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.
"Ask the Pharmacist" is written by Armon B. Neel Jr., PharmD, CGP, in collaboration with journalist Bill Hogan. They are coauthors of Are Your Prescriptions Killing You? (Atria Books).
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