![]() However, the study was complicated by worsening disease states (such as vascular disease) and by increased patient-physician contact. A recent study found an association between leg cramps and the use of quinine in the year following new prescriptions for diuretics, statins, and inhaled long-acting beta 2 agonists. 11 Leg cramps also have been reported in studies of medications such as clonazepam (Klonopin), citalopram (Celexa), celecoxib (Celebrex), gabapentin (Neurontin), and zolpidem (Ambien), which, ironically, are used to treat leg cramps. Medication-related leg cramps are most commonly associated with intravenous iron sucrose, conjugated estrogens, raloxifene (Evista), naproxen (Naprosyn), and teriparatide (Forteo), although the overall incidence is very low ( Table 1). Muscle cramps are reported as an adverse effect for hundreds of medications, but only a few are specific to the legs. Quinine is no longer recommended to treat leg cramps. Limited evidence supports treating nocturnal leg cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol, or vitamin B 12. Laboratory evaluation and specialized testing usually are unnecessary to confirm the diagnosis. A history and physical examination are usually sufficient to differentiate nocturnal leg cramps from other conditions, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy. Medications that are strongly associated with leg cramps include intravenous iron sucrose, conjugated estrogens, raloxifene, naproxen, and teriparatide. Nocturnal leg cramps are associated with vascular disease, lumbar canal stenosis, cirrhosis, hemodialysis, pregnancy, and other medical conditions. The exact mechanism is unknown, but the cramps are probably caused by muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. ![]() The recurrent, painful tightening usually occurs in the calf muscles and can cause severe insomnia. Quinine sulfate, but not vitamin E, is superior to placebo in the treatment of nocturnal leg cramps.Up to 60 percent of adults report that they have had nocturnal leg cramps. ![]() Vitamin E was not effective in reducing leg cramp frequency, severity, or sleep disturbance. There was evidence of a mild increase in side effects while subjects received quinine. Thirteen of 27 patients had at least a 50% reduction in the number of cramps while receiving quinine the response was usually seen within 3 days. Patients reported cramp frequency, severity, and sleep disturbance caused by cramps.Ĭompared with treatment with placebo, quinine reduced the frequency of cramps and sleep disturbance, but not the average cramp severity. These periods were separated by 4-week washout intervals. Subjects received, in random order, quinine sulfate (200 mg at supper and 300 mg at bedtime), vitamin E (800 U at bedtime), or placebo for 4-week periods. Fifty-five subjects were contacted, 30 were enrolled consecutively, and 27 completed the study. Twenty-seven male veterans, aged 38 to 73 years, who experienced at least six leg cramps per month were recruited through the general medicine walk-in clinic or were referred from other clinics. The study was conducted at the Veterans Affairs Medical Center, White River Junction, Vt. This study compared the efficacy and safety of quinine sulfate, vitamin E, and placebo in the treatment of nocturnal leg cramps.Ī random-order, double-blind, placebo-controlled crossover trial was performed.
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