cramp and steroids?

Hi everyone and hope you are feeling ok today.

As the title suggests I am wondering whether there is a connection between muscle cramps and meds.

My son has recently been experiencing cramp in his hamstrings, calves and instep, he is also having trouble sleeping at night (waking about 4am and going to the loo alot then not being able to get back to sleep.)

He has been on alternate day low dose Pred (10mg) since January and has had 2 lots of 4 weekly triamcinalone injections in the past 5 weeks. He has also just changed from Slo-phyllin to Neulin don't know if this might have anything to do with it.

Any advice welcomed as am now a very warnout mum who is being woken every night with lots of shouting and then inability to get back to sleep!

7 Replies

  • Hi koolkat,

    Sorry to hear that Jayden is having problems and that you are both suffering from sleepless nights!

    The main asthma medications that are implicated in causing cramps are beta-2 agonists such as salbutamol, terbutaline, salmeterol and formoterol, especially in high doses (eg nebulisers or sub-cut). These are very well known for causing the sorts of foot cramps that you describe, which can be very painful.

    Low potassium can also be a cause of cramps - and steroids, beta-2 agonists and theophyllines such as Slo-phyllin and Neulin all have the effect of causing the body to lose more potassium. If Jayden hasn't had a blood test to check his potassium levels recently, it might be worth asking your GP about this - and also getting the theophylline levels checked, if this hasn't been done, as he's recently changed the formulation. It's also worth encouraging him to eat potassium rich foods such as bananas, tomatoes, oranges and potatoes, provided there is no reason that he can't eat a high potassium diet (for example, kidney problems) and provided he is not allergic to any of these, of course! A banana dipped in dark chocolate (also high in potassium) and then put in the freezer makes a lovely 'choc ice' which is a good way to induce a fruit-phobic child to eat bananas!

    Dehydration can also contribute to cramps - so make sure he is drinking plenty throughout the day and has water by his bed at night. Obviously very sugary and carbonated drinks like coke are not the best for preventing dehydration in children. If you're giving him orange juice to drink, for the potassium, it's best given with a meal, I believe, to minimise the effects of the acid on his teeth.

    The fact that you mention that he's getting up a lot in the night to go to the loo just makes me slightly worried about diabetes - steroids can increase the risk of diabetes. It's worth mentioning this to your GP so that Jayden's sugar can be checked to rule this out.

    In terms of dealing with the cramps - massaging the affected area, pulling back on the foot to stretch the hamstring, and walking around can all help to ease the cramps off more quickly. I find a warm wheat bag over my foot can help as well.

    Overall, I think there are enough potential issues here to make it well worth going and discussing this with your doctor. If none of these things are a factor, it may simply be due to the beta-2 agonists (which can cause cramp even in the absence of a low potassium) and it may be a case of managing the symptoms. Your doctor could prescribe quinine tablets, which can help, but I'm not sure if these are licensed in children.

    Hope this helps and you both get some relief soon!


  • EmH has given you all the advice I can think of. It only remains for me to welcome Jayden to the AUK funky chicken dancers!


    Lead soloist :)

  • Nothing else to add but wanted let you know Sean has cramps like that most days. He wakes up shouting and yelling so loud I jump out of sleep, surprised the neighbours not complained yet! I made the stupid mistake of asking if he was ok a couple nights ok, I wont repeat the reply that came out!!

    I was interested to read Jayden is also having Tricemilone (sp) injections, Sean been having them since April, must be the latest phase at Rbh. Have the injections helped?

  • EmH - Thanks for your wonderfully informative reply (as always!), I think the AUK team could write an Asthma encyclopaedia from the infinate knowledge written in your posts :)

    Jayden seems to pee a lot and has restless nights when he has any increase in theo meds. I am assuming Neulin tabs are in line with Slo-phyllin as he was switched to get a 175mg dose. He has probs with the dosing on Slo-phyllin - 125 bd has low levels (6.1 when last checked) but 250 bd goes too high (21.5) with the all too familiar side effects. Was changed to Neulin 175mg to hopefully find an inbetweeny range. Not had levels checked yet but Jayden has side effects with levels around 15 but GP says it's ok as it's in the theraputic range.

    Love the idea of choccy ice nanas - think I'll make a few extra for me lol. Will try to get appointment to get potassium and theo levels checked, kill two birds with one stone type thing.

    Bex - do you have room for another member of the club - perhaps you could post some footage of the dancing on you tube!!!!

    Julie - hope you and Sean are ok and the winter is not having it's evil way with Seans lungs. Jay has had two doses of 80mg Triamcinolone and i have to say I think it is making a difference. The first month was a bit difficult to tell as he caught a chest infection a week after having it which knocked him a bit for the next 3 weeks and he also needed additional Pred for 7 days. Good thing was he stayed out of hospital - this time round he had a dip for the first week but this second week has been pretty good only really needing extra Ventolin for exercise and PF around the 250 mark (best is 320) so fingers crossed we will stay like this till next appointment beginning of December. How has it been for Sean? He has had it far longer than Jay (he is only having 3 doses which he is pleased about as his little cheeks are looking a bit puffy and people keep commenting).

    Keep wrapped up and keep the lurgies at bay - good health everyone.

  • Jayden is very welcome anyone want to make costumes :) Hmm Funky Chicken on your tube only with no sound as I am fluent in expletives when dancing! Got stuck in the bath last night with cramp in both feet going off together. Thats another 6 weeks of therapy I will need to pay for apparently according to the son who chucked me a t shirt and dragged me out, bless him.


  • I hadn't made a connection between the two but now it's been raised...I have been experiencing alot of leg cramp at night in my hamstrings since having been on reducing-dose pred, as well as high-dose inhaled steroids. I put it down to a high-salt low-potassium diet (although I don't have silly amounts of salt) but perhaps there is a correlation?

    Hey ho, only three weeks of pred left...

    Emz x

  • You've mainly been given the advice that I'd give - but can I stress the hydration bit, and also avoiding caffeine (Ha! Says the caffeine addict of the century).


    (Part-time Funky Chicken-er, mainly in embarrassing places like the M&S Lingerie Section)

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