Question to GP Maarten: Medicines for muscle rheumatism make me dizzy, tired and cause pain in my lower legs

Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.

Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information such as:

• Age
• Complaints)
• History
• Medication use, including supplements, etc.
• Smoking, alcohol
• Overweight
• Any laboratory results and other tests
• Possible blood pressure

Photos and attachments can be sent to [email protected] everything can be done anonymously, your privacy is guaranteed.

Dear Martin,

Hello doctor Maarten, my name is C, 79 years old and diabetic 2. Do not smoke or drink. Blood pressure 119 and 75 mmH9. Weight 85 kg. 30 years ago had 4 at pass, from that time 1 x per day acetylsaliylic acid 80 mg and 2 x metformin 1000 mg. As a supplement, take vitamin A – Calcium and B12. I walk half an hour a day.

Musculoskeletal rheumatism was discovered 6 months ago, which means that I have now received extra medicines, namely:

• Prednisolone: ​​Take 2 tablets per day. 5mg (at the same time)
• Forxiga: 1 tablet per day. 10mg.
• Gliclazide: 1 tablet per day. 30mg.
• Omeprazole: 1 time per day. 30mg.

Complaint:

I've been back in Thailand for 2 weeks now and notice that if I bend over slightly, I immediately get dizzy. I am very very tired after walking up 2 flights of stairs (14 steps). My lower legs feel like they have a very tight bandage wrapped around them. Been suffering from this for a long time.

I have to have blood taken in 10 weeks for a check up because of Prednisolone.

Thank you very much.

Regards,

C.

********

Dear C,

Your complaints indicate that you retain moisture.

Now the medication:
Prednisone has many side effects, including fluid retention and an increase in sugar levels. You might ask about other medications for your rheumatoid arthritis, such as DMARD (eg, methotrexate) or biosimilars (eg, etanercept and infliximab). A combination is also often used. Biosimilars are usually very expensive. Not the ones mentioned here. They are no worse than the more expensive preparations. You can then omit the prednisone and only use it if necessary for breakthrough pain. Incidentally, diabetes can also cause muscle complaints.

Your diabetes medication:

Forxiga (Farxiga, dapafliglozin) is a product with many side effects. Astra-Zeneca is currently involved in lawsuits as a result. It belongs to a new class of diabetes drugs. I would never prescribe them myself, as they probably do more harm than good. Gliclazide, like metformin, is an old drug. The combination of both works well. You could consider taking the metformin 3 times a day and possibly the gliclazide 2 times a day under control of your sugar level, which should be slightly higher than the indicated normal value. You can use 130 mg/dl (7.5 mmol/l) as the maximum.

For rapid improvement of the tension in the legs you can take spironolactone (Aldactone) 50 mg in the morning. Watch out for a drop in blood pressure. If you stop taking prednisone, you can probably take it off again

Acetylsalicylic acid (Aspirin) can be omitted. That's not good company for prednisone anyway, and at your age it's doing more harm than good.

All in all, not that simple and I therefore strongly advise you to discuss this with a rheumatologist and internist. Blood checks are needed regularly in the beginning.

The list then becomes:

• Metformin 3x daily.
• Glipizide 2 x daily depending on the sugar level.
• A DMARD (methotrexate). Maybe later combine with a biosimilar.
• Omeprazole (for stomach upset) as needed.

Aldactone as long as you take prednisone.

Yours faithfully,

Dr. Maarten

Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information (see list at the top of the page).