Muscle cramps and pain can occur during cancer treatment, and it is a common side effect of Gleevec. Treatment with Gleevec can cause a reduction in levels of calcium and magnesium in the blood. It is believed that this can be one of the causes of muscle cramps. Talk to your doctor about monitoring calcium and magnesium levels and whether you should take calcium and magnesium supplements. In addition, a number of patients have reported low levels of Vitamin D while on Gleevec and/or Sutent. Vitamin D helps absorb calcium and it is a good idea to have Vitamin D levels checked as well. This can be done by a blood test. In some patients taking Gleevec, low levels of phosphorus (hypophosphatemia) or high levels (hyperphosphaturea) have been reported. Monitoring phosphate levels may also be useful.

Here are some tips for easing muscle cramps:

  • Increase your fluid intake. Dehydration can cause muscle pain, so make sure to drink a lot of fluids. We have had several patients report improvement in cramps after increased water consumption. This may be especially important if you are having other problems like diarrhea (which causes dehydration).
  • Electrolyte replacement beverages
  • Tonic water (also see the last bullet point)
  • Undergo a physical therapy program.
  • Undergo an occupational therapy program.
  • Make sure you are getting the appropriate amount of sleep.
  • Try hot/cold therapy to relax the muscle(s).
  • Some patients have used quinine (also found in tonic water) to relieve cramps. Recently the FDA has been telling people not to use the drug quinine for leg cramps because they have received many reports of serious adverse events from quinine since 1969.

Some patients taking Gleevec can have an increased CPK (CK) level in the blood. CPK is a marker of muscle damage and can be increased in up to 57% of GIST patients taking Gleevec1. It has been suggested to consider CPK into a standard clinical chemistry work up of Gleevec patients as an objective measure of muscoloskeletal complaints1.

Besides these lifestyle change or adaptation suggestions, there are medications that can help to alleviate the muscle pain you experience (one possibility is muscle relaxants). Before starting any type of treatment, discuss your muscle pain with your doctor. Be sure to bring a record that details the onset, characterization, location, intensity, and duration of the pain along with any factors that have relieved the pain in the past. If cleared by your physician, you may take a non-steroid, anti-inflammatory drug (NSAID) such as Aleve to alleviate the pain.Ibuprofen can be taken for a short period, if approved by your doctor; however, since there is potential for ibuprofen to affect Gleevec transport into the tumor cell, patients on Gleevec  should probably not take it on a long-term basis. Tylenol can also be used if your doctor says it is okay, however, if you are taking Gleevec, limit Tylenol to 1300 mg per day (1/3 the normal maximum dose) as Gleevec slows the metabolism of Tylenol increasing the risk for liver damage.

References

  1. Increase of creatine kinase value (CK) correlates with muscoloskeletal complaints (MSC) in GIST patients during imatinib therapy, P. Allione, G. Grignani, S. Aliberti, D. Rota Scalabrini, F. Carnevale Schianca, A. Capaldi, R. Vormola, D. Caravelli, A. Galla, M. Aglietta.
  1. NCCN Task Force Report: Optimal Management of Patients with Gastrointestinal Stromal Tumor (GIST)—Update of the NCCN Clinical Practice Guidelines (July, 2007) George D. Demetri, MD; Robert S. Benjamin, MD; Charles D. Blanke, MD; Jean-Yves Blay, MD, PhD; Paolo Casali, MD; Haesun Choi, MD; Christopher L. Corless, MD, PhD; Maria Debiec-Rychter, MD, PhD; Ronald P. DeMatteo, MD; David S. Ettinger, MD; George A. Fisher, MD, PhD; Christopher D.M. Fletcher, MD, FRCPath; Alessandro Gronchi, MD; Peter Hohenberger, MD, PhD; Miranda Hughes, PhD; Heikki Joensuu, MD; Ian Judson, MD, FRCP; Axel Le Cesne, MD; Robert G. Maki, MD, PhD; Michael Morse, MD; Alberto S. Pappo, MD; Peter W.T. Pisters, MD; Chandrajit P. Raut, MD, MSc; Peter Reichardt, MD, PhD; Douglas S. Tyler, MD; Annick D. Van den Abbeele, MD; Margaret von Mehren, MD; Jeffrey D. Wayne, MD; and John Zalcberg, MBBS, PhD.