Iron Infusion

[Graham3196]

Sue perhaps you can help me,

I have been successfully relying on diet for years but RLS seems to be catching up. I am in Australia. Perhaps its simply a matter of getting older (currently 79) but a couple of other things might be a problem. I tore a hamstring muscle or tendon that apparently caused an unexpected amount of internal bleeding. At the last MRI this appeared to have cured completely and all is well but my RLS is worse.

I don't understand inflammation but is it possible that an injury like this could increase RLS for a period of months?

At about the same time I started taking Rosuvastatin , 10mg daily because I have a small amount of build up in a heart artery. The arteries are generally "very good" but the statin is "just to minimise the risk". Is this dose enough to make RLS worse or can you please recommend the best substitute? Additionally I have been taking a PPI for indigestion. Pantoprazole 20mg twice a day. This didn't seem to be working well as I am still getting painful reflux. The doctor doubled the dose to 40mg which didnt seem to help so I have dropped it and I am relying on sodium bicarbonate to neutralise the acid. This is useful but still a bit painful and I don't think its very healthy.

Additionally I had an IV iron infusion about 2 years ago that raised my ferritin to 350 with no benefit to the RLS. Since then the ferritin has dropped steadily to less than 90 so I would like to try again. In a chance conversation with a sleep specialist at a major hospital he said that if the infusion didn't work the first time it was a waste of time trying again. His support for this was that it was "logical" Do you know of any experience that supports his argument? I didn't want to put him offside by arguing too much because he seemed to be really wanting to help and had indicated that he was willing to prescribe opiates if he thought it was appropriate. I, of course, choose to worry about internal bleeding or something worse. (Esophageal cancer? My imagination is my enemy) I am getting a gastroscopy and colonoscopy next month. Its two years since my last.

[Madlegs1]

Not Sue here, but I can tell you that both the statin and ppi may well be causing you problems.

[SueJohnson]

Your main problem is the Rosuvastatin. Statins are known to make RLS worse. Nexlizet (Nustendi (UK) is a cholesterol lowering drug that is not a statin, but I don’t know if it exacerbates RLS symptoms. Ezetimibe (Zetia) - reduces cholesterol although It doesn't reduce cholesterol as fast as the statins, but according to Chris Columbus it didn't trigger his RLS and then there is Triglide which seems safe. You might want to discuss these with your doctor. A more difficult way to reduce cholesterol is to go vegan. My husband lowered his cholesterol from 221 to 131 this way.If you take gabapentin or pregabalin you should be closely monitored as it can raise the bad LDL and lower the good HDL.

If the infusion didn't work it won't help your RLS but you should raise it above 100 anyway so if you can get one, do so, Otherwise take 325 mg of ferrous sulfate which contains 65 mg of elemental iron, the normal amount used to increase ones ferritin, or 50 mg to 75 mg (which is elemental iron) of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption. Ferrous sulfate is fine for most people, but if you have problems with constipation, iron bisglycinate is better. Take it every other day, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption. If you take magnesium, calcium or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after. Don't take your iron tablets before or after exercise since inflammation peaks after a workout. Don't take tumeric as it can interfere with the absorption of iron or at least take it in the morning if you take your iron at night. If you take thyroid medicine don't take it within 4 hours. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months.

Instead of the sodium bicarbonate you could try gaviscon extra strength tablets or liquids. Don't take within 2 hours of iron or gabapentin.

Yes inflammation can make RLS worse but should go down within 4 to 6 weeks.

[ChrisColumbus]

While I didn't find rosuvastatin as bad as atorvastatin it still exacerbated RLS for me. If you really need to take anything for cholesterol at all - doctors still tend, despite mounting evidence, to prescribe "just to minimise the risk" without considering the impact of side effects - ezetimibe or Nexlizet/Nustendi if available in Australia (a combination of bempedoic acid and exetimibe) may be a better choice. I say "may be" because I was on eze but not bempedoic acid.

[Jules1953]

I live in Perth Western Australia and I see a sleep specialist who specialises in RLS. Dr Richard Warren. You may be able to have a phone appt with him. He is up to date with the latest research from overseas in relation to treating RLS. He attends seminars overseas with the top specialists in RLS. Kind regards Julie

[Graham3196 in reply to Jules1953]

Thanks Julie. I'll follow this up.