Muscle cramps in legs

[Barb G]

Hi all
I havn't posted a long time. I've been on Requip for quite some time and have gotten relief. Latley though I've been experiencing leg cramps. The muscle tightens right up. It's verging on becoming a charlie horse but not quite yet.
Wondering if others have had the same thing. I've also noticed a rise in RLS symptoms latley and hope i don't have to change meds.

[ViewsAskew]

So sorry to hear about the cramps and the increase in symptoms.

I hope others will chime in about the cramps - I don't know if they are related to Requip in any way.

Although I wish it were different, I would be concerned about the increase in symptoms. It could be natural progression, but there is a good chance it's augmentation.

A doctor in Florida advises immediately stopping the Requip and switching to Mirapex when this happens. Just for a few weeks. Then go back to Requip. I don't know if she's still doing it, but a woman on the Yahoo board did this for years and she never had to increase her initial dose. She was switching between Mirapex and Requip and you're vice versa, but I'm sure he said it would work both ways.

I can't say I've heard of another doctor recommend it, but it sure worked for her.

[DARCYUK]

That's exactly what I do, should I feel any cramps coming on, or I think that I may be experiencing augmentation. I switch from Requip to Mirapex for a couple of weeks, until things calm down, although,as I have stated in previous posts in other topice, I take both on a daily basis, and rarely experience cramps or augmentation, but when I do, this is what I do, and it works for me.

[Barb G]

That's exactly what I do, should I feel any cramps coming on, or I think that I may be experiencing augmentation. I switch from Requip to Mirapex for a couple of weeks, until things calm down, although,as I have stated in previous posts in other topice, I take both on a daily basis, and rarely experience cramps or augmentation, but when I do, this is what I do, and it works for me.

I first tried Mirapex and it didn't help and i went to Requip. So would you still recomment the switch?

[Neco]

I wouldn't.

There is no reason to switch back to a medication that did not help you at all, just to avoid the side effects of your current medication. I'd let your doctor know about the cramping issue and ask if anything can't be done to try to resolve it.

Maybe switching to opiates for a week or two and then beginning the Requip again to see if that helps. There is also Lyrica, Gabapentin (Neurontin). But no guarantee they'll work for you if you've never tried them before.

Ultram (tramadol) is a weak pseudo-opiate that is not a controlled substance, so you can also try that. Unless you are taking anti-depressants, then I'd reccomend you NEVER take Tramadol as you'll likely end up having a seizure.

But if you are on no other meds and your doctor is resistant to something like Hydrocodone or Tylenol #3, askin about Tramadol wouldn't hurt. Although not technically regarded as a true opiate. It has opiate like properties and acts on some of the same receptors. Again, it's not a controled substance and only requires a prescription to obtain so it may be worth looking into.

You could either add it to your Requip regime, or try stopping the Requip for a week or two and then starting up again to see how you do.

[Barb G]

My problem is i'd have to try to get an appointment with the Nerologist. He's the one who prescribed my meds. But i've been just going to the family doc for refills. The Family doc knows nothing about RLS. So I'd better get on getting an appointment. I may have to get referred again???

[ViewsAskew]

If it didn't work, I can't imagine why switching to it would help.

It sounds to me like you are in a tough spot...you either need to see the neuro or do a LOT of education of your GP. Most of us find that pretty daunting and go for the specialist.

[sardsy75]

Ultram (tramadol) is a weak pseudo-opiate that is not a controlled substance, so you can also try that. Unless you are taking anti-depressants, then I'd reccomend you NEVER take Tramadol as you'll likely end up having a seizure.

Hey Zach,

Could you elaborate on that pretty please? I read it and went "Whoa Boy". I'm on two anti-depressants my brains "off-switch" and my "happy face.

When I had that debilitating disgusting headache a couple of weeks ago, my GP whacked an injection of Tramadol straight into my caboose, quickly followed by an anti-chuck injection.

I'm just curious about the relationship between Tramadol, Anti-depressants and seizures. Or if any of our resident pharmacists on the Board know of this, I'd certainly like to know.

Thanks heaps

[sardsy75]

Hi Barb

Muscle cramps in my legs usually occur when I've actually been wrestling unsuccessfully with RLS breakthrough symptoms.

When you see your Doc, ask how long the referral to the Neuro was for. Mine are usually for 12 months; then my Doc just sends another letter asking for continued review and consult.

I'm with Ann ... go see your specialist. As for your GP, print out some of the material that is available on the main RLS Foundation web-site.

Take care of you

[dogeyed]

The cramps are RLS symptoms, no question. There is a chance, though, that if you take certain other over-the-counter meds sometimes, for example Tylenol PM, you'll get those cramps.

[Neco]

I don't know the exact science, but I think Tramadol and anti-depressants may compete for the same liver enzyme pathways. In my case it was explained as a likely scenario where my anti-depressants prevented my tramadol from being metabolised properly and it built up in my system.

Tramadol in high doses all by itself has been known to cause seizures, so its quite possible that is specifically what happened to me..

http://www.rxlist.com/ultram-drug.htm

On this site you can see what happened to me.. Look through page 1,2,3,4,5... at the top of the center of the document, kind of hard to find but you can flip through to different information..

DRUG INTERACTIONS

CYP2D6 and CYP3A4 inhibitors: Concomitant administration of CYP2D6 and/or CYP3A4 inhibitors (See CLINICAL PHARMACOLOGY-Pharmacokinetics), such as quinidine, fluoxetine, paroxetine and amitriptyline (CYP2D6 inhibitors), and ketoconazole and erythromycin (CYP3A4 inhibitors), may reduce metabolic clearance of tramadol increasing the risk for serious adverse events including seizures and serotonin syndrome.

Serotonergic Drugs: There have been postmarketing reports of serotonin syndrome with use of tramadol and SSRIs/SNRIs or MAOIs and α2-adrenergic blockers. Caution is advised when ULTRAM ER is coadministered with other drugs that may affect the serotonergic neurotransmitter systems, such as SSRIs, MAOIs, triptans, linezolid (an antibiotic which is a reversible non-selective MAOI), lithium, or St. John's Wort. If concomitant treatment of ULTRAM ER with a drug affecting the serotonergic neurotransmitter system is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases (see WARNINGS - Serotonin Syndrome).

Triptans: Based on the mechanism of action of tramadol and the potential for serotonin syndrome, caution is advised when ULTRAM ER is coadministered with a triptan. If concomitant treatment of ULTRAM ER with a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases (see WARNINGS - Serotonin Syndrome ).
Use With Carbamazepine

Patients taking carbamazepine, a CYP3A4 inducer, may have a significantly reduced analgesic effect of tramadol. Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol, concomitant administration of ULTRAM ER and carbamazepine is not recommended.
Use With Quinidine

Coadministration of quinidine with ULTRAM ER resulted in a 50-60% increase in tramadol exposure and a 50-60% decrease in M1 exposure (see CLINICAL PHARMACOLOGY, Drug Interactions). The clinical consequences of these findings are unknown.
Use With Digoxin and Warfarin

Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity and alteration of warfarin effect, including elevation of prothrombin times.
Potential for Other Drugs to Affect Tramadol

In vitro drug interaction studies in human liver microsomes indicate that concomitant administration with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some inhibition of the metabolism of tramadol. Administration of CYP3A4 inhibitors, such as ketoconazole and erythromycin, or inducers, such as rifampin and St. John's Wort, with ULTRAM ER may affect the metabolism of tramadol leading to altered tramadol exposure.
Potential for Tramadol to Affect Other Drugs

In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on quinidine metabolism. In vitro studies indicate that tramadol is unlikely to inhibit the CYP3A4-mediated metabolism of other drugs when administered concomitantly at therapeutic doses. Tramadol is a mild inducer of selected drug metabolism pathways measured in animals

Seizure Risk

Seizures have been reported in patients receiving tramadol within the recommended dosage range. Spontaneous post-marketing reports indicate that seizure risk is increased with doses of tramadol above the recommended range. Concomitant use of tramadol increases the seizure risk in patients taking:

* Selective serotonin re-uptake inhibitors (SSRI antidepressants or anorectics),
* Tricyclic antidepressants (TCAs), and other tricyclic compounds (e.g., cyclobenzaprine, promethazine, etc.), or
* Other opioids.

Administration of tramadol may enhance the seizure risk in patients taking:

* MAO inhibitors (see also WARNINGS - Use with MAO Inhibitors),
* Neuroleptics, or
* Other drugs that reduce the seizure threshold.

Risk of convulsions may also increase in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections). In tramadol overdose, naloxone administration may increase the risk of seizure.

Serotonin Syndrome Risk

The development of a potentially life-threatening serotonin syndrome may occur with use of tramadol products, including ULTRAM ER, particularly with concomitant use of serotonergic drugs such as SSRIs, SNRIs, TCAs, MAOIs and triptans, with drugs which impair metabolism of serotonin (including MAOIs) and with drugs which impair metabolism of tramadol (CYP2D6 and CYP3A4 inhibitors). This may occur within the recommended dose. (See CLINICAL PHARMACOLOGY-Pharmacokinetics).

Serotonin syndrome may include mental-status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).

[chefws]

Muscle cramps are a known side effect of both Requip and Mirapex. Use the phrase "Pain in extremity" along with the drug name as a search term. Mirapex and Neupro has left me with chronic calf pain that doesn't go away.

[Barb G]

Muscle cramps are a known side effect of both Requip and Mirapex. Use the phrase "Pain in extremity" along with the drug name as a search term. Mirapex and Neupro has left me with chronic calf pain that doesn't go away.

Not good news but thank you for replying to the cramp issue.

[waterloo2]

Hi all

I dont agree.
Im not on any meds but I do get cramp.

gill (UK)

[Neco]

What don't you agree with?

I think there are situations where cramps/cramp sensations have been shown to be an RLS symptom, and also where dopamine agonists have been known to cause cramps and severe pain in patients who otherwise didn't have these problems, or if they did made them that much worse.

Both ideas were expressed in this thread.