Adjunct Faculty, Albany College of Pharmacy, Albany, New York; Clinical Pharmacy Coordinator, VA Medical Center, Bath, New YorkPosted: 06/14/2010
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.
References
- Brinker AD, Beitz J. Spontaneous reports of thrombocytopenia in association with quinine: clinical attributes and timing related to regulatory action. Am J Hematol. 2002;70:313-317. Abstract
- FDA Drug Safety Newsletter. Postmarket Reviews - Volume 2, Number 2, 2009. US Department of Health and Human Services. US Food and Drug Administration. Available at: http://www.fda.gov/Drugs/DrugSafety/DrugSafetyNewsletter/ucm167883.htm Accessed May 14, 2010.
- Sheon RP. Nocturnal leg cramps, night starts and nocturnal myoclonus. Available at: http://www.uptodate.com/home/index.html (subscription required to view). Accessed April 29, 2010.
- Katzberg HD, Khan AH, So YT. Assessment: symptomatic treatment for muscle cramps (an evidence-based review). Report of the Therapeutics and Technology Assessment subcommittee of the American Academy of Neurology. Neurology. 2010;74:691-696. Abstract
http://www.medscape.com/viewarticle/723218
regards, taniafdi ^_^
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