Athena Vale
Muscle spasms can be caused by a variety of factors, including certain medications. Drug-induced myopathies, or muscle diseases, can result in a range of symptoms such as muscle weakness, pain, inflammation, stiffness, and spasms. These myopathies can be caused by cholesterol-lowering drugs, antiarrhythmic medicines, corticosteroids, antimalarial drugs, and even common medications like isotretinoin for acne. Muscle relaxants, such as carisoprodol and diazepam, are often prescribed to treat muscle spasms, but they can also be habit-forming and cause side effects such as drowsiness and muscle weakness. It is important to consult a doctor before starting or stopping any medication, as they can provide advice on managing side effects and preventing more severe consequences.
| Characteristics | Values |
|---|---|
| Drugs that cause muscle spasms | Pregabalin (Lyrica), Isotretinoin (Accutane, Absorica), Bisphosphonates, Cholesterol-lowering drugs (statins), Antiarrhythmic medicines, Corticosteroids, Antiepileptic drugs, Omeprazole, Marijuana, Benzodiazepines, Muscle relaxants (carisoprodol, diazepam) |
| Treatment for muscle spasms | Over-the-counter medications like acetaminophen and NSAIDs, Prescription medications (antispasmodics and antispastics) |
| Muscle spasticity | Continuous muscle spasm causing stiffness, rigidity, or tightness that interferes with normal movement |
| Drug-induced myopathies | Muscle pain, weakness, inflammation, stiffness, spasms, and cramps |
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What You'll Learn
Cholesterol-lowering drugs
Statins, or 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, are a class of lipid-lowering drugs commonly used to manage high cholesterol, or hyperlipidemia. They are routinely recommended for people with cardiovascular disease and those aged 40-75 with at least one risk factor for cardiovascular disease, such as high blood pressure, high cholesterol, diabetes, or smoking.
Statins are one of the most popular classes of prescription medications, with almost a third of US adults over 40 taking them. While they are effective at lowering cholesterol and reducing the risk of cardiovascular problems, they have also been associated with several side effects, the most well-known being muscle pain and cramping. This side effect can vary and is not experienced by everyone, but it can be severe in some cases, with recent research identifying common causative factors. For example, statins may worsen unintentional calcium leakage from muscle cells, damaging the cells and causing pain and weakness. Additionally, statins may block muscle cells from making cholesterol, although it is unknown if low cholesterol levels in muscles can cause muscle pain.
If you are experiencing muscle pain while taking statins, it is important to consult your doctor. They may recommend a brief break from the medication, typically three to four weeks, to see if the pain disappears. They may also suggest lowering your statin dosage or switching to a different statin, as not all statins cause muscle pain. In some cases, adding another type of cholesterol-lowering drug, such as ezetimibe (Zetia), which has not been associated with muscle pain, may allow your doctor to lower your statin dosage.
Making lifestyle changes can also help manage statin-related muscle pain. Adopting a heart-healthy diet high in fibre and low in saturated and trans fats can lower your "bad" cholesterol (LDL) levels. Regular physical activity, such as 150 minutes of moderate exercise per week, can boost your "good" cholesterol (HDL) levels. Additionally, if you smoke, quitting can help reduce your cholesterol levels and lower your statin dosage.
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Antiarrhythmic medicines
There are four classes of antiarrhythmics, based on the Vaughan-Williams (VW) classification system:
- Class I, sodium channel blockers: These drugs prevent sodium from getting through cell membranes, which can slow electrical impulses in the heart muscle. Examples include disopyramide, flecainide, mexiletine, propafenone, and quinidine.
- Class II, beta-blockers: These drugs slow down the heart rate, often by blocking hormones such as adrenaline. Examples include acebutolol, atenolol, bisoprolol, metoprolol, nadolol, and propranolol.
- Class III, potassium channel blockers: These drugs prevent potassium from getting through cell membranes, slowing down electrical impulses in all of the heart's cells. Examples include amiodarone, bretylium, dofetilide, dronedarone, ibutilide, and sotalol.
- Class IV, nondihydropyridine calcium channel blockers: These drugs block calcium channels in heart muscle.
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Corticosteroids
Corticosteroid-induced myopathy is a toxic noninflammatory myopathy caused by exogenous corticosteroids. It typically affects the pelvic muscles and presents as muscle weakness without pain. This muscle weakness can become troublesome in everyday life, such as climbing stairs or lifting objects. Studies have shown that 15-40% of patients treated with high doses of corticosteroids for several weeks reported experiencing muscle weakness.
The mechanism behind corticosteroid-induced myopathy involves both catabolic and anti-anabolic processes. Corticosteroids upregulate proteolytic systems, increasing the breakdown of muscle proteins. They also induce muscle cell death through various signalling pathways. Additionally, corticosteroids inhibit amino acid transport into cells, reduce muscle growth factor production, and impede the formation of new muscle fibres, thereby inhibiting muscle growth and repair.
Treatment for corticosteroid-induced myopathy includes steroid withdrawal or switching to non-fluorinated glucocorticoids. Physical therapy, including aerobic and resistance exercises, has been shown to effectively reverse muscle atrophy and improve skeletal muscle strength in patients with corticosteroid-induced myopathy. In some cases, experimental agents such as branched-chain amino acids, creatine, and androgens have been investigated, but they are not currently recommended for human use.
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Antiepileptic drugs
The use of AEDs in the treatment of epilepsy has been well-established, with the modern treatment of seizures starting in 1850 with the introduction of bromides. Since then, various drugs have been developed and approved for use in treating epilepsy, including phenobarbital (PHB), primidone, phenytoin (PHT), carbamazepine (CBZ), and clobazam. These drugs work by modifying the processes involved in the development of a seizure, such as neurons, ion channels, receptors, and synapses, to favour inhibition over excitation.
While AEDs have been effective in treating epilepsy and other neurological disorders, they can also cause muscle-related side effects. For example, clobazam can cause muscle fatigue and weakness, and pregabalin (Lyrica) can cause joint pain and muscle spasms. It is important for healthcare providers to carefully prescribe these medications, considering medication interactions and potential side effects, especially for special populations such as patients with HIV/AIDS.
In some cases, reducing the dose or switching to another medication may help relieve muscle aches and pains caused by AEDs. However, it is important to consult a healthcare provider before making any changes to the medication. Early recognition and discontinuation of the offending drug may prevent severe adverse effects associated with muscle spasms and myopathies.
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Muscle relaxants
There are several types of muscle relaxants, including antispastics and antispasmodics, which differ in their uses, mechanisms of action, and side effects. Antispastic skeletal muscle relaxants include Baclofen (Lioresal) and Dantrolene (Dantrium), which are used to treat muscle spasms caused by spinal cord injury, stroke, cerebral palsy, or multiple sclerosis (MS). Antispasmodic skeletal muscle relaxants include Carisoprodol (Soma, Vanadom) and Tizanidine (Zanaflex), which is one of two medications with both antispastic and antispasmodic effects. The other is Diazepam (Valium), a benzodiazepine that is also used to treat anxiety and seizures.
It is important to note that muscle relaxants can depress the central nervous system (CNS), causing side effects such as drowsiness and fatigue. They may also be habit-forming, and their long-term safety is not yet known. Therefore, it is crucial to discuss the risks and benefits of these medications with a healthcare provider.
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Frequently asked questions
Some drugs that can cause muscle spasms include Pregabalin (Lyrica), Isotretinoin (Accutane, Absorica), and antiepileptic drugs such as lamotrigine and phenytoin. In addition, cholesterol-lowering drugs such as statins and fibrates, as well as antiarrhythmic medicines like amiodarone and procainamide, have been known to cause muscle spasms and other symptoms of myopathy.
If you are experiencing muscle spasms as a side effect of medication, it is important to consult your doctor or pharmacist. They may recommend over-the-counter treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or ibuprofen to help manage the pain and reduce inflammation. In some cases, they may suggest lowering your dosage or switching to an alternative medication.
Muscle spasms caused by drugs can range from mild to severe symptoms. While they are often manageable with OTC treatments, in some cases they may require medical attention, especially if they are impacting your daily life. Severe cases of drug-induced myopathy can lead to rhabdomyolysis and even mortality, so early recognition and intervention are crucial.
