Management

Specific causes should be sought and treated appropriately.

Otherwise, consider:

• physical methods:
  • passive or active stretching of opposing muscle group; e.g. for cramp in the calf, extending the knee with the ankle flexed
  • other approaches, for example, raising the foot of the bed, electrical stimulation of the affected muscles, and placing a magnet under the affected muscle, all have their advocates but are not supported by published trials of their efficacy
    
    
• pharmacological:
  • quinine - 200-300 mg nocte; benefits may be delayed for 4 weeks - there is evidence from the Netherlands that hydroquinine (the only quinine derivative in that country licensed for the prevention of muscle cramps) is effective in preventing leg cramps. Hydroquinine therapy does not reduce their duration or severity - note that in the USA, the Food and Drugs Administration has abandoned the use of quinine in the treatment of leg cramps because of potentially fatal immune-allergic reactions (2)
    
    
• naftidrofuryl oxalate e.g. 30 mg bd - there is evidence from a small double-blind, placebo-controlled study of 14 patients, that this treatment option was more effective than placebo in increasing the number of cramp free days (3)
  
  
• other potential alternatives that have been used in the management of nocturnal cramps include verapamil, gabapentin, carisprodol, and orphenadrine in the general population, and vitamin E in the dialysis population (4)
  
  
• magnesium may provide relief in pregnant women with leg cramps (5)

Reference:

• (1) Jansen PH et al (1997). Randomised controlled trial of hydroquinine in muscle cramps. Lancet, 349, 528-32
• (2) Prescriber (2001); 12 (3):93-97.
• (3) Young JB, Connolly MJ (1993). Naftidrofuryl treatment for rest cramp. Postgrad Med J, 69, 624-6.
• (4) Guay DR. Are there alternatives to the use of quinine to treat nocturnal leg cramps? Consult Pharm. 2008;23(2):141-56.
• (5) Guerrera MP et al. Therapeutic uses of magnesium. Am Fam Physician. 2009;80(2):157-62