What About These Remedies for Leg Cramps?

Laurie Briceland, PharmD

Disclosures

September 28, 2010

Question

Since quinine is generally off-limits for leg cramps, what is the evidence for other available remedies?

Response from Laurie Briceland, PharmD
Professor of Pharmacy, Albany College of Pharmacy and Health Sciences, Albany, New York


Editor's Note:

A recent Ask the Expert column, How Can Leg Cramps Be Treated?, prompted a number of letters from readers about common remedies for leg cramps that were not addressed. In this follow-up column, we answer those queries.

Idiopathic leg cramps, also termed benign nocturnal leg cramps, are a relatively common and bothersome complaint, particularly among patients older than 65 years of age. While a majority of cases can be attributed to an underlying and sometimes treatable cause (eg, peripheral vascular disease, diabetes, electrolyte imbalance), some cases have no known etiology or trigger. In addition, what may trigger cramping in 1 person does not reliably trigger it in another, and likewise, what may ease cramping in 1 person may not be effective in another.[1]

Because prescription and nonprescription quinine is no longer endorsed by the US Food and Drug Administration (FDA) for prophylaxis or symptomatic treatment, due to its serious adverse effect profile despite some clinical efficacy,[2,3] clinicians wonder about the use and evidence for alternative methods for treating leg cramps.

What About Calf Stretches?

Little evidence supports the use of calf-stretching for the treatment of muscle cramps. No conclusion can be made regarding the efficacy of calf-stretching in decreasing muscle cramp frequency.[2]

What About Alternative Sources of Quinine?

Ingestion of tonic water (which contains small amounts of quinine) in patients with leg cramps can lead to serious adverse effects such as thrombocytopenia.[4,5,6] Use of tonic water for this purpose is not recommended.

Quinine may be available in homeopathic remedies. Although these products may be touted as "100% natural" and "safe," they are not strictly regulated by the FDA and should not be recommended to patients.

Risks associated with alternative sources of quinine outweigh any benefits. Anyone consuming quinine-containing beverages or taking quinine-containing homeopathic products should be warned of the potential risks involved.

What About Magnesium or Vitamin E Supplementation?

Evaluation of small trials using magnesium or vitamin E for leg cramps found no improvement in cramp frequency or sleep disturbance.[2]

What About Herbal Remedies?

Some herbal products, such as ginkgo and ginger, are touted as effective for leg cramps. Evidence is lacking to support these claims; clinical trials are not available. Like homeopathic products, herbal products are not strictly regulated by the FDA. Patients considering use of herbals should always consult their physician first due to the myriad adverse effects and drug interactions possible.

What About Salt Supplementation or "A Banana A Day"?

Use of bananas or other foods/supplements for leg cramps is not supported by evidence. As stated above, all patients should be referred to a physician for initial evaluation and management of a potential electrolyte disorder.

Summary

Unfortunately, there is no known panacea for treating nocturnal leg cramps that are of unknown etiology. Quinine-containing products should be ingested only under the supervision of a healthcare provider due to potentially serious adverse effects. Other nonpharmacologic treatments, alternative medicines, or supplements do not yield reliable results in clinical trials and thus cannot be recommended.

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