From the Guidelines
To treat muscle cramps, albumin infusion or baclofen administration (10 mg/day, with a weekly increase of 10 mg/day up to 30 mg/day) are recommended 1. When managing muscle cramps, it is essential to consider the underlying cause and the patient's overall health status. In patients with liver disease, muscle cramps are common, particularly in those on diuretic treatment for ascites 1. The exact mechanisms by which they occur remain unclear; however, besides the correction of electrolyte alterations, muscle cramps may respond to medications.
Treatment Options
- Albumin infusion: This is a recommended treatment for muscle cramps, especially in patients with liver disease 1.
- Baclofen administration: Starting with 10 mg/day and increasing by 10 mg/day weekly up to 30 mg/day, baclofen has been shown to be effective in managing muscle cramps 1, 1.
- Correction of electrolyte alterations: Hypokalemia and hypomagnesemia should be corrected to help alleviate muscle cramps 1.
- Other medications: Orphenadrine, methocarbamol, and quinidine have been proposed for muscle cramps in patients with cirrhosis, but their use may be limited by side effects 1.
Prevention Strategies
- Regular stretching before and after exercise
- Proper warm-up and cool-down routines
- Avoiding sudden increases in physical activity
- Staying hydrated by drinking plenty of water
- Replenishing electrolytes with foods rich in potassium, magnesium, and calcium or sports drinks
It is crucial to note that if muscle cramps are severe, persistent, or associated with swelling, weakness, or skin changes, medical attention should be sought as they may indicate an underlying condition requiring specific treatment 1.
From the FDA Drug Label
Quinine sulfate capsules may cause unpredictable serious and life-threatening hematologic reactions including thrombocytopenia and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) in addition to hypersensitivity reactions, QT prolongation, serious cardiac arrhythmias including torsades de pointes, and other serious adverse events requiring medical intervention and hospitalization. The risk associated with the use of quinine sulfate capsules in the absence of evidence of its effectiveness for treatment or prevention of nocturnal leg cramps, outweighs any potential benefit in treating and/or preventing this benign, self-limiting condition
The treatment for muscle cramps (muscle spasms) is not specified in the provided drug label for quinine sulfate capsules, as it is not approved for this use due to the risk of serious adverse events outweighing any potential benefit 2.
From the Research
Treatment Options for Muscle Cramps
The treatment for muscle cramps can vary depending on the underlying cause and severity of the condition. According to 3, treatment decisions should be oriented according to the classification of reversible, potentially reversible, and irreversible causes.
- For reversible causes, the remedy is to attack the underlying process, if possible.
- For potentially reversible and irreversible causes, pharmacologic suppression of cramps is the primary approach.
- Membrane-stabilizing agents, such as quinine, phenytoin, or carbamazepine, may be selected according to either nocturnal or daytime predominant occurrence of cramps 3.
- Other treatment options include mexiletine, which has been shown to be a safe and efficient alternative for patients with amyotrophic lateral sclerosis 4.
- Physical measures, such as stretching, can also be effective in managing muscle cramps 5.
- Quinine sulfate is widely used as an effective therapy for idiopathic leg cramps, although its effectiveness has been questioned by some studies 6.
Diagnostic Approach
A careful history and examination should allow the physician to determine the significance of cramp 5.
- ENMG and biological tests are needed in cases of severe symptoms (severity and frequency of cramps) and/or abnormal examination 5.
- The diagnostic approach should include identifying the underlying cause of the muscle cramps, such as neurologic abnormalities or nonneurologic causes 3.
- The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? 7.
Pharmacologic Treatments
Pharmacologic treatments have a moderate interest because of the potential of toxicity (quinine sulfate) or a little effectiveness (vitamin B complex, naftidrofuryl, and calcium channel blockers such as diltiazem, gabapentin) 5.
- Quinine appears to decrease the excitability of the motor end plate, thereby reducing the muscle contractility 6.
- A dosage of 200 to 300 mg of quinine every night has not been shown to cause significant side effects, but it should be used cautiously, especially in the elderly and patients with renal failure, and should be avoided in patients with liver disease 6.