- 4 leg problems and what might be causing them
- Hypertensive Emergency
- Topic Overview
- What to know about high blood pressure
- High Blood Pressure and Your Feet
- Managing Hypertension
- What’s Causing Tingling in My Feet?
- What Is High Blood Pressure?
- When to Visit a Podiatrist
- Diagnosis and Treatment
4 leg problems and what might be causing them
The primary purpose of your legs is to keep you upright and mobile. Yet, your legs can also act as an indicator of your overall health. Although some symptoms you may experience are specific to a leg problem, others can suggest trouble with your heart, nervous system, kidneys, or other organs. Use the following symptom guide to help you decipher what broader problems your leg pain might suggest.
Symptom: Leg cramps
Possible cause: Dehydration
A cramp in your leg after you’ve been working out, especially in the heat, could be an important sign that your body is low on fluids. To contract and relax normally, muscles rely on water and electrolytes like sodium and potassium. Too little fluid or electrolytes can hypersensitize the nerves that control muscles in the legs, causing the
muscles to contract abnormally, or spasm.
All of your organs rely on fluids to function normally. Dehydration prevents cells from properly using energy, transporting nutrients, and dividing. If not quickly remedied, it can become a life-threatening condition. To avoid getting too low on fluids, drink water or an electrolyte-containing sports drink before, during, and after exercise.
Symptom: Calf pain during activity
Possible cause: Atherosclerosis
Pain in your legs that’s triggered by activity—along with weak pulses in your legs and feet, pale skin, and sores on your legs or feet that don’t heal well—are signs of peripheral artery disease, a blockage in blood flow to your legs. The most likely cause is atherosclerosis, ahardening and narrowing of the arteries as a result of sticky cholesterol and fat deposits called plaques.
If your legs are suffering from inadequate blood flow, likely your heart is, too. Peripheral artery disease shares risk factors with heart disease—namely, smoking, high cholesterol, diabetes, and high blood pressure. It increases your risk of developing heart disease and of having a heart attack or stroke in the future.
To avoid serious complications, you need to make changes to your lifestyle by losing excess weight, getting more active, eating a heart-healthy diet, and quitting smoking. Sometimes surgery is needed to open up or bypass a blocked artery. Your doctor may recommend blood thinners and vasodilators (medications that help open up blood vessels).
Symptoms: Pain, burning, numbness, and tingling
Possible cause: Diabetes
These feelings in your legs or feet could be signs of diabetic neuropathy—nerve damage due to persistently high blood sugar. High blood sugar damages not only the small blood vessels that send oxygen and nutrients to the nerves, but also the nerves themselves, preventing them from sending the correct signals to your brain.
The keys to preventing neuropathy, as well as other diabetes complications like vision loss, heart disease, and kidney damage, are to keep your blood sugar under good control and modify other risk factors. Don’t smoke; also, bring down high blood pressure and cholesterol. Good blood sugar control requires a combination of dietary changes, physical activity, blood sugar monitoring, and sometimes blood sugar-lowering medications.
Symptom: Leg swelling
Possible causes: Heart, kidney, or liver disease
Many things can cause swelling in the legs. At the least worrisome level, it may be the result of an injury, such as a sprain or strain, or venous insufficiency. Or it could point to a more serious problem, such as:
- a blood clot in the leg
- heart failure
- kidney disease or kidney failure
- liver disease (cirrhosis).
Each of these conditions is unique and requires you to work with your doctor to get a diagnosis and start on a treatment plan.
For more information on treating common leg problems, checking Healing Leg Pain, a Special Health Report from Harvard Medical School.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
A hypertensive emergency is very high blood pressure that damages the body. It can cause damage to the brain, heart, eyes, or kidneys. A hypertensive emergency needs immediate care.
Symptoms include numbness, blurry vision, chest pain, severe headache, and confusion.
This problem is also called malignant hypertension.
Quick-acting medicines are used to lower blood pressure.
The cause may be unknown. Or the problem may be caused by medicine or another condition.
When to call a doctor
Call 911 anytime you think you may need emergency care. This may mean having symptoms that suggest that your blood pressure is causing a serious heart or blood vessel problem. Your blood pressure may be over 180/120.
For example, call 911 if:
- You have symptoms of a heart attack. These may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
- You have symptoms of a stroke. These may include:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
- You have severe back or belly pain.
Do not wait until your blood pressure comes down on its own. Get help right away.
Call your doctor now or seek immediate care if:
- Your blood pressure is much higher than normal (such as 180/120 or higher), but you don’t have symptoms.
- You think high blood pressure is causing symptoms, such as:
- Severe headache.
- Blurry vision.
Watch closely for changes in your health, and be sure to contact your doctor if:
- Your blood pressure measures higher than your doctor recommends at least 2 times. That means the top number is higher or the bottom number is higher, or both.
- You think you may be having side effects from your blood pressure medicine.
What other problems can happen when you have a hypertensive emergency?
A hypertensive emergency can cause:
- Bleeding in your brain or body.
- Heart attack.
- Heart failure.
- Kidney failure.
- Eye damage and loss of vision.
How can you prevent it?
It is better to prevent a hypertensive emergency than to treat an episode after you have already had one. One of the most common causes of a hypertensive emergency is not taking your blood pressure medicines properly. Sometimes this happens unintentionally. For example, your prescription may run out or you may forget to take a dose. But try to stay on your medicine schedule as best as you can. Another cause is illegal drug use, such as stimulants like cocaine.
How is it treated?
To treat a hypertensive emergency, doctors and nurses will carefully monitor your blood pressure and give you medicine intravenously (through a needle inserted in one of your veins). The immediate goal is to lower your blood pressure enough so that your organs are no longer in immediate danger. But it must be lowered slowly so that your body has enough time to adjust to the change in blood pressure. If blood pressure is lowered too quickly, your body may have a hard time getting blood to your brain.
The other goal of treatment is to treat organ complications. For example, your doctor may give you a diuretic if you have fluid buildup in your lungs. Or your doctor may give a beta-blocker and nitrates if you have myocardial ischemia (not enough blood is reaching your heart). After your doctor has lowered your blood pressure to a safe level and treated your complications, he or she will try to identify the cause of the acute episode. Your doctor will then work with you to create a treatment regimen that can help prevent future attacks.
What to know about high blood pressure
Treatment will depend on several factors, including:
- how high the blood pressure is
- the risk of cardiovascular disease or a stroke
The doctor will recommend different treatments as blood pressure increases. For slightly high blood pressure, they may suggest making lifestyle changes and monitoring the blood pressure.
If blood pressure is high, they will recommend medication. The options may change over time, according to how severe the hypertension is and whether complications arise, such as kidney disease. Some people may need a combination of several different medications.
Conventional drugs for treating high blood pressure include:
1) Angiotensin converting enzyme inhibitors
Angiotensin converting enzyme (ACE) inhibitors block the actions of some hormones that regulate blood pressure, such as angiotensin II. Angiotensin II causes the arteries to constrict and increases blood volume, resulting in increased blood pressure.
ACE inhibitors can reduce the blood supply to the kidneys, making them less effective. As a result, it is necessary for people taking ACE inhibitors to have regular blood tests.
People should not use ACE inhibitors if they:
- are pregnant
- have a condition that affects the blood supply to the kidneys
ACE inhibitors may cause the following side effects, which usually resolve after a few days:
- a persistent dry cough
If the side effects are persistent or too unpleasant to manage, a doctor may prescribe an angiotensin II receptor antagonist instead.
These alternative medications often cause fewer side effects, but they may include dizziness, headaches, and increased potassium levels in the blood.
2) Calcium channel blockers
Calcium channel blockers (CCBs) aim to decrease calcium levels in the blood vessels. This will relax the vascular smooth muscle, causing the muscle to contract less forcefully, the arteries to widen, and blood pressure to go down.
CCBs may not always be suitable for people with a history of heart disease, liver disease, or circulation issues. A doctor can advise on taking CCBs and which type of CCB is safe to use.
The following side effects may occur, but they usually resolve after a few days:
- redness of the skin, generally on the cheeks or neck
- swollen ankles and feet
- skin rash
- swollen abdomen, in rare cases
Learn more here about calcium channel blockers.
3) Thiazide diuretics
Thiazide diuretics help the kidneys get rid of sodium and water. This lowers blood volume and pressure.
The following side effects can occur, and some of them may persist:
- low blood potassium, which can affect heart and kidney function
- impaired glucose tolerance
- erectile dysfunction
People taking thiazide diuretics should have regular blood and urine tests to monitor their blood sugar and potassium levels.
Beta-blockers were once popular for treating hypertension, but doctors only tend to prescribe them now when other treatments have not been successful.
Beta-blockers slow the heart rate and reduce the force of the heartbeat, causing a drop in blood pressure.
Side effects may include:
- cold hands and feet
- slow heartbeat
- Less common side effects are:
- disturbed sleep
- erectile dysfunction
Beta-blockers are often the standard medication for a person with very high blood pressure, known as a hypertensive crisis.
5) Renin inhibitors
Aliskiren (Tekturna, Rasilez) reduces the production of renin, an enzyme that the kidneys produce.
Renin helps produce a hormone that narrows blood vessels and raises blood pressure. Reducing this hormone causes the blood vessels to widen and blood pressure to fall.
This drug is relatively new, and healthcare professionals are still determining its optimal use and dosage.
Possible side effects include:
- flu-like symptoms
- a cough
It is essential to read the packaging of any medication to check for interactions with other drugs.
Find out more detail here about blood pressure medications.
Managing the diet can be an effective way of both preventing and treating high blood pressure.
A healthful, balanced diet includes plenty of fruits and vegetables, vegetable and omega oils, and good quality, unrefined carbohydrates, such as whole grains. People who include animal products in their diet should trim all the fat off and avoid processed meats.
Lowering salt intake
Experts recommend reducing salt consumption and increasing potassium intake to manage or prevent high blood pressure. Limiting salt intake to less than 5–6 grams per day could help improve cardiovascular health and reduce systolic blood pressure by 5.6 mm Hg in people with hypertension.
In moderation, plant sources of fats, such as avocados, nuts, olive oil, and omega oils, can be healthful. People should limit their intake of saturated fats and trans fats, common in animal-sourced and processed foods.
The DASH diet
Health experts recommend the DASH diet for people with high blood pressure. The DASH diet focuses on an eating plan that emphasizes whole grains, fruits, vegetables, nuts, seeds, beans, and low-fat dairy products.
|Food groups||Number of weekly servings for those eating 1,600–3,100 calories a day||Number of weekly servings for those on a 2,000-calorie diet|
|Grains and grain products||6–12||7–8|
|Mostly low-fat or non-fat dairy foods||2–4||2–3|
|Lean meat, fish, or poultry||1.5–2.5||2|
|Nuts, seeds, and legumes||3–6||4–5|
|Fats and candy||2–4||Limited|
Which foods are good for reducing blood pressure? Find out here.
Some studies indicate that consuming some alcohol may help lower blood pressure. However, others report the opposite, noting that even drinking a moderate amount might increase blood pressure levels.
People who regularly drink more than moderate amounts of alcohol will almost always experience elevated blood pressure levels.
Studies into the relationship between caffeine and blood pressure have produced conflicting results. A report published in 2017 concluded that a moderate intake of coffee appears to be safe for people with high blood pressure.
The AHA recommend a range of lifestyle adjustments that can help reduce blood pressure, such as:
- managing stress
- quitting smoking
- eating healthfully
- getting exercise
- following any treatment plan the doctor prescribes
Discuss any planned lifestyle changes with a healthcare professional before introducing them.
Share on PinterestRegular exercise may help lower blood pressure.
The AHA note that most healthy people should do at least 150 minutes of moderate intensity physical exercise a week. This could be 30 minutes — or three lots of 10 minutes a day — on 5 days of the week.
This amount of exercise is also appropriate for people with high blood pressure.
However, a person who has not exercised for a while or who has a new diagnosis should talk to their doctor before starting a new physical activity program to ensure the choices they make are suitable for them.
Studies have revealed that losing as little as 5–10 pounds in weight can help reduce blood pressure.
Weight loss will also improve the effectiveness of blood pressure medications.
Ways of achieving and maintaining a healthy weight include:
- getting regular exercise
- following a diet that emphasizes plant-based foods and limits the intake of fat and added sugars
For more advice on maintaining weight loss, click here.
Increasing sleep alone cannot treat hypertension, but too little sleep and poor sleep quality may make it worse.
A 2015 analysis of data from a Korean national health survey found that people who had less than 5 hours of sleep per night were more likely to have hypertension.
In this article, you can find more tips on how to manage high blood pressure.
According to the National Center for Complementary and Integrative Health (NCCIH), the following may help lower blood pressure:
- meditation, yoga, qi gong, and tai chi
- biofeedback and transcendental meditation
- supplements such as garlic, flaxseed, green or black tea, probiotics, cocoa, and roselle (Hibiscus sabdariffa)
The NCCIH add, however, that there is not yet enough evidence to confirm that these can make a difference.
They also warn that:
Some supplements can have adverse effects. They may raise blood pressure or interact with medications.
Meditation and exercise therapies are usually safe, but some poses may not be suitable for people with high blood pressure.
Anyone who is considering an alternative therapy should speak to their doctor first.
Get some tips for lowering blood pressure naturally.
High Blood Pressure and Your Feet
At NY Foot Health one of our goals is helping patients become better educated about the health of their feet and how it relates to the overall health of their body. Are you aware of the connection between high blood pressure and your feet? Often times, high blood pressure is associated with atherosclerosis—that’s a buildup of plaque in your blood vessels which can lead to decreased circulation. Your feet are the part of your body that’s furthest away from your heart and for this reason circulation issues can more seriously affect your lower extremities. In fact, signs of poor circulation are often first visible in your feet. Some podiatric symptoms that may signal high blood pressure include:
- Changes in color or temperature of the feet
- Cramping in the feet or lower legs, especially during or after exercise
- Sores on the feet
- Loss of hair on legs or feet
- Swelling (this may be a sign that hypertension has progressed to heart disease)
If you have already been diagnosed with high blood pressure it’s important that you inform your podiatrist of this and also any medications you are currently taking to treat this or any other medical condition. (If you don’t have a podiatrist, we can help you find one. Check out our online directory.) High blood pressure will also be a factor if you have to have surgery for foot or ankle problems.
There are a number of ways you can work to reduce high blood pressure. Several of these are also beneficial to your feet, including:
- Lose weight if you are overweight. Check out our community programs dealing with obesity.
- Eat more fruits and vegetables and reduce the fatty, fried or high-calorie foods in your diet.
- Exercise regularly. This will help improve circulation, reduce weight and maintain flexibility and range of motion.
- Follow all your doctors’ instructions for managing your high blood pressure.
Your podiatrist will be a partner with you in the care of diseases that affect your feet and the rest of your body. To learn more about diseases that affect your feet, contact us and subscribe to our free e-newsletter.
What’s Causing Tingling in My Feet?
Diabetes is one of the most common causes for persistent tingling in the feet. Diabetic neuropathy is the result of nerve damage caused by high blood sugar.
Symptoms of diabetes include:
- frequent urination
- extreme thirst
- dry mouth
- itchy skin
- fruity smelling breath
- pain or numbness in hands and feet
- increased hunger
- unexpected weight loss
- slow healing of cuts or sores
- yeast infections
- drowsiness or lethargy
- vision changes
- nausea and vomiting
Your doctor will take a medical history, complete a physical exam, and run blood tests to determine if you have diabetes or if your diabetes is causing your tingling feet.
Diabetes can be managed with lifestyle changes and several medications, such as insulin.
It’s not uncommon to experience tingling in your feet during pregnancy. As the uterus grows, it can put pressure on the nerves that run down the legs. This causes a “pins and needles” sensation.
You may be able to relieve the tingling by:
- resting with your feet up
- changing positions
- making sure you’re well hydrated
If the tingling worsens, doesn’t go away, or is accompanied by weakness or swelling, you should see your doctor to make sure nothing serious is going on.
Not getting enough of certain vitamins, particularly B vitamins, can cause tingling of the feet. Being vitamin deficient can be due to a poor diet or to an underlying condition.
If you’re deficient in vitamin B-12, you may have some of the following symptoms:
- shortness of breath
- tingling and coldness in hands and feet
- chest pain
- digestive issues
- enlarged liver
Your doctor will take a medical and family history, complete a physical exam, and draw blood to determine if you have a vitamin deficiency.
You may need vitamin supplements or another treatment, depending on the cause of your low vitamin levels.
Kidney failure may cause tingling in the feet. Kidney failure can have many causes, but the most common are diabetes and high blood pressure.
Symptoms of tingling feet caused by kidney failure include:
- pain, tingling, and numbness in the legs and feet
- cramping and muscle twitches
- “pins and needles” sensation
- muscle weakness
Your doctor may do a number of tests to determine if kidney failure is the cause of your tingling feet. Tests may include:
- a neurological exam
- electromyography (EMG), which measures muscle activity
- a nerve conduction velocity test
- blood tests
Treatment for kidney failure includes dialysis and a kidney transplant.
Autoimmune diseases occur when the body attacks itself. A number of autoimmune diseases can cause tingling in the feet. Some of these conditions include:
- Sjögren’s syndrome
- Guillain-Barré syndrome
- celiac disease
- rheumatoid arthritis (RA)
To determine if an autoimmune disorder is causing the tingling in your feet, your doctor will take a detailed family and medical history, complete a physical exam, and likely run a number of blood tests.
Treatments for autoimmune diseases vary. They may include dietary changes and medications.
A number of infections can cause inflammation of the nerves. This can lead to tingling of the feet. These infections include:
- Lyme disease
- hepatitis B and C
If you think you may have an infection, you should see your doctor. They’ll take a medical history, complete a physical exam, and likely draw blood to test for infectious diseases.
Treatment will vary depending on what infection you have, but will likely include medication.
Some medications can cause tingling in the feet as a side effect. The most common drugs that cause this are those used to fight cancer (chemotherapy) and those used to treat HIV and AIDS. Others include medications to treat:
- heart conditions
- high blood pressure
If you’re taking a medication and experiencing tingling in your feet, you should talk to your doctor. They’ll be able to determine if this is a side effect of your medication. They’ll also decide whether your dose needs to be changed.
If you have a pinched nerve in your back it can cause tingling in your feet. Pinched nerves may be due to injury or swelling.
You may also experience:
- changes in sensation in your feet
- decreased range of motion
Your doctor will complete a medical history and physical exam to determine if you have a pinched nerve. They may also complete an EMG to look at muscle activity, or a nerve conduction velocity test. Other tests may include an MRI or ultrasound.
Treatment for a pinched nerve may include:
- physical therapy
- possibly surgery
Exposure to certain chemicals and toxins can cause tingling in the feet. They may also cause pain, numbness, weakness, and difficulty walking.
Some toxins that can cause tingling in the feet if they’re swallowed or absorbed through the skin are:
- organic insecticides
- some herbal medicines
It can be difficult to diagnose toxin exposure as the cause of tingling in the feet. Your doctor will take a medical history, including details about your work and home environment, your diet, and any supplements you take. They may perform other tests, including blood tests.
Treatment may include medications, safety measures, and changing your environmental exposure to toxins at work or home.
Sometimes people experience tingling in their feet and there’s not a known cause. Doctors call this “idiopathic.”
This condition is most common in people over 60 years old. You may experience symptoms of tingling, pain, numbness, weakness, and unsteadiness when standing or walking.
Your doctor will complete a physical exam and perform a number of tests to rule out anything that could be causing your symptoms.
Treatment may include:
- pain medication
- safety measures
- special shoes
Beta-blockers make your heart beat less forcefully and more slowly. These medications may cause side effects such as:
- Asthma symptoms
- Cold hands and feet
- Erection problems
- Insomnia and sleep problems
Angiotensin Converting Enzyme (ACE) Inhibitors
These high blood pressure medications block formation of a hormone that causes blood vessels to narrow, so vessels relax. ACE inhibitors may cause these side effects:
- A dry, hacking cough that doesn’t go away. If you have this side effect, the doctor may prescribe another type of medication.
- Skin rash and a loss of taste are two other possible side effects of ACE inhibitors.
Angiotensin II Receptor Blockers (ARBs)
These high blood pressure medications shield blood vessels from a hormone that causes blood vessels to narrow. This allows blood vessels to stay open. One of the more common side effects of ARBs is dizziness.
Calcium Channel Blockers (CCBs)
These high blood pressure medications keep calcium from entering heart muscle and blood vessel cells. Blood vessels can then relax. CCBs may cause these side effects:
- Irregular or very rapid heartbeat (palpitations)
- Swollen ankles
Alpha-blockers reduce nerve impulses to blood vessels, allowing blood to flow more easily. These medications may cause:
- Dizziness, lightheadedness, or weakness when standing up suddenly or getting up in the morning (from reduced blood pressure)
- Fast heart rate
Alpha-2 Receptor Agonist
This high blood pressure medication decreases activity in the adrenaline-producing part of the nervous system. It may cause drowsiness or dizziness.
These high blood pressure medications reduce nerve impulses and also slow the heartbeat. Patients with severe high blood pressure often receive them by intravenous (IV) injection. But the doctor may also prescribe these medications for people who have congestive heart failure. Alpha-beta blockers may cause a drop in blood pressure when you stand up suddenly or first get up in the morning. This can cause dizziness, lightheadedness, or weakness.
These high blood pressure medications control nerve impulses, relaxing blood vessels.
Central agonists may cause:
- Dizziness, lightheadedness, or weakness when standing up suddenly or getting up in the morning (from a drop in blood pressure)
- Dry mouth
- Erection problems
What Is High Blood Pressure?
High blood pressure is also known as hypertension. Hypertension occurs when your blood pressure rises and stays above normal over a period of time.
Hypertension is often related to atherosclerosis, which is the buildup of plaque in blood vessels, often associated with an increase in your “bad” cholesterol. This condition can also lead to decreased circulation and peripheral arterial disease (PAD). People with decreased circulation in their legs and feet may develop ulcerations (open wounds on the skin) that can lead to amputations.
As a member of the health-care team, your podiatrist is also concerned about hypertension and vascular disease (heart and circulatory problems). Make sure you tell your podiatrist if you have high blood pressure and any medications that you may be taking for treatment.
Symptoms of poor circulation in the feet and legs may include:
- Cramping in the feet and legs, particularly with exercise
- Sores on the feet or legs
- Changes in color to the feet
- Changes in temperature to the feet
- Loss of hair on the feet and legs
Uncontrolled hypertension can also lead to heart disease, which may present as swelling in your feet and legs.
When to Visit a Podiatrist
If you experience any of the above symptoms, it is important to visit a podiatrist. And if you have been diagnosed with hypertension, it is important to tell your podiatrist, because medications that may be prescribed for a foot or ankle condition could interact with your blood pressure medications. Also, if you need to have foot or ankle surgery, it is important that your blood pressure is under control prior to any surgical procedures.
Diagnosis and Treatment
As part of your visit, your podiatrist may check your vital signs—height, weight, and blood pressure. Your podiatrist will conduct a careful examination to determine if there is lower than normal temperature in any of the extremities, absence of normal skin color, or diminished circulation in the feet. Your podiatrist may also ask you about increased or periodic swelling in the lower extremities.
If any abnormalities in your blood pressure are noted, your podiatrist will notify you and may refer you to your primary care physician for further evaluation and treatment.
Diabetes & Cardiovascular Disease
Diabetes & Cardiovascular Disease
Diabetes & Cardiovascular Disease Find a Podiatrist
Suffering From Leg Cramps? Check Your Medicine Cabinet.
While aches and pains are nothing new to those of us who are getting older, the sudden sharp pain that is experienced during a leg cramp is not pleasant. While most cramps in the calf, thigh and foot are caused by sitting, standing on hard surfaces for extended periods of time, wearing uncomfortable shoes or high heels, dehydration, and medical conditions such as diabetes or edema, sometimes it’s your medication that’s the problem.
A January 2013 AARP.com article listed eight common types of medications that can cause nighttime leg cramps:
1. Short-acting loop diuretics
Why they’re prescribed: Diuretics (also called water pills) are used to treat high blood pressure, congestive heart failure and edema, among other conditions. Diuretics help the body get rid of excess fluid by moving it into the urine.
Short-acting loop diuretics, so named because they are rapidly eliminated from the body, include bumetanide (Bumex) and furosemide (Lasix, Puresis).
How they can cause leg cramps: Diuretics increase the body’s excretion of some electrolytes — including sodium, chloride and potassium — through the urine. Low levels of these can cause extreme fatigue and muscle weakness, as well as achy joints, bones and muscles.
Alternatives: A low dose of a long-acting loop diuretic, such as torsemide (Demadex), can reduce the risk of electrolyte loss. It may also be helpful to cut back on dietary salt, exercise more and control your fluid intake. Be careful with salt substitutes, however, as most contain potassium chloride and can also cause electrolyte imbalances. And be sure to consult a health care professional before beginning a new exercise regimen.
2. Thiazide diuretics
Why they’re prescribed: Thiazide diuretics are most commonly used to treat high blood pressure, although they are also used to treat congestive heart failure, edema and other conditions.
Examples of thiazide diuretics include chlorothiazide (Diuril), hydrochlorothiazide (Microzide), indapamide (Lozol) and metolazone (Zaroxolyn).
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.
Alternatives: Talk with your health care provider about the advisability of switching to a low dose of 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 also be helpful to cut back on dietary salt, exercise more and control your fluid intake. Be careful with salt substitutes, however; most contain potassium chloride and can also cause electrolyte imbalances. And consult a health care professional before beginning a new exercise regimen.
Why they’re prescribed: Beta-blockers are typically prescribed to treat high blood pressure (hypertension) and arrhythmias (abnormal heart rhythms). These drugs slow the heart rate and lower blood pressure by blocking the effect of the hormone adrenaline. Beta-blockers are also used to treat angina, migraines, tremors and, in eyedrop form, certain kinds of glaucoma.
How they can cause leg cramps: Researchers have known for more than 20 years that beta-blockers can induce leg cramps, but they haven’t yet determined why. Studies have shown that beta-blockers cause the arteries in the legs and arms to narrow, which in turn causes less blood to flow through the limbs. That’s why some people who take beta-blockers have cold hands and feet, a condition known as peripheral vasoconstriction. (Should you experience this side effect, it’s important to let your physician know as soon as possible.) Because there’s often a delay between starting on a beta-blocker and the appearance of leg cramps — anywhere from a few months to more than two years) — patients typically don’t suspect a connection between the two.
Alternatives: For older people, benzothiazepine calcium channel blockers, another type of blood pressure medication, are often safer and more effective than beta-blockers.
4. Statins and fibrates
Why they’re prescribed: Statins and fibrates are used to treat high cholesterol. The top-selling statins are atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor); the top-selling fibrate is fenofibrate (Tricor).
How they can cause leg cramps: Studies show that statins can inhibit the production of satellite cells in the muscle, interfering with muscle growth. Some researchers have also suggested that statins work, at the cellular level, to sap energy. Muscle weakness and aches throughout the body can be symptoms of statin-induced rhabdomyolysis, a breakdown of skeletal muscle that causes muscle fibers to be released into the bloodstream, sometimes harming the kidneys. Additionally, older adults who take these drugs are at greater risk of developing sarcopenia, or the wasting away of skeletal muscle and strength that’s associated with aging.
Alternatives: If you’re among the many millions of older Americans who don’t have known heart disease but are taking these drugs to lower their slightly elevated cholesterol, ask your doctor or other health care provider about trying to lower your cholesterol by changing your diet. You also might try lowering your blood levels of homocysteine — which is linked to high cholesterol — by 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).
Why they’re prescribed: Beta2-agonists are bronchodilators — drugs that relax the smooth muscles surrounding the bronchial tubes, making it easier to breathe. They’re frequently prescribed to relieve the symptoms of chronic obstructive pulmonary disease (COPD).
Beta2-agonists are typically given through an inhaler, which delivers a measured dose of the drug as a fine mist. They’re also sometimes given in pill or injectable form to patients who can’t use inhalers.
How they can cause leg cramps: Researchers don’t yet know why beta2-agonists can cause leg cramps.
Alternatives: If you’re using a beta2-agonist for a condition other than pulmonary disease, talk with your doctor or other health care provider about possibly switching medications or types of treatment. Systematic reviews of studies have found that beta2-agonists do not provide significant relief to non-COPD patients with acute bronchitis or cough.
If you do have pulmonary disease, I’d suggest talking with your physician about switching to tiotropium bromide (Spiriva), a different type of long-acting bronchodilator, used once a day. Spireva has been shown to outperform beta2-agonists at improving the overall health status of people with COPD.
6. ACE inhibitors
Why they’re prescribed: Angiotensin-converting enzyme (ACE) inhibitors are used to treat high blood pressure, congestive heart failure and other conditions. These drugs help relax blood vessels by preventing the body from producing angiotensin II, a hormone that causes blood vessels to narrow and, in turn, blood pressure to rise.
How they can cause leg cramps: ACE inhibitors can cause potassium to build up in the body (another type of electrolyte imbalance), which can lead to leg cramps and achy joints, bones and muscles.
Alternatives: If you’re taking an ACE inhibitor for a cardiovascular problem, talk with your doctor about possibly switching to a benzothiazepine calcium channel blocker, another form of blood-pressure medication that is often better tolerated by older adults. This is especially important for African Americans and Asian Americans, who because of differences in their renin-angiotensin systems, have much higher incidences of adverse effects.
If your condition is accompanied by fluid retention, your doctor may consider adding a low dose of a long-acting loop diuretic such as torsemide.
7. Angiotensin II-receptor blockers (ARBs)
Why they’re prescribed: ARBs are often used 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. Instead of blocking the body’s production of angiotensin II, ARBs prevent it from exerting its blood vessel-constricting effects.
How they can cause leg cramps: Like ACE inhibitors, ARBs frequently lead to potassium overload in the body, which can cause leg cramps and achy joints, bones and muscles.
Alternatives: As with ACE inhibitors, I’d recommend you 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. This is especially important for African Americans and Asian Americans, who because of differences in their renin-angiotensin systems, have much higher incidences of adverse effects.
A low dose of a long-acting loop diuretic such as torsemide may also be desirable.
Why they’re prescribed: Antipsychotics are used to treat schizophrenia,bipolar disorder and other serious psychiatric conditions. Antipsychotic drugs also are often prescribed “off label” to treat agitation and depression, among other conditions.
How they can cause leg cramps: Antipsychotics are powerful central nervous system depressants. In studies, their side effects include fatigue, lethargy and weakness. All of these drugs also lower dopamine levels, which can cause drowsiness and sleepiness, and lead to muscle stiffness and muscle cramping. Serious dopamine deficits caused by the continued use of antipsychotics can cause muscle rigidity and often-irreversible movement disorders such as akathisia (an urge to keep moving around) and tardive dyskinesia (a syndrome characterized by involuntary, repetitive body movements).
Alternatives: Talk with your doctor or other health care provider about the advisability of reducing the dosage or switching to another medication, especially if you have been prescribed an antipsychotic drug for problems with sleeping, anxiety or depression.
If you routinely suffer from painful leg cramps and think your medications may be the cause, it’s best to consult your physician before changing your medication routine. Your doctor can not only help you weigh the risks and benefits of making a change, he or she can also rule out more serious medical issues that may be the cause of your symptoms.
If you have questions about any of the medications prescribed by your physician, please don’t hesitate to visit any Owens Healthcare location and speak with one of our pharmacists.