Sound Advice on Treating Muscle Cramps

A muscle cramp, commonly called a ‘Charley Horse’, arises when a muscle or group of muscles involuntarily contracts and cannot be relaxed by the subject’s will.  Although cramps recover in a minute or so, prevention is often sought, as they are usually very painful.  The American Academy of Neurology (AAN) formed a committee to establish guidelines for the best approach to treating or preventing leg muscle cramps; their recommendations are published in the journal Neurology.  Here’s a summary.   

For years, quinine or quinine derivatives have been the most popular drugs for leg cramps.  Quinine is approved for treatment of malaria, and because malaria is life-threatening, the risks associated with quinine use are justifiable for that condition. But because of the drug's risks, the FDA believes it should not be used to prevent or treat leg cramps.  The AAN committee also says that quinines should not be used routinely because of the potential for adverse events.  Serious side effects include: cardiac arrhythmias (irregularities), thrombocytopenia (a decrease in blood platelets that can cause hemorrhage or clotting problems), severe hypersensitivity (allergic) reactions, and the potential for serious interactions with other drugs.  Quinines should be considered only when cramps are very severe and the patient can be monitored for serious side effects. 

What about other therapeutic approaches?  None have been recommended as better than “possibly effective” by the committee, based on a positive result in a single clinical trial of questionable quality. The “possibly effective” substances are: vitamin B complex, naftidrofuryl oxalate (Praxilene® - a blood vessel dilator), lidocaine, and calcium channel blockers such as diltiazem (Cardizem®).

Things that don’t work, or haven’t been studied in clinical trial at all,  – include gabapentin, baclofen, carbamazepine, oxcarbazepine, and stretching exercises for the affected muscle group.     

I imagine most sufferers have tried the stretching approach. Your family physician can prescribe one or other of the “possibly effective” drugs.  And, if all else fails, she/he can see if you are eligible to take prescription quinine.   Being a former Brit, I take my quinine as an evening gin-and-tonic, but that’s less than a quarter of a therapeutic dose, so I still get the occasional Charley Horse.

Comments

[Susie]

I work at a Senior Center and most of our Seniors are told to first drink more water if they are experiencing cramps, as they are probalby dehydrated. This has come from their doctors and seems to work in a lot of cases. Waht do you think?

[Robert Griffith]

Susie:
Your comment reminded me: I used to drink a glass of water every night before going to bed, just to avoid muscle cramps. Then a few years ago I stopped - as I got older, I wanted to avoid 'getting up at night', like many Seniors. And my cramps resumed - but I'd forgotten the water cure! I'll give it another try. (This is what's called a 'clinical trial with an n = 1'.)
Thanks for the advice.
Bob G.

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