Sunday, October 14, 2012

How do you prevent leg cramps?


Leg cramps are common. Most involve the calves. Most occur at night while sleeping.
How do you prevent those painful leg cramps?

Now, I am not talking about cramps that happen with exercise, like running in a marathon; those are a completely different problem. And they are far less common than nighttime leg cramps.

First keep in mind that some medications can make cramps more likely.
Those medications that reduce the concentration of potassium or of sodium in your blood may increase your risk of leg cramps.
These include certain diuretics and probably certain inhalers for asthma called beta agonists.

But most people with leg cramps have no electrolyte imbalance.
Their serum levels of potassium, sodium, calcium and magnesium are fine.  
Low thyroid hormone levels, hypothyroidism, can also cause muscle cramps. 
Once the thyroid hormone levels are normal, the cramps should go away.

Statins can cause muscle aching, but muscle cramps on the other hand, in my experience are not usually an issue with statins.
So, if my patients on statins have muscle cramps at night, when taken off the statin, they usually still have those cramps just as badly.

Some drugs cause leg cramps for unclear reasons. A few of these are estrogen, teriparatide (Forteo) and raloxifene (Evista).

So how about preventing leg cramps.
Non-drug treatments are always preferred. But it seems most don't work.

Fortunately,  recent evidence confirms the benefit of calf stretches at night to reduce calf cramps.

But for goodness sake don't drink pickle juice!
That's another goofball idea one of my patients heard from Dr. Oz.
Pickle juice has been studied for treating exercise associated muscle cramps
It might work for treatment of those cramps, but not prevention.

Quinine clearly works to reduce calf cramps as confirmed in a recent review. Around 300 milligrams is the dose that seems to have shown benefit.
Since 1994, in the U.S., quinine has only been available with a prescription.
Qualaquin is the only quinine available in the United States. The FDA warns patients and doctors about Qualaquin.
And Qualaquin is not approved for prevention of nighttime muscle cramps. By the way, the amount of quinine in tonic water is so low,  don't expect that to help.

Other treatments, like gabapentin or verapamil, have less convincing data to support their benefit. But they are safe and may be worth a try.

So, sadly, I do not have any great ideas to prevent leg cramps besides avoiding electrolyte imbalance and doing calf stretches.

What have you done that works? I'd like to know.

Daniel Weiss MD CDE FACP PNS CPI








1 comment:

  1. Treating Vitamin D deficiency has helped some of my patients.

    ReplyDelete