What to do for nighttime leg cramps?

Patients and doctors are still looking for something that works and is safe for nocturnal leg cramps. Almost half of elderly patients have frequent leg cramps with no obvious cause. The problem is there are no proven treatments.

So, the experts at the Natural Medicines Comprehensive Database (NMCD) advise healthcare professionals and patients:

  • First look for possible causes such as diuretics or beta-agonists. Also check the blood for abnormalities in the serum potassium, magnesium, and calcium.
  • Advise patients to try simple measures … calf stretches, hot or cold packs, hydration with electrolytes (Gatorade, etc).
  • Recommend acetaminophen or ibuprofen for pain relief … but explain they won’t prevent cramps.
  • Some experts suggest B-complex vitamins and magnesium supplements … or low-dose prescription diltiazem … but there’s only weak evidence of a possible benefit.
  • Don’t use vitamin E supplements, or prescription gabapentin … evidence suggests that they DON’T work for muscle cramps.
  • Other prescriptions, such as anticonvulsants and baclofen, are sometimes tried for severe cramps, but they aren’t proven to help. NMCD tells prescribers, “Don’t use them routinely.”
  • In addition, the NMCD says to not rely on prescription clonazepam or ropinirole for leg cramps, either. These can be helpful for restless legs syndrome … but there’s no evidence that they prevent leg cramps.

Of course the 800-pound gorilla is quinine … which has been used for decades for nighttime leg cramps. Of the quinine choices, the NMCD recommends:

  • Don’t recommend Hyland’s Leg Cramps with Quinine or similar homeopathics. Their quinine content is miniscule and not proven to work.
  • Tonic water has only 20 mg quinine/cup … not enough to help.
  • Prescription quinine is still used a lot. But FDA questions its efficacy and says the risks are too high for leg cramps.

Qualaquin is the only FDA approved quinine. But its labeling warns not to use it for leg cramps … and it costs about $5 per cap.

NMCD tells prescribers, “It’s okay to prescribe Qualaquin off-label for leg cramps, but consider the risk of thrombocytopenia, arrhythmias, etc. Consider using a quinine consent form if you’re concerned about legal exposure. “

However, the FDA recently released new cautions against using quinine for leg cramps

The Los Angeles Times reported, “The Food and Drug Administration cautioned consumers against using quinine [Qualaquin] for “nocturnal” leg cramps, warning that the drug could cause severe side effects, including death.”

Indeed, “studies have shown that it can reduce the incidence of cramps by one-third to one-half.” However, “as many as one in every 25 users can suffer serious side effects.”

The FDA decided to issue the warning after reviewing data in its adverse-event reporting system, according to a report in the Wall Street Journal. Between April 2005 and October 2008, 38 reports had been submitted.

In those reports, “24 instances of serious life-threatening reactions” were noted, “including thrombocytopenia, electrolyte imbalance, hearing loss, cardiovascular problems, and hemolytic uremic syndrome,” MedPage Today reported.

“These adverse events resulted in permanent kidney impairment and hospitalization in some people, and death in two.”

“Under a risk management plan approved by the agency, the drug’s manufacturer,” AR Scientific, “will issue a letter to prescribers warning of the risk for hematologic reactions to the drug,” Medscape reported.”In addition, patients must be given a medication guide explaining what quinine is and is not approved for, and its potential adverse effects.”

Notably, the agency “issued a similar warning in 2006, but the agency noted today that the majority of quinine used in the United States is still for the prevention or treatment of leg cramps.”

So, what’s a sufferer to do.  Try the several of the simple steps recommended above first.