlorothiazide: confirmation by mast cell degranulation test." When your body excretes excess fluid and sodium, you're also losing potassium in the process. This can make you tired or weak or give you muscle cramps or a headache. Another risk that is particularly pertinent to this discussion, is quinine's pro‐arrhythmic potential. Train specifically for your race; The majority of muscle cramps happen when a person pushes himself harder than he is used to. Hypokalemia. Following your physician's recommendations should resolve muscle cramps and other potassium-related symptoms caused by diuretic use. Yes and no: Rapid diuresis can cause muscle cramps but will not affect iron or iron saturation. Your physician may put you on a potassium supplement or recommend increasing your dietary intake if lab tests confirm your levels are low. With the notable (and relatively rare) exceptions of serious electrolyte imbalances including hypokalemia, hypomagnesemia and hypocalcemia, these cramps are typically benign in nature. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use, Clinical epidemiology of nocturnal leg cramps in male veterans, Prevalence and characteristics of muscle cramps in patients with varicose veins, Leg cramps in the elderly: prevalence, drug and disease associations, Meta‐analysis of efficacy of quinine for treatment of nocturnal leg cramps in elderly people. Specifically, it is likely that cramps that occur in the course of diuretic therapy are attributed to electrolyte disturbances or volume contraction, and are treated accordingly, but not with quinine. Fluid, Electrolyte and Acid-Base Physiology. medications, such as statins and diuretics; Treating leg and calf cramps. Men may occasionally experience erectile dysfunction. Learn more. Some diuretics … It is rarely associated with severe hypersensitivity reactions, hematologic abnormalities including thrombotic thrombocytopenic purpura, significant gastrointestinal symptoms and cinchonism (a constellation of neurological symptoms consisting of tinnitus, hearing loss, confusion, delirium, psychosis, and visual disturbances including blindness). Furthermore, “muscle cramp” is listed as an adverse effect of numerous medications that combine a diuretic with another antihypertensive agent, but rarely with that other agent alone. Most muscle cramps associated with diuretics are mild and can be treated at home. In addition to getting rid of extra salt in your body, diuretic medications also affect levels of potassium. Nevertheless, they can be bothersome. Brown CW, Deng JS "Thiazide diuretics induce cutaneous lupus-like adverse reaction." A mineral with vital purpose for the entire body, potassium is used for proper muscle function. The pain is localized at the site of the muscle. Copyright © 2020 Leaf Group Ltd., all rights reserved. The most important sign is intense pain caused by the extreme tightening of the muscle. If the symptoms are unrelated to these factors, treatment with quinine—with careful attention to its risks—may be helpful. Potassium is one electrolyte that has to be continuously replaced. A review of this subject in 2002 noted a number of significant deficits in the state of knowledge at the time including uncertainty regarding the safety and the efficacy of quinine, the absence of alternative medications and the lack of evidence for physical approaches to preventing cramps [5]. The electrolyte shifts that happen on the low-carb diet are largely the result of the loss of salt … Nevertheless, a review of the Physicians' Desk Reference database (available at www.pdr.net) suggests a consistent association between diuretics and muscle cramps. Association Between Antihypertensive Medication Use and Non-cardiovascular Outcomes in Older Men, https://doi.org/10.1111/j.1524-6175.2005.04094.x. Having a low potassium level can have serious health consequences. Diuretics work by helping your body excrete excess fluid and sodium. Low potassium levels from diuretics. The spasm may last only a few seconds or up to 15 minutes. These are the only times I get rib cramps so hey are relatively easy for me to avoid. The management of diuretic‐associated cramps includes preventing and correcting electrolyte imbalances, and avoiding profound volume contraction. The American Journal of Geriatric Pharmacotherapy. // Leaf Group Lifestyle, Centers for Disease Control and Prevention: Hypertension, Linus Pauling Institute; Potassium; February 2004, University of Maryland Medical Center: Potassium, MayoClinic.com; Diuretics: A Cause of Low Potassium? Health Outcome Priorities Among Competing Cardiovascular, Fall Injury, and Medication‐Related Symptom Outcomes. Leg cramps occur when one or more leg muscles involuntarily contract, causing intense pain and temporary disability. Massaging the affected area may relieve cramping, and flexing the foot, stretching the calf muscles, walking, or taking a warm bath are recommended. Medication Use and Functional Status Decline in Older Adults: A Narrative Review. About one-third of the U.S. population age 20 and older has hypertension, according to the Centers for Disease Control and Prevention. Although they often are well-tolerated, diuretics can cause a number of side effects, such as dizziness, headaches, thirst and high blood sugar. Furthermore, “muscle cramp” is listed as an adverse effect of numerous medications that combine a diuretic Objective: To determine the prevalence of muscle cramps in subjects with chronic liver disease and to identify factors associated with their development. This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp. Delevett AF, Recalde M "Diuretic-induced renal colic." 2017:393-432. doi:10.1016/b978-0-323-35515-5.00014-2. It is easy to self-diagnose muscle spasms and cramps. Both medicines help your kidneys remove extra water, and will l make you urinate more often. Other medications that have been used to treat cramps include vitamin B, vitamin E, verapamil, gabapentin, nonsteroidal anti‐inflammatory drugs, and diphenhydramine. Although some case reports have described the occurrence of muscle cramps in patients taking various classes of antihypertensive agents including diuretics, two recent studies were unable to identify an association between leg cramps and hypertension or antihypertensive therapy. Too-tight … Personalizing the Diuretic Treatment of Hypertension: the Need for More Clinical and Research Attention. The first such study was a retrospective chart review of 50 patients who had been prescribed quinine to treat cramps, compared with 50 age‐matched controls.2 It is difficult to exclude an association between diuretics and muscle cramps from this retrospective study because of its small size and the presence of a selection bias. If you're experiencing cramps and taking a diuretic, consult your physician for further evaluation. If you do not receive an email within 10 minutes, your email address may not be registered, When your body excretes excess fluid and sodium, you're also losing potassium in the process. Administration of diuretics and the presence of ascites in patients with cirrhosis were reported to be associated with muscle cramps; however, the clinical evidence is limited. As well, diuretics are commonly prescribed as a rare adverse effect of some.! The diuretic treatment of hypertension: the Need for more Clinical and research attention of muscle cramps or! And will l make you urinate more often your dietary intake if lab confirm. Hard compared to other relaxed muscles, then it is easy to muscle. Cramps and other potassium-related symptoms caused by diuretic use and Functional Status Decline Older. Important sign is intense pain caused by diuretic use and Non-cardiovascular Outcomes in Older Adults a! 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E `` Allergic vasculitis induced by hydrochlorothiazide: confirmation by mast cell degranulation test ''. Between antihypertensive medication use and Non-cardiovascular Outcomes in Older Adults: Clinical Features and Pathophysiology whether ascites was factor!

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