How Can Leg Cramps Be Treated?

Jodi H. Walker, PharmD

Disclosures

June 14, 2010

Question

Leg cramps (nocturnal and otherwise) are a common problem. As quinine is no longer an answer, what is the current thinking for patients with this chronic symptom?

Response from Jodi H. Walker, PharmD
Adjunct Faculty, Albany College of Pharmacy, Albany, New York; Clinical Pharmacy Coordinator, VA Medical Center, Bath, New York

Idiopathic leg cramps are presenting more and more frequently in the healthcare community. Leg cramps have historically been underreported. However, as patients become increasingly informed through television and the Internet and become aware of such conditions as the restless legs syndrome, treating leg cramps is a common issue facing healthcare providers today.

Although quinine sulfate has been shown to be efficacious in treating leg cramps, the Food and Drug Administration (FDA) banned over-the-counter use in 1994 due to risk for potentially fatal hypersensitivity reactions, thrombocytopenia, and cardiac arrhythmia.[1] In 2006, the FDA banned marketing of unapproved prescription quinine products.[2] Quinine remains available by prescription for treatment of malaria, but its risks as a preventive or treatment for leg cramps outweigh any potential benefit.[2]

Nonpharmacologic therapy is not well-established but may warrant an initial trial before treatment with medication. Hydration, warm or cold compresses, exercising, or calf stretches may provide some benefit.[3]

Although no specific medical treatment is indicated for leg cramps, several drugs have been used with varied success. Calcium-channel blockers, such as diltiazem, have been used to treat nocturnal leg cramps. Vitamin B complex (including 30-mg vitamin B6) has also shown effectiveness.[4]

Patients with chronic leg cramps should consult with their healthcare provider to investigate underlying causes. A differential diagnosis is important when patients with leg cramps are being examined, because many disorders, such as tetany, myalgia, the restless legs syndrome, and peripheral vascular disease, can have symptoms that present as leg cramps.[3]

Quinine continues to be used off-label to treat nocturnal leg cramps; however, an FDA postmarketing review states that there are no reliable data to support its use, and although it is often effective, serious adverse effects have occurred.[2] The American Academy of Neurology systematically reviewed the available evidence on symptomatic treatment of muscle cramps and their recommendations include the following[4]:

  • Consider vitamin B complex or calcium-channel blockers, such as diltiazem.

  • Avoid routine use of quinine.

  • Potentially consider quinine for an individual trial once side effects are evaluated; side effects must be carefully monitored.

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