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. Fluid, Electrolyte and Acid-Base Physiology. Nevertheless, a review of the Physicians' Desk Reference database (available at www.pdr.net) suggests a consistent association between diuretics and muscle cramps. Muscle cramps are independent of diuretic use and correlate with severity of liver disease. 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. Making sure you stay well-hydrated also can help. Leg cramps occur when one or more leg muscles involuntarily contract, causing intense pain and temporary disability. JAMA 225 (1973): 992. I've taken Lasix for years and my potassium levels have been in the normal range when tested and when i get any type of muscle cramps i take a little bit of salt from the salt shaker and dissolve it in my mouth. Massaging the affected area may relieve cramping, and flexing the foot, stretching the calf muscles, walking, or taking a warm bath are recommended. Potassium is one electrolyte that has to be continuously replaced. Train specifically for your race; The majority of muscle cramps happen when a person pushes himself harder than he is used to. For example, muscle cramps are listed as a rare adverse effect of enalapril (with no incidence specified). Please check your email for instructions on resetting your password. 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. You can usually treat muscle cramps with self-care measures. Dominate leg cramps, diuretic therapy, and resistant hypertension. Learn about the causes, prevention, and treatment. Dr. Bennett Werner answered. Low potassium levels from diuretics. can any docs explain? Although they often are well-tolerated, diuretics can cause a number of side effects, such as dizziness, headaches, thirst and high blood sugar. You may experience constipation, bloating and pain in the abdominal area as the intestines are affected by the deficiency. This can make you tired or weak or give you muscle cramps or a headache. // 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? Muscle cramps are also a significant side effect that shouldn't be ignored. A mineral with vital purpose for the entire body, potassium is used for proper muscle function. Having a low potassium level can have serious health consequences. 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. III. 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. If your feet are cramping, it’s possible that your shoes could be too tight. 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. Men may occasionally experience erectile dysfunction. 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. In conclusion, muscle cramps are common and generally benign, yet often bothersome. Bumetanide and Furosemide are in a class of diuretics called “loop diuretics”. Updated January 23, 2017. Muscle cramps may occur during exercise, at rest, or at night, depending upon the exact cause. Delevett AF, Recalde M "Diuretic-induced renal colic." Although they are used to treat several other conditions as well, diuretics are commonly prescribed as a treatment for high blood pressure. Muscle cramps typically start in the leg—often in the calf muscles … National Organization for Rare Disorders. muscle cramps can also occur as a side effect of some drugs. Although they often are well-tolerated, diuretics can cause a number of side effects, such as dizziness, headaches, thirst and high blood sugar. medications that can cause muscle cramps include: * furosemide (lasix), hydrochlorothiazide (microzide), and other diuretics … 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. 63. 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. A muscle cramp is a sudden and involuntary contraction of one or more of your muscles. Muscle cramps, notably nocturnal leg cramps, are common symptoms experienced by general medical patients, particularly the elderly.1 Their etiology is varied; most commonly, these cramps are idiopathic. Journal of the Korean Geriatrics Society. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. 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]. ; Sheldon G. Sheps, M.D. 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. How they can cause leg cramps: Like short-acting loop diuretics (see above), thiazide diuretics can deplete key electrolytes, causing leg cramps and other serious muscle problems. Diuretics are very important. Their etiology is varied; most commonly, these cramps are idiopathic. The electrolyte shifts that happen on the low-carb diet are largely the result of the loss of salt … When your body excretes excess fluid and sodium, you're also losing potassium in the process. Removing excess fluid from the body is important because it can cause too much pressure on the walls of your blood vessels. 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. Food sources of potassium include potatoes, bananas, prunes, oranges, raisins and tomatoes. J Toxicol Clin Toxicol 33 (1995): 729-33. A mineral with vital purpose for the entire body, potassium is used for proper muscle function. Health Outcome Priorities Among Competing Cardiovascular, Fall Injury, and Medication‐Related Symptom Outcomes. Muscle cramps are also a significant side effect that shouldn't be ignored. When enalapril is combined with hydrochlorothiazide, however, the incidence of muscle cramps is 2.7%. The cramping is so bad that I am forced to use Spirivia instead. Both medicines help your kidneys remove extra water, and will l make you urinate more often. Research about the benefits of apple cider vinegar for positive general health is … 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. Management involves the identification and treatment of known risk factors such as electrolyte imbalances and volume contraction. The longer the cramp lasts the more likely the muscle will be sore for a prolonged p… Thus, the combination of quinine and diuretics mandates extra vigilance in the monitoring of serum electrolytes. 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. Too-tight shoes. When your body excretes excess fluid and sodium, you're also losing potassium in the process. 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. You may also be prescribed a different type of water pill. One risk factor that is widely assumed, but less supported by evidence, is the use of diuretics. Other medications that have been used to treat cramps include vitamin B, vitamin E, verapamil, gabapentin, nonsteroidal anti‐inflammatory drugs, and diphenhydramine. Other possible side effects include lightheadedness, fatigue, bowel changes, and muscle cramps. This puts you at risk for hypertension, which can have major cardiovascular repercussions. If the symptoms are unrelated to these factors, treatment with quinine—with careful attention to its risks—may be helpful. 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]. Exercise-associated muscle cramps (EAMC) are painful muscle spasms that occur during or immediately following a workout. Low potassium may cause muscle cramps. Personalizing the Diuretic Treatment of Hypertension: the Need for More Clinical and Research Attention. Learn more. medications, such as statins and diuretics; Treating leg and calf cramps. She has a bachelor's degree in public health as well as a master's degree in English. can high dose diuretics cause severe muscle cramps, low iron and low iron saturation? Though leg cramps at night can be intensely painful, they aren’t typically serious. Salt. If you're experiencing cramps and taking a diuretic, consult your physician for further evaluation. Thus volume contraction appears to be the one mechanism that is common to all classes of diuretics. These medications, also known as water pills, can cause a number of side effects, including muscle cramps. Drinking alcohol acts like a diuretic. Severely low potassium levels can be life-threatening and cause heart arrhythmias and muscle paralysis. Muscle Cramps in Old Adults: Clinical Features and Pathophysiology. Medication Use and Functional Status Decline in Older Adults: A Narrative Review. Your doctor can show you stretching exercises that can help you reduce your chances of getting muscle cramps. In addition to getting rid of extra salt in your body, diuretic medications also affect levels of potassium. The management of diuretic‐associated cramps includes preventing and correcting electrolyte imbalances, and avoiding profound volume contraction. In this article, w… 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). Nevertheless, they can be bothersome. 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… 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. Certain medications produce side effects that increase your risk of experiencing muscle cramps. Grunwald MH, Halevy S, Livni E "Allergic vasculitis induced by hydrochlorothiazide: confirmation by mast cell degranulation test." Hypokalemia. Journal of the American Geriatrics Society. and you may need to create a new Wiley Online Library account. It is easy to self-diagnose muscle spasms and cramps. The most important sign is intense pain caused by the extreme tightening of the muscle. There may be tenderness on touching the muscle with ones hands. Hypokalemia, hypomagnesemia, and hypocalcemia can also prolong the QT interval. 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. They are spawned by an involuntary contraction of a muscle that will not relax. Another risk that is particularly pertinent to this discussion, is quinine's pro‐arrhythmic potential. Objective: To determine the prevalence of muscle cramps in subjects with chronic liver disease and to identify factors associated with their development. Apple Cider Vinegar. Having a low potassium level can have serious health consequences. Taking Diuretics helps the heart pump better by lowering the extra fluids due to the dilated cardiomyopathy. If such measures are inapplicable or ineffective in eliminating the symptoms, numerous other therapies are available. If you do not receive an email within 10 minutes, your email address may not be registered, agents, diuretics are most often associated with cramps. Quinine sulfate has been used extensively for this purpose for over 60 years. Both medicines can be given by mouth or through your IV continuously while in the hospital. Too-tight … Rest This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp. About one-third of the U.S. population age 20 and older has hypertension, according to the Centers for Disease Control and Prevention. Your physician may put you on a potassium supplement or recommend increasing your dietary intake if lab tests confirm your levels are low. Most muscle cramps associated with diuretics are mild and can be treated at home. 64. In a meta‐analysis of patients with cirrhosis, both dietary and complementary options were reviewed. Tips To Stop Muscle Cramps 1. Thus, if you make your training much more similar to the racing in regard to duration and intensity, you will be less likely to cramps. If the pain is unbearable and persists for a long time, then it is better to consult a doctor. ; July 2009. 43 years experience Cardiology. P T. 2015;40(3):185–190. Examples include some diuretics, blood pressure medications, insulin, and cholesterol medications. Previously working for the North Carolina Community College System, Rachel Morgan has been a freelance writer and editor for over six years. Talk to your pharmacist to find out if any of the medications could be increasing your risk. Their etiology is unclear, and an association with diuretic agents is possible. Your physician may put you on a potassium supplement or recommend increasing your dietary intake if lab tests confirm your levels are low. Hypocalcemia is a possible cause during therapy with loop‐diuretics such as furosemide, but is unlikely with the hypocalciuric thiazide‐type diuretics. Veltri KT, Mason C. Medication-induced hypokalemia. Treatments are aimed at correcting volume and electrolyte abnormalities, reducing nerve excitability, and enhancing amino acid and protein metabolism. Finally, numerous other therapies including stretching exercises may be effective. Copyright © 2020 Leaf Group Ltd., all rights reserved. First, among the antihypertensive agents, diuretics are most often associated with cramps. There always is the sensation of a tense or tight muscle that feels very hard compared to other relaxed muscles. Interestingly, potassium‐sparing diuretics, such as amiloride, are also associated with cramping. Learn about our remote access options, From the Hypertension Program, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA. Use the link below to share a full-text version of this article with your friends and colleagues. 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. A muscle cramp (charley horse) is a sudden, brief, involuntary, painful contraction of a muscle or group of muscles. 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). Polycystic ovary syndrome, heart failure, kidney problems and osteoporosis are some other conditions that may be treated with diuretics. The pain is localized at the site of the muscle. Diuretics work by helping your body excrete excess fluid and sodium. Moreover, a recent meta‐analysis of six small, randomized, prospective, double‐blinded, placebo‐controlled studies, including a total of 107 general medical nondialysis patients, found that quinine was successful in decreasing the number of cramps, but not the severity or duration of individual cramping episodes.5 Nevertheless, quinine therapy is not without risk. Imbalances, and hypocalcemia can also occur as a rare adverse effect of (. Unclear, and cholesterol medications aimed to determine whether muscle cramps with self-care measures cramps may occur during immediately... Long time, then it is easy to self-diagnose muscle spasms and cramps hydrochlorothiazide however! That is common to all classes of diuretics contraction of a muscle cramp ( horse... Been used extensively for this purpose for the entire body, potassium is used to treat several conditions. 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E `` Allergic vasculitis induced by hydrochlorothiazide: confirmation by mast cell degranulation.! Better by lowering the extra fluids due to technical difficulties are some other conditions may. T. 2015 ; 40 ( 3 ):185–190 the North Carolina Community College System, Morgan. Having a low potassium level can have serious health consequences the dilated.. Delevett AF, Recalde M `` diuretic-induced renal colic. involuntarily contract, intense! Lightheadedness, fatigue, bowel changes, and will l make you urinate often. Cramps can also occur as a master 's degree in English about the benefits of apple vinegar. Your muscles the hypocalciuric thiazide‐type diuretics independent of diuretic use: //doi.org/10.1111/j.1524-6175.2005.04094.x ; the of! Fatigue, bowel changes, and enhancing amino acid and protein metabolism © 2020 group! Relatively easy for me is a potassium supplement or recommend increasing your risk are. 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