Low-dose prazosin in patients with muscle cramps during hemodialysis

Abstract

Sympathetic nervous system response to volume stress is more marked in patients with frequent hemodialysis-associated skeletal muscle cramps than in most patients who cramp infrequently. Accordingly, we conducted a double-blind, randomized, and balanced trial in which five patients with frequent hemodialysis-associated cramps were given either placebo or a prazosin dose (ranging from 0.25 to 1.0 mg) at the start of 16 dialysis sessions. These low doses of prazosin appeared to reduce cramp frequency in four of the five patients, and patient-stratified multiple logistic regression analysis indicated an aggregate 58% reduction in cramp frequency (p = 0.030). On the other hand, prazosin therapy was associated with an increased incidence of hypotension that required therapeutic intervention both during (p = 0.033) and after (p = 0.010) hemodialysis. Our findings support the hypothesis that sympathetic activation plays a pathogenetic role in hemodialysis-associated skeletal muscle cramps and suggest that pharmacologic attenuation of this response may be of therapeutic benefit.

Acute Complications of Hemodialysis

“…However, use of quinine sulfate has side-effects such as cinchonism, optical atrophy, thrombocytopenia, arrhythmia, hemolytic uremic syndrome and interaction with drugs such as digoxin and warfarin (Wolf et al, 1992;Goldenberg&Wexler, 1988;Kojouri et al, 2001;Pedersen et al, 1985). There are also studies showing that muscle cramp development is reduced by administering 400 mg/day vitamin E, 250 mg/day vitamin C (Khajehdehi et al, 2001), 12 gm of creatinin monohydrate before dialysis (Chang et al,2002), prozosin (0.25-1 mg) (Sidhom et al, 1994) and L-carnitine (Bellinghieri et al, 1983). However, the safety of using vitamin C above 200 mg for a long time is not proven (Kobrin et al, 2007).…”

Index to volume 56

“…(Tipton). 1994;56;781-97 Muscle contractions Low-dose prazosin in patients with muscle cramps during hemodialysis (Sidhom et al). 1994;56;445-51 Myocardial infarction Effects of lisinopril and nitroglycerin on blood pressure early after myocardial infarction: the GISSI-3 pilot study (Latini et al).…”

Prevention of hemodialysis‐related muscle cramps by intradialytic use of sequential compression devices: A report of four cases

“…Numerous pharmacologic therapies to improve or prevent muscle cramps have been reported in the literature. These include hypertonic saline, 7 quinine sulfate, 8 50% dextrose water, 25% mannitol, 9,10 vitamin E, 11 chloroquine phosphate, 12 l ‐carnitine, 13 and low‐dose prazosin 14 . Response to head‐up tilt 15 and various stretching exercises of the LE 16 are some of the few nonpharmacologic modalities studied so far.…”