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Edema-Causing Medications Take Note of Your Medications and Talk with Your Doctor

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Edema-Causing Medications Take Note of Your Medications and Talk with Your Doctor Ask the Expert Edema-causing medications Take note of your medications and talk with your doctor By Vaughan Keeley and Neil Piller Introduction Calcium channel blockers (CCBs) rheumatoid arthritis. In these situations Some medications may cause edema in These are probably the medications most long term corticosteroids can help reduce people who do not normally have swelling. frequently implicated in causing edema, the inflammatory edema but may cause leg They can also exacerbate swelling in those potentially affecting up to 50% of those swelling. A decision about their continued use who already have lymphedema and may who take them, depending upon the specific will depend on the balance of benefit v. side be contributing factors in those who have type and dose. They are used to treat high effects. In some conditions such as asthma, chronic edema due to a number of causes, blood pressure. They cause edema by short courses of corticosteroids are used particularly the elderly. This means that increasing capillary filtration of fluid and e.g. up to 2 weeks and during this time leg the potential role of medications in the cause may also reduce lymphatic drainage. swelling is unlikely to occur. Corticosteroids of edema needs to be considered in all The time to onset of edema after com- are also used to treat peripheral edema in people with chronic swelling. mencing CCBs may vary with different drugs, advanced cancer (they work by reducing the Most medications which e.g. one month with amlodipine; two inflammatory edema around the cancer) but cause edema do so by months with nifedipine. again decisions on duration and dose depend increasing the amount of on weighing up the benefit v. side effects. fluid filtered from the blood Nonsteroidal anti-inflam- capillaries into the tissues matory drugs (NSAIDs) Sex hormones and related compounds but some may impair the These medications are Whilst the combined oral contraceptive pill lymph drainage. commonly used in the and hormone replacement therapy can cause treatment of a wide variety edema in some women, hormone treatments Do many drugs of conditions e.g. arthritis. such as those used in breast cancer e.g. Qcause edema? They cause edema by fluid tamoxifen, anastrozole and megestrol may lead The list of medications retention. The likelihood of this to edema in 7 to 14% of women taking them. Awhich may cause edema is depends upon the individual drug very long. For some, it may be a common e.g. up to 9% with naproxen. Other drugs side effect, but for others it is rarely seen. Other drugs which may be responsible for The most commonly used drugs which can Corticosteroids edema include anticonvulsants used in cause edema are: Corticosteroids can cause sodium retention pain management e.g. pregabalin (affects through a direct action on the kidney. This 5 to 12%), antidepressants e.g. trazodone • calcium channel blockers e.g. amlodipine can result in fluid retention and hypertension. (10%), anti-diabetics e.g. rosiglitazone • nonsteroidal anti-inflammatory drugs The effect is dependent upon the dose and (5%), antipsychotics e.g. risperidone (16%), (NSAIDs) e.g. ibuprofen duration of treatment. Corticosteroids are bisphosphonates e.g. zoledronic acid • corticosteroids e.g. prednisolone used to treat a variety of illnesses. These (21%), chemotherapy agents e.g. docetaxel • hormones and related compounds include some inflammatory conditions (47 to 64%) and immunosuppressants e.g. e.g. tamoxifen in which edema can be a feature e.g. sirolimus (more than 10%). Vaughan Keeley, PhD, FRCP is a Consultant Physician in Lymphoedema, Derby, UK and a Director of the International Lymphoedema Framework. Neil Piller, PhD, FACP, is a Director of the International Lymphoedema Framework and Director of the Lymphoedema Clinical Research Unit, Department of Surgery, Flinders University School of Medicine, Australia. 16 Lymphedemapathways.ca Summer 2017 B936_CLF_Pathways_Summer2017.indd 16 6/2/17 1:38 PM How can we tell if a If a drug effect is suspected, Qmedication is contributing Qhow should this be managed? to the edema? Ideally, e.g. with calcium channel Some medications may There may be a clear time relationship Ablockers used to treat high blood cause edema in people who Abetween starting the medication and pressure, the medication should be with- do not normally have swelling. the onset or worsening of swelling. For some drawn or switched to another product. They can also exacerbate medications, e.g. corticosteroids, the effect However in some circumstances where swelling in those who already may take some weeks to develop. the blood pressure has been difficult to have lymphedema. Checking whether edema is manage, continuing the medication but a common side effect with a reduced dose may improve the for a particular edema. In some cases, however, the medi- medication cation may be essential in treating a serious References is important, medical condition and therefore manag- 1. Keeley, V (2008) Drugs that may exacerbate but it is still ing the side effect, eg. with compression and those used to treat lymphoedema. necessary to garments or the use of diuretics in certain Journal of Lymphoedema 3(1). consider the instances, may need to be considered. 2. Given the prevalence of use of Calcium potential role of a Channel blockers the following older medication, which only Conclusions article may be of interest. It indicates causes edema rarely. A medication may For many people with chronic edema, the their mechanisms of actions and provides cause more widespread edema in someone cause of the swelling is often multifactorial. a generic review of our thinking. Sica, with a pre-existing localized swelling, eg. Medications can play a significant part in this D A Calcium Channel Blocker-Related it could cause swelling, eg. in both legs and it is important to consider what role they Peripheral Oedema: Can It Be Resolved in someone who may have lymphedema may have and whether changes should be Journal Clinical Hypertension (Greenwich). previously affecting one leg only. made to improve the control of the edema. LP 2003 5(4):291-4. Beautiful, Comfortable & Seamless Compression LympheDIVAs, founded by two young women Featuring over 100 patterns, crystals and with breast cancer related lymphedema, is the color options for both women and men, only brand offering breathable, comfortable LympheDIVAs truly has something for and beautiful arm sleeves, gauntlets and gloves everyone. All garments are made in the available in 20-30mmHg and 30-40mmHg USA featuring a completely hypoallergenic graduated medical compression. construction free of latex and silicone. www.lymphedivas.com Summer 2017 Lymphedemapathways.ca 17 B936_CLF_Pathways_Summer2017.indd 17 6/2/17 1:38 PM.
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