TREATMENT FOR LEG CRAMPS
Treating Leg Cramps
When I first became a pharmacist, recommendations for treating leg cramps were pretty straight forward. We walked our customer out to the supplement section and handed them a bottle of Quinine capsules. No, it wasn't a perfect remedy, but frankly it was all we had to offer.
Then came 1994. The FDA banned the over-the-counter versions of quinine due to concerns related to potentially fatal allergic reactions and heart abnormalities. In other words, they felt the risks associated with quinine use outweighed the possible benefits. Since this time, finding an effective treatment for leg cramps, especially the very painful "night leg cramps" has become challenging.
Leg cramps can be very common, with greater prevalence in the elderly. Some studies indicate that up to 70% of patients over 65 years old suffer from them. Patients will sometimes call these cramps a "charlie horse" or a "spasm" or a "knot." They often occur at night.
Leg cramps are more common in females than males. They may be due to other underlying conditions such as arthritis or PVD (peripheral vascular disease). Some medications may contribute to leg cramps, such as diuretics. Dehydration is another possible cause. But in many cases the cause of the leg cramps is simply unknown.
MEDICINE FOR LEG CRAMPS
Treatments currently available for leg cramps can be divided into "medication" and "non-medication" therapies.
Medications that may be used to treat leg cramps include both prescription and non-prescription drugs. None of these have been sufficiently studied to allow them to be "approved" for leg cramps as such. But anecdotal evidence has provided sufficient success to merit trying them in certain patients.
Vitamin B Complex: B complex vitamins contain a variety of B vitamins (e.g. B1, B2, B6, etc) typically in doses far beyond the daily requirements. They are available without a prescription in the vitamin section of your local pharmacy. If you have not taken this before, do not be alarmed at the darkening of your urine as this is normal. Don't worry if you are already taking a multi-vitamin with B vitamins. The extra will not hurt, as these are water soluble and thus you will not overdose on them. Take 1 daily.
Magnesium & Calcium Supplements: There is only limited evidence, but some patients have reported benefits from taking one or both of these supplements. Consider taking 1,000mg of calcium daily, and anywhere from 200mg to 400mg of Magnesium. Have trouble swallowing the big Calcium tablets? Try Tums instead! Check the ingredients on the label for the amount you would need. These are chewable!
Acetaminophen or Ibuprofen: These are pain relievers, and although not stictly for leg cramps, may provide some relief for pain associated with cramping. Be sure to check with your doctor or pharmacist to be sure you can safely use these. Use the lowest effective dose. If the cramps are at night, try taking one of these prior to bedtime.
Prescription Calcium channel blockers (like diltiazem): Calcium channel blockers may be effective for some patients with leg cramps. These are typically used to treat high blood pressure, angina or heart conditions. Not every patient will be eligible to try these, but they may be worth discussing for leg cramps that cannot be resolved through other approaches.
Prescription Quinine: Although quinine was removed from the "over-the-counter" market, it continues to be available by prescription, but is "approved" only for the treatment of malaria. The brand name is known as "Qualaquin." A physician may write a prescription for Qualaquin for leg cramps, although the risks and benefits must be carefully considered.
Note: Some people are confused about quinine availability because they see products on the pharmacy shelf that say "quinine" on them, like Hyland's Leg Cramps with Quinine. This is deceiving. Hylands products are "homeopathic" which, by definition, mean that they do not have any active ingredients in them. They start with quinine, but then dilute the product down until it no longer actually contains quinine. Thus they can sell it.
Persistent leg cramps should always be evaluated by your doctor. Although usually harmless (though painful), they may occasionally be a symptom of a more serious condition.
Here are some non-medical approaches to managing leg cramps:
1) Increase your fluid intake. Try drinking a glass of Gatorade every day, and also increase the amount of water you drink on a regular basis. Leg crams can sometimes be caused by dehydration.
2) Stretch. Stretching your legs regularly, and especially before bedtime, may be helpful. Cramps can be due to circulation problems, and stretching your legs may help improve blood circulation to the leg muscles.
3) Warm or Cold compresses. A warm compress can be made by simply soaking a face cloth in warm tap water and applying it to the leg. A heating pad may also be used to provide moist heat. There is even an OTC product called "Thermacare" that is an adhesive patch that delivers heat. A cold compress can be achieved by a cloth soaked in a cold water, or by applying a frozen gel pack to the area.
© Jason P RPh
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