RLS and low blood pressure

[Rajabodhistanley]

My restless legs have gotten worse in the past months — often during the day not just the evening, and affecting my whole body not just my legs. In the same time period, I have developed low blood pressure whereas it has been high for quite some time; in fact, I’ve been taking lisinopril for high blood pressure for a few years. Do you know of any correlation between RLS and low blood pressure?

[SueJohnson]

Actually it is just the opposite. It is associated with high blood pressure. Are you taking any medicines and if so what?

[Rajabodhistanley in reply to SueJohnson]

Thanks for your response, Ms Johnson. I am under the care of a neurologist/sleep medicine MD, a metabolic syndrome specialist MD, and an internal medicine/primary care MD. In addition to severe RLS I've been diagnosed with sleep apnea (treated with CPAP) and periodic limb movements. My low ferritin levels, which affect RLS, required an iron infusion a year ago and have been falling again since. Finally, I have a severe dry mouth (partially due to some of my meds) which has resulted in cavities and 3 root canals this year -- despite taking good care of my teeth.

RLS meds: currently 0.5 mg pramiprexole x 3 (gradually decreased from 6-9/day with no side effects; i.e., so far no augmentation). Other previous RLS meds (didn't work): Neurontin, ropinirole, gabapentin.

Other meds: Acyclovir 400 mg/day except 2000 mg with occasional outbreak of herpes simplex. Lisinopril 20 mg x 2. Modafinil 400 mg for daytime sleepiness (I had a major car accident due to falling asleep while driving). Methylphenidate 10-20 mg PRN before driving, for previous reason. Omeprezole 20 mg PRN (rarely). B12 folate 667 mcg x 3. Diosmin 600 mg. Levothyroxine 150 mcg. Glyxambi 25/5 mg for metabolic syndrome/possible diabetes. Wild bitter melon 750 mg x 4 for same. Icosapent ethyl 1 gm x 4. CoQ10 ubiquinol 500 mg. Macuguard 173 mg. Collagen 3,000 mg. Amlodipine 5 mg. Fenofibrate 134 mcg. Metoprolol 50 mg. Rosuvastatin 40 mg. Vitamin D 10,000 IU. Bupropion 450 mg for recurrent major depression. Paxil 1.5 mg for recurrent major depression. Calcium 500 mg with Magnesium 250 mg. Homeopathic remedy Nux-m 10M once a week. Mounjaro 7.5 mg injection once a week.

Thanks for whatever observations you can offer.

[SueJohnson in reply to Rajabodhistanley]

If you end up taking iron for your ferritin (more on that in my separate post), take Omeprezole several hours apart as it interferes with the absorption of iron. Levothyroxine can probably make RLS worse, but there is no safe substitute. Amlodipine is a calcium channel blocker and makes RLS worse in most people, Metoprolol is a beta blocker and makes RLS worse in most people - a safe beta blocker might be propranolol, Rosuvastatin is a statin and all statins make RLS worse in most people, Paxil - an antidepressant makes RLS worse in many people - why take it if you are already taking Bupropion which is safe for RLS, magnesium is best taken at night but if you take iron, take it 2 hours apart and if you end up taking gabapentin, take if at least 3 hours before the gabapentin. All the others you list are safe. You seem to be taking a lot of medicines and OTC supplements for the same thing. Have you shared all these with your doctor?

[SueJohnson]

Have you had your ferritin checked? If it is below 100 improving it to 100 or more helps 60% of patients and in some will completely eliminate their symptoms. If you haven't had your ferritin checked, ask your doctor for a full iron panel. Stop taking any iron supplements 48 hours before the test and fast after midnight. Have your test in the morning when your ferritin is lowest. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your ferritin to be over 100 and your transferrin saturation to be between 20 and 45. If your ferritin is less than 100 or your transferrin saturation is not between 20 and 45 post back here and we can give you some advice.

[Rajabodhistanley in reply to SueJohnson]

Thank you for all the helpful information, Sue.

Yes, all my doctors do know about all my meds and conditions. My current ferritin (taken last month) is 39 . After my iron infusion in 2020, it was 184; then in 2021, one year later, it was132; then it declined gradually below 100 to the current 39. I will ask my doctor for a full iron panel, following your instructions, and I will let you know my ferritin and transferrin saturation (TSAT) numbers .

The Paxil is a tough one. When I asked my prescribing doc about coming off it, he said he was reluctant to make any change because he had seen me in my major depression (suicidal, etc.), and then it recurred after I tapered off the antidepressants. I would like to follow up on that in some way, however, as I know about Paxil's bad effect on RLS and also on my dry mouth which is causing my dental problems.

I will ask about the amlodipine and metoprolol to see if there are alternatives for those.

Thank you again for your thorough response and helpful info.

[Rajabodhistanley in reply to SueJohnson]

Sue, I'm getting back to you with the results of a complete iron panel I just had done:

Ferritin 33. Iron 77. Iron binding capacity 414. TSAT 19

With these numbers, what would you advise? Thanks!

P.S. I have not been taking oral iron so far but am meeting with my MD next week. I've heard an effective, easily absorbed iron is Iron Complex by Integrative Therapeutics (integrativepro.com/products.... I have reduced my pramiprexole to two .05 mg pills per day with no augmentation so far. Since my last post I've been prescribed 1) cevimeline (Evoxac) 30 mg x 3/day for Sjogren's and dry mouth ; and 2) valacyclovir to replace acyclovir. At my annual exam with my PCP in January I plan to discuss alternatives to amLODipine and metoprolol. Finally, I am planning long term to see about an alternative to Paxil and am in the process of getting referrals for good prescribing shrinks. No changes otherwise.

[SueJohnson in reply to Rajabodhistanley]

That's great that you have reduced your pramiexole down. I wouldn't take the Iron Complex by Integrative Therapeutics as it is heme iron and heme iron can increase your risk of heart problems and cancer and there are plenty of other iron products without that risk. Since your ferritin is less than 75 you can take 325 mg of ferrous sulfate with 100 mg of vitamin C or some orange juice since that helps its absorption. You can take it every day as long it is at the same time so you don't take them within 24 hours of each other. Take them with 100 mg of vitamin C or some orange juice at least 1 hour before a meal or coffee and at least 2 hours after a meal or coffee since iron is absorbed better on an empty stomach. If you have problems with constipation switch to iron bisglycinate. Since your TSAT was just slightly below 10% you could have another iron infusion as that seemed to work well before. Iron isn't absorbed as well once you reach a ferritin of 75 and above. If you take magnesium or calcium take them at least 2 hours apart since they interferes with the absorption of iron. Don't take tumeric as it can interfere with the absorption of iron. Also antacids interfere with its absorption. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after 8 weeks if you have an iron infusion or after 3 months if you are taking iron tablets.

[Rajabodhistanley in reply to SueJohnson]

Wow, thanks for your speedy and helpful reply! I'm feeling optimistic.

[Rajabodhistanley in reply to SueJohnson]

I'm reading up on heme iron risks following your response. Is it relevant that I am a total vegetarian, have been for about 35 years? Also I am 78, just FYI.

[SueJohnson in reply to Rajabodhistanley]

I don't know. I just wouldn't take any risk myself especially because of your age when there are other iron tablets just as good.

[Amelanchier]

Hi there,

This is interesting because I have wondered about the same thing. When my blood pressure was up due to the stress and upset of my Mothers illness I experienced a number of months when I had much less trouble with RLS . Now it has returned to normal levels (although not low) the RLS has returned with a vengeance.

I hope you find relief .