Antidepressants and other meds

[Cobobay]

Hi all, especially Sue who I'm hoping can help. I have at last had blood tests which showed my levels were around 50, which she said wasn't that low, but I'm now on Iron 200mg a day, havibg another blood test in January. Also my sodium levels were little low so was told to use more salt on my food. I have stopped my omeprazole 40mg a day, but haven't really noticed any difference yet, apart from suffering with reflux etc., but have been on them for many years so perhaps it will take time. I also am taking 150mg sertraline along with atorvastatin 20mg, lercandipine 20mg, bendroflunethiazide 20mg, also vit D, I am now taking 4 x ropinirole at night and now I'm having to take 1 during the afternoon as now suffering as soon as I stop moving, including driving. I have to say I am sleeping better since being on them once I doze off and not waking as any times as I was before. Has anyone found that any of the above aggravates RLS please 🙏 Ropinirole and proproximol are the only meds they tend to recommend by changing, from one to the other, the Doc I was referred to who is a parkinsons spec, has also mentioned the patch if I feel these arent working, but from reading on here that's not a good option either, tbh I don't feel anyone knows enough about RLS and I'm at a loss as to what to do, so look forward to reading responses. Many thanks Debbie

[Cobobay]

Should say Pramipexole NOT proproximol

[SueJohnson]

You are taking a number of medicines that make RLS worse. Sertraline is an SSRI antidepressant. A safe antidepressant is trazodone or Wellbutrin.

All statins make RLS worse for most. NEXLIZET is a cholesterol lowering drug that is not a statin, but don’t know if it exacerbates RLS symptoms. Ezetimibe (Zetia) - reduces cholesterol drug: It doesn't reduce cholesterol as fast as the statins, but per Chris Columbus didn't trigger RLS. FDA does show increases RLS for some. -Triglide - seems safe. Of course the best way to reduce cholesterol is probably the hardest which is to switch to a vegan diet. My husband lowered his cholesterol from 221 to 131 by going on a vegan diet.

Lercandipine is a calcium channel blocker which makes RLS worse for many. For high blood pressure propranolol (Inderal, Hemangeol, InnoPran) seems safe and there is Isosorbide Mononitrate (Monoket, Imdur) which is not a beta blocker nor calcium channel blocker. And then there are the ace inhibitors such as Zestril (Lisinopril, Qbrelis, Prinivil) and Perindopril (Coversyl). Other possibilities are: Clonidine (Catapres) an Alpha-2-Agonist used to treat high blood pressure which may help RLS, which also treats insomnia and ADHD (not a stimulant) and may help RLS, tenex (Guanfacine, Intuniv) treats adhd and high blood pressure, prazosin (Minipress) - alpha-adrenergic blocker that treats high blood pressure; useful in managing sleep-related problems caused by PTSD and Tadalafil.

bendroflunethiazide is a diuretic and although I can't find anything about this one specifically most diuretics make RLS worse.

[SueJohnson]

It also sounds like you are augmenting since your symptoms are now in the afternoon. The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen. If you think this applies to you, post back here and we can give you some advice.

[SueJohnson]

Have you had your ferritin checked?

[Cobobay in reply to SueJohnson]

hi Sue yes I have now and it came back around 50 so I'm now in 200mg iron.

[SueJohnson in reply to Cobobay]

200 mg iron is overkill. Unless that is not elemental iron. Elemental iron is the important number. Anything over 75 to 80 elemental iron is not absorbed very well. Take your iron tablets with 100 mg of vitamin C or some orange juice since that helps its absorption. Take it every other day 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. Don't take tumeric as it can interfere with the absorption of iron. If you take magnesium or calcium take them 2 hours apart as they interfere with its absorption. Also antacids interferes with its absorption. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months if you are taking iron tablets.

[Cobobay in reply to SueJohnson]

This is the ones I'm on

Does this help you Sue

[SueJohnson in reply to Cobobay]

OK - they are only 65 mg of elemental iron.

[Cobobay in reply to SueJohnson]

So is that the right ones to be taken Sue

[SueJohnson in reply to Cobobay]

yes

[Cobobay in reply to SueJohnson]

Thank you so much Sue x

[ChrisColumbus in reply to Cobobay]

I believe that 200 mg Ferrous Sulfate tabs generally contain the equivalent of 65 mg of Ferrous Iron, but it should say on the packet or in the patient info leaflet in the packet. I can't take those because they give me stomach/ bowel problems, but you may be fine.

If I take iron I have to take Ferrous Bisglycinate aka Gentle Iron.

[ChrisColumbus]

Just to add to Sue's comprehensive list:

My main recommendation is to ask your doctor to get you off the Atorvastatin (and indeed any statins): they gave me terrible RLS problems. Unfortunately doctors and consultants can be wedded to statins and very reluctant to take you off and put you on e.g. Ezetimibe. I had quite a fight with my consultant.

Sue's other points about Augmentation and Ferritin levels are also very important.

Cholesterol reducing Ezetimibe (branded Ezetrol in the UK) doesn't trigger my RLS; however you'll also find Ezetimibe branded as Inegy, but this is a mixture of Ezetimibe and Simvastatin - and I haven't found a statin yet that doesn't trigger my RLS.

For high blood pressure Perindopril (Coversyl) didn't trigger my RLS but it did give me an annoying persistent cough, a common side effect. I'm therefore now on Losartan (Cozaar): this doesn't trigger my RLS, but it can increase the levels of potassium in the blood which some report can exacerbate RLS (and too much Potassium can cause other problems).

[Cobobay in reply to ChrisColumbus]

Thank you Chris, I am going to make an appointment tomorrow and go armed with this information, so fingers crossed I get somewhere.

[ChrisColumbus]

If it helps (although docs can just dig their heels in) the consultant who eventually agreed to me coming off Atorvastatin and going on to Ezetimibe worked at the Wolfson Centre for Stroke & Dementia in Oxford, the UKs leading research centre into these subjects

[Bruxelles]

Hi Cobobay,

I can’t really help you as in the end I decided not to take the Setraline. Apparently Setraline makes RLS worse. There are about two antidepressants which don’t. I didn’t want to make my legs any worse and thought it better to struggle on with the depression. Sue knows a lot about antidepressants. I don’t know how to find old information, but somewhere, if you can find it, I think she gave me information about Setraline. If I remember correctly I asked about it on the site and she answered. She would know the names of the antidepressants which are ok to take I think. I also got information from a Belgian site. Good luck and I hope you find something to help. I will try and find anything I have and send it on if I do.