Medication induced EM?

General
1

My family doctor believes that my burning feet & ankles are caused by the Amlodipine I'm taking.

I have had this problem since last January. I'll give you some history. About 15months ago, I was taking 10mgs of Amlodipine..then my ankles & feet swelled, which is a very common side effect of the Amlodipine. My doctor took me off this medication, & we started another. Long story short here...

we decided to try the Amlodipine yet again, but this time I was also given a diuretic. A few days after resuming the Amlodipine, I felt a strange sensation around my ankles..but it was't bothersome in any way. At the end of a week, I felt burning..& saw that my skin had flushed to a light pinkish colour.

There wasn't any pain...just the burning & flushing. I went back to my doctor & reported this. He seemed a little impatient with me (we tried a few bp meds & I was having bad side effects from them),

& said "That's the Amlodipine doing it's job. If you come off it, your bp will go up by 10 points!". Naturally, that scared me because I certainly didn't want the bp going up any more than it already was.

Time went by...leading into months. I complained yet again of the burning legs...was told there wasn't any neuropathy because I hadn't experienced any trauma to my legs/ankles.We tried compression

socks..they haven't worked. I walk a lot..the excercise didn't worsen things, but the problem didn't go away either. Finally I'd had enough & went back to him a few weeks ago, told him I couldn't put up with this any longer & wanted the situation investigated. He said he strongly suspected the Amolodipine to be the culprit because I'd had a sensitivity to it in the past (when I originally started taking it). The best way for us to find out for sure was for me to come off the Amlodipine, but the Nephrologist whom I saw just before this, didn't want to change my medications. Having to deal with a Nephrologist & yet another doctor was enough on my plate, & I didn't want to make the decision to come off the Amlodipine at that time. Simply put, I had enough to deal with. Just last week, I had an ultrasound

of my legs to see if there's any vascular problem. As of this writing, I don't have the results.

I do see the Nephrologist Dec. 8...& I will certainly advise him about this Amlodipine subject, AND

he will be advised of what I'm experiencing. Prior to seeing the Nephrologist, I have an appt. to see an Endocrinologist, as my family doctor things the problem COULD be hormone related. We;ll see.

Again, I certainly will be telling the Endocrinologist of my problem...then perhaps he can investigate as well...& I will be advising him of all I experience, when it happens, etc.etc.

In my heart of hearts, I believe the Amlodipine is the culprit. I have read that Nefidipine is known to cause symptoms of EM...& I have also been advised that Amlodipine & Nefidipine are the same...& have many of the same side effects. Also one forum specifically stated that "Amlodipine is known for causing burning sensations". Amlodipine is also heavily complained about in another Health Forum. According to what I read..Amlodipine is banned in Holland.

If any of you out there are taking Amlodipine, it may very well be worth your while to ask your doctor if it could be contributing or causing your problems. I'm hoping this is the case for me.. I'm also hoping that whatever this thing I've got reverses once I stop the medication.

2

Dear Mexicanrose,

Thank you for posting ;). Just to recap on our chat conversation.

You take Amlodipine which is a calcium channel blocker . Calcium channel antagonists have been reported to trigger secondary EM (vasodilatory effects). As you have shown this sensitivity twice , I agree that it might be worth discussing this with your Dr. Maybe he would be amenable in trying you on another BP medication instead :-).

You can try to test your tolerance to CCB(a vasodilator) with magnesium. Im attaching medicationsense report on this for you to read/or show your Dr. Premise is that CCB intolerance can be reflected by taking magnesium. Magnesium (a CCB itself) will induce flares- so in theory your flares should get a little worse whilst taking . Some EM'ers use this tactic to ascertain whether they might have a CCB intolerance. However, not foolproof, every EM'er can react differently. Some find CCB helps their EM. But , in your case, maybe its the reverse. Interesting because you mentioned you have Raynauds(vasoconstriction). EM frequently co exists with Raynauds so possibly another avenue to explore. Again, it would be classed as secondary. (Articles attached)

BP- many EM'ers have issues with blood pressure. Autonomic functioning can be affected.

Diuretics do not commonly help EM swelling. Swelling is not due to fluids.

Thyroid - many EM'ers have thyroid issues. (Article attached)

If what you are describing is secondary erythromelalgia it can occur in a variety of disorders and begin at any age. There may be a long period of treatment (years) with these agents before the appearance of the erythromelalgia, but also symptoms may appear in a matter of weeks. It is said that stopping the offending medication usually leads to improvement of symptoms. Good news is that medications and toxins are reported potentially reversible causes of secondary erythromelalgia.

How are you finding relief? Have you been given any topical creams to help you try to better manage pain?

Medication induced EM

http://forum.livingwitherythromelalgia.org/forum/topics/cipro-induced...

http://forum.livingwitherythromelalgia.org/forum/topics/has-anyone-he...

.http://www.medicationsense.com/articles/2012/emtreatment.php

Blood pressure

http://forum.livingwitherythromelalgia.org/forum/topics/low-blood-pre...

Raynauds and EM

http://forum.livingwitherythromelalgia.org/forum/topics/spotlight-on-...

Hypothyroidism and EM

http://forum.livingwitherythromelalgia.org/forum/topics/spotlight-on-...

Articles on EM. See magnesium/medication induced EM

http://www.medicationsense.com/pages/erythromelalgia.php

3

It sounds as if this could be the culprit however it is smart that you are continuing to investigate further in case it is something else as well. I know there are other types of blood pressure meds that do the job of lowering BP via different methods. I have added some different options you may want to discuss with your doctor. Possibly a Beta Blocker Or other type that doesn't work by relaxing or widening the blood vessels. If you and your doctor can decide on an alternate treatment then you can stop your current Med and hopefully this will all go away.

  • ACE inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
  • Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
  • Beta blockers. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
  • Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
  • Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.

  • ACE inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
  • Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
    • ACE inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
    • Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
    • Beta blockers. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
    • Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
    • Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.
    s. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
  • Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
  • Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.

Please continue to let us know how your appointments go and how you are doing.

4


Hi Alina....

I"m already on a Beta Blocker (Atenolol)...& the Coversyl Plus HD is an A.C.E. Inhiibitor which also contains a diuretic.

I know the Amlodipine is a vasilodator (spelling)...which opens the blood vessels..I'm hoping with all my might, that this horrible medication is the cause. If A.C.E. inhibitors cause the vessels to widen..isn't that the same a vasilodation???
Alina Delp said:

It sounds as if this could be the culprit however it is smart that you are continuing to investigate further in case it is something else as well. I know there are other types of blood pressure meds that do the job of lowering BP via different methods. I have added some different options you may want to discuss with your doctor. Possibly a Beta Blocker Or other type that doesn't work by relaxing or widening the blood vessels. If you and your doctor can decide on an alternate treatment then you can stop your current Med and hopefully this will all go away.

  • ACE inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
  • Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
  • Beta blockers. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
  • Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
  • Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.

  • ACE inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
  • Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
    • ACE inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
    • Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
    • Beta blockers. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
    • Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
    • Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.
    s. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
  • Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
  • Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.

Please continue to let us know how your appointments go and how you are doing.

5

Hey there,

Seems that you are on 3 vasodilatory medications. One(Amlodapine) you know you are sensitive too - it has mimicked EM symptoms in past. One (Atenonol) can also constricts -so go figure. Atenonol side effects highlight problems with circulation (such as Raynaud's syndrome). You already have Raynauds so maybe Atenenol isnt helping either????.

Alina has kindly posted BP options so you can just print that off and prepare yourself to chat with your Dr. Knowledge is empowering ;)

So based on what we know seems likely that,

1. You could be intolerant to Amlodapine- a CCblocker.

2. You could be having too much vasodilation(you take 3 medications report to do this)

3. Some relation to Raynauds. EM and Raynauds can and do co exist

May be wise to discuss your symptoms ASAP with your Dr, review medications - especially if you have a known sensitivity, and even rule out an underlying condition such as lupus, thrombotics etc with blood tests. You have the details of EM aware Dr's in Canada in case you wish to consult someone more proactive :-) .

Have you any other conditions/ take any other tablets that could be affecting ? Have you high cholesterol ? Do you take any statin type drugs? Just wondering as you have high BP

Does it seem worse at certain times of day, after certain activities?

Good thing is that you are getting yourself informed and arming yourself with information.

Go to that appointment and bamboozle them!

Check out this article on CCB's

http://www.bhsoc.org/pdfs/therapeutics/Calcium%20Channel%20Blockers%20%28CCBs%29.pdf

6

Sorry I couldn’t be of more help . I Am unfortunately not a doctor and am not terribly familiar with blood pressure meds. As Mads said it still might help to discuss with your doctor some other options to try so you don’t have to live with this ( if it’s the cause) or have the risks of higher blood pressure. I do hope medicine is the cause and you can find a better alternative.

7

Goodmorning, again Mads...Just a note further to what I've written earlier. With regard to the previous sensitivity to Amlodipine, I did NOT have burning, nor flushing of any sort. I did however have swollen feet/ankles, which is why the doctor took me off the Amlodipine in the first place. Please recall that the burning, flushing started when I resumed taking the Amlodipine in January 2014..just one week afterwards...but it has continued...& become progressively worse...& yes, it's spreading which is another reason why I pressed my family doctor to finally do something (ultrasound), & referral to Endocrinologist.I do wonder that if indeed the sensitivity is attributed to the Amlodipine, why the sensitivity didn't stay the same...(burning/flushing at times) rather than spread. Perhaps my body is saying "I hate this Amlodipine?"

mads said:

Hey there,

Seems that you are on 3 vasodilatory medications. One(Amlodapine) you know you are sensitive too - it has mimicked EM symptoms in past. One (Atenonol) can also constricts -so go figure. Atenonol side effects highlight problems with circulation (such as Raynaud's syndrome). You already have Raynauds so maybe Atenenol isnt helping either????.

Alina has kindly posted BP options so you can just print that off and prepare yourself to chat with your Dr. Knowledge is empowering ;)

So based on what we know seems likely that,

1. You could be intolerant to Amlodapine- a CCblocker.

2. You could be having too much vasodilation(you take 3 medications report to do this)

3. Some relation to Raynauds. EM and Raynauds can and do co exist

May be wise to discuss your symptoms ASAP with your Dr, review medications - especially if you have a known sensitivity, and even rule out an underlying condition such as lupus, thrombotics etc with blood tests. You have the details of EM aware Dr's in Canada in case you wish to consult someone more proactive :-) .

Have you any other conditions/ take any other tablets that could be affecting ? Have you high cholesterol ? Do you take any statin type drugs? Just wondering as you have high BP

Does it seem worse at certain times of day, after certain activities?

Good thing is that you are getting yourself informed and arming yourself with information.

Go to that appointment and bamboozle them!

Check out this article on CCB's

http://www.bhsoc.org/pdfs/therapeutics/Calcium%20Channel%20Blockers...

8

Hello Mexicanrose,

Based on what you report it does seem possible that Amlodipine doesnt like you lol! We do have several EM'ers in the community who are medication - induced. Unfortunately all our hypothesising is exactly that - we obviously can not diagnose. Moderator teram (Alina , Nel and I ) know you have already made arrangement to see your Dr ASAP- thats great news!. To reiterate ,EM diagnosis is based on clinical presentation and patient questioning. Any blood work/tests serve to build the patient profile .

Re: Topic of conditions that mimic some of the EM symptoms e.g. burning, skin perfusion(flushing/flaring) . Just wanted to highlight 'postmenopausal syndrome'.

EM or Burning feet syndrome? (Excellent article attached)

Skin perfusion - ref to hormonal issues ( 2 articles attached)

Menopause and EM (Note: Alina's observation and Dragica's thoughts on BRADYKININ)

'A peptide that causes blood vessels to dilate, and therefore causes blood pressure to fall. A class of drugs called ACE inhibitors, which are used to lower blood pressure, increase bradykinin further lowering blood pressure. So ,it is likely it has some impact on EM'

http://forum.livingwitherythromelalgia.org/forum/topics/menopause-and-em

Like Alina, Im sorry we cant be more helpful. We are trying our best :-)

Hope you are comfortable today

God bless

9

Hi Mexicanrose. Mads mentioned that you have Raynauds and I wondered do you find the betablockers make the Raynauds and EM worse? I wasn’t able to tolerate Bisoprolol because my extremities became so cold and painful that I had to warm them and any warming eventually resulted in an EM flare. Obviously if you need a betablocker there’s not much you can do about that but it might be worth mentioning to your doctor. My doctor, totally unsympathetic, just said “the choice is yours” :frowning:

10

Hi Nel...

Yes, I do have Raynaud's...but I have not had a flairup of the Raynaud's for a very long time. I'm very careful about keeping my extremities out of the cold. Actually, it's been nearly 30 years since my doctor told me I had Raynaud's.

As for the BetaBlockers..it has not affected my Raynaud's at all. I was given the BetaBlocker to help lower my bp..

as we were having difficulty in the bp down to a satisfactory level. About the only medication that I'm taking that is suspected of causing a problem is the Amlodipine.

I don't know what dosage of Bisoprolol you were taking. I take just 25mgs 2x/daily of the Atenolol. Metropolol gives me terrible headaches. Hope this sheds some light on things for you. :)



Nel said:

Hi Mexicanrose. Mads mentioned that you have Raynauds and I wondered do you find the betablockers make the Raynauds and EM worse? I wasn't able to tolerate Bisoprolol because my extremities became so cold and painful that I had to warm them and any warming eventually resulted in an EM flare. Obviously if you need a betablocker there's not much you can do about that but it might be worth mentioning to your doctor. My doctor, totally unsympathetic, just said "the choice is yours" :(
11

Thanks. I was on the lowest dose of Bisoprolol. I suppose it didn’t help that at the time I was 2 months in/on a bed so unable to walk around to help myself warm up. Once upon a time I would have been under a nice fat duvet with a water bottle if I felt that cold but as we all know that’s impossible.
I’m afraid I know nothing about Amlodipine so can’t contribute but am finding the conversation interesting.

12

Hi! Does elevating your legs help the burning? Also, does cooling with fans or air conditioning help reduce the pain and redness?

13

Hi Carol....

I don't have swelling or pain...just burning..more like a mild sunburn, & the redness is more like a light pinkish colour..but the flushing does not happen all the time. Cooling does help..but again, I don't always have to do that. I strongly suspect that my situation could be caused by medication, & I'm seeing a specialist tomorrow with the hope of him coaching me while I come off the medication to see what happens.


Carol Finke said:

Hi! Does elevating your legs help the burning? Also, does cooling with fans or air conditioning help reduce the pain and redness?