Are your legs cramping?

Cramps, especially at night, unlike being sore from lifting massive weights, is no fun at all

I talk to people who complain of leg cramps. I’ve actually had a few myself and know they are some of the most unpleasant ways to wake up in the middle of the night. I see magnesium used with limited success. Some tell me that if they quit taking their multivitamin the cramps reappear. I know people used to swear by quinine till it got pulled from the market. Some people will eat bananas in hopes of reducing the problem. Today I want to delve a bit into some medication related associations of leg cramps. Sometimes we forget that medication, any medication has drawbacks and just like water can be harmful at the right dose.

A study that came out earlier this year from Canada looked at quinine prescriptions before and after certain medications were prescribed in patients to see if there were any associations. I want to be clear that from this type of study we cannot definitely say that the following medication cause leg cramps. We just have some good associations to say “hey, there sure are a lot of people who seem to have cramping going on with these medications and they didn’t before”. Quinine, for those who don’t know, is a drug that was commonly used for malaria but worked well in people with cramps. The FDA said there was no studies saying that it worked and because it can cause heart problems, it got yanked from the market. It is under brand name again, Qualaquin, but that will cost you 1 arm and 1 leg per pill.

Just as a side note, acetaminophen or Tylenol has killed about 458 people/year during the 1990’s. Quinine has killed about 93 people since 1969. So we actively sell 1 drug over the counter that kills people regularly and causes 26000 hospitalizations annually but take 1 off the market because it has killed 93 people since 1969 and works on cramps. Way to go FDA, you sell-outs!

Here are your references for the above stats:

http://www.bloomberg.com/apps/news?pid=newsarchive&sid=an0NgFGyErgU&refer=worldwide

http://www.adrugrecall.com/quinine/quinine.html

Anyhow, back to the science. The researchers found some associations between a couple of different classes of medications and cramps. Here are your results:

Long acting beta agonists or LABAs, thiazidelike diuretics and potassium-sparing diuretics seem to be the main culprits. Statins and loop diuretics had some associations but were smaller than the aforementioned. Now it’s time to whip out that medication list and see if any might match up with these classes of drugs.

LABAs (inhaled for diseases like asthma)

  • Salmeterol, Formoterol, Fenoterol
  • Advair (fluticasone/salmeterol) Symbicort (Formoterol/budesonide)

Thiazidelike diuretics

  • Hydrochlorothiazide (HCTZ)
  • Indapamide

Potassium-sparing diuretics

  • Triamterene-hydrochlorothiazide
  • Sprinolactone
  • Amiloride-hydrochlorothiazide
  • spironolactone=hydrochlorothiazide

Drugs with smaller associations

  • Statins
  • loop diuretics i.e Furosemide (1)

If you happen to be taking a medication in the first 3 categories and are having leg cramps, there is a good chance it may be due to the medication. A wise approach would be to ask your most awesome pharmacist or doctor if there are alternatives if you think one of these may be the cause of your nocturnal pains. I have talked with a few people who have told me that CoQ10 seems to work wonders for them. Others again say that magnesium works well, but most tell me magnesium just gives them the runs. I think CoQ10 is a good start, especially since I feel most people over 30-40 should probably be taking it anyway. I don’t recommend magnesium oxide. It is poorly absorbed and will definitely give you the diarrhea. There are other mixed forms which are better absorbed and might be therapeutically advantageous.

A good multivitamin helps some people although you have to be careful that they will actually deliver. Many vitamins won’t even dissolve in the stomach. Place a tablet in some vinegar and see what happens. If it stays relatively firm after 10-20 minutes then it probably won’t break down well in your stomach. Generally I think if something is working stick to it unless it is damaging your health in some other way.

The best thing to do would be eliminate the offending agent, if there is indeed one to begin with. This is where talking with that awesome pharmacist or doc comes in handy. Stopping the agent for a time and restarting to see if there is any change in the cramps is a great way to test the hypothesis for your experiment on yourself. If you stop the agent for a month or two and the cramps start to go away, you can re-challenge by starting the medication again to see if it was the problem. Most docs aren’t going to be keen on stopping most of the above medications because they are for blood pressure and asthma. This is where you need an understanding doc who can work with you rather than just treat a possible side effect of another medication. And as always, try getting some good exercise and taking a good look at your diet. If high blood pressure is causing you to take one of the above listed meds, then lifestyle modifications can often play a role in eliminating the problem, barring any unforseen complications. Again, this is where a good doc comes in handy.

CIAO

The Brute

1. SR Garrison, CR Dormuth, RL Morrow et al. Nocturnal leg cramps and prescription use that precedes them, a sequence symmetry analysis. Arch Intern Med. 2012 172(2); 120-126

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Advertisements

Making an RX an OTC

I was just alerted to this article from the Washington Times about letting certain prescription drugs become OTC products under certain circumstances. According to the article one would simply have to ask some questions at say a kiosk in the pharmacy for example and then be able to buy drugs for certain chronic conditions. The story can be found here:

http://www.washingtontimes.com/news/2012/apr/29/fda-may-let-patients-buy-drugs-without-prescriptio/?page=all

For starters I want to point out the obvious and that is that this is a suggestion by the FDA. Mmmhmm, the FDA. For anyone that has any question about how I feel about the FDA lets just say I think most of what they do is a waste of my tax money. Of course they are mostly funded by big pharma now so I’m sure my tax money covers just the vending machines in the halls.

Lets indulge the argument for a moment just for the sake of argument. I’m now a 63 year old whose grandfather died of a heart attack 60 years ago. I had my cholesterol checked 3 years ago and it was 240. I take lisinopril for my blood pressure which is well controlled by my doc and the medicine. I’m thinking (again this is for the sake of argument, if it were really me at 63 I wouldn’t be worried about my cholesterol so much as I would about my retirement fund) my cholesterol might be a problem so I answer a few questions and the kiosk says that I’m the perfect candidate for some simvastatin or atorvastatin, both cholesterol lowering medications. I swipe my debit card and a few seconds later I get a vial with some pills in it with instructions on the label. I might talk with the pharmacist about how my car is running and if there is anything I should be worried about. If my pharmacist is a typical grad of an ACPE accredited college of pharmacy he/she will tell me to take it in the evening if it’s simvastatin and to avoid grapefruit juice or any time of the day with atorvastatin. A savvy pharmacist might even recommend some CoQ10. I go off along my way knowing that I just got some medicine and I didn’t even have to go to the doctor’s office. Swell!

Now I take my statin, in this case most likely for primary prevention, not knowing that there is no real evidence to back up all cause mortality reduction with a statin for primary prevention. Maybe my muscles will ache some, but hey I’m gettin older and that’s supposed to happen. I’ve given up that wonderful grapefruit juice which I love so much (which is an absolute truth by the way) so I can be healthy. I’m saving tax payer money by not going to the doctor and reaping all the benefits of having the medication that I think I so desperately need to save my health. Multiply this by a few million and just start to watch the savings roll in…to the government of course. But that will just mean the deficit will be reduced and maybe, just maybe will have a surplus.

Ok I can’t take all this sarcasm. I could write on but I had to stop. I was feeling sappy. I’m not even going to address the last sentence in the above paragraph because if you live in the United States or are any kind of aware of the current situation here, you know that a surplus isn’t in the cards and this is supposed to be about health of the human body anyway, not the US government. Now don’t get my wrong, I’m all about a pharmacist helping a person make informed decisions about his/her healthcare. I discuss some aspect of lifestyle with at least 1 person every single working day. I would love to have more authority to make more decisions about the medications people use on a daily basis. I’m not trained to diagnose, but I’ve done plenty of research on some of your more major topics like GERD and diabetes that I think I could easily help manage a person with those types of problems. But what is being proposed by the FDA is just something that is downright dumb. Letting a kiosk make your health decisions for starters is about as smart as letting government decide what to do with all of our tax money.

I do believe in freedom. If a person wants to be unhealthy by choice and pay the consequences of those choices that is all fine by me. If you want to disregard everything I tell you at the pharmacy window because you don’t care what I have to say, that is your God given freedom. If you want to be healthy and find ways of beating a disease, that is also your choice and the decisions is yours to make a choice to do something about it. If you are overweight and you don’t like it, then do something about it. If you can’t walk up the stairs without puffing and wheezing like a 60 yr chain smoker, then change something. And for the love seek out someone who can help. If you don’t like your doc, switch. If you need to learn some fitness, find out someone who can help that works with you. If you need to relearn nutrition, then relearn. My knowledge about medications, nutrition and supplements exploded after I got out of pharmacy school because I finally had free time to study things that were more interesting. There is so much knowledge out there and it is ripe for the learning. I think healthcare professionals are great for helping with matters of health, I just think people need to find professionals that relate with them and are truly going to help, rather that ask a series of questions, follow an algorithm and then send you off to a specialist if the algorithm doesn’t fit. Don’t get me wrong I have nothing against specialists or family practitioners who are just in over their heads and aren’t afraid to admit it. But find a doc you like and for love’s sake find a pharmacist you like. I’m willing to bet someone reading this blog would find me a horrible pharmacist and would never come to my window. That’s fine by me. Others keep coming back and asking my advice. That’s also fine by me.

Take healthcare into your own hands. Please don’t think that getting your medicine from a kiosk is going to solve anything because it won’t. I suspect this idea won’t make it very far but if it did I believe it would only make matters worse.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.