What treatment is recommended for muscle cramping (cramps)?

From the Guidelines

For cramping, I recommend taking baclofen at 10 mg/day, with a weekly increase of 10 mg/day up to 30 mg/day, as it has been shown to be effective in managing muscle cramps, particularly in patients with liver disease, as stated in the 2018 EASL clinical practice guidelines for the management of patients with decompensated cirrhosis 1.

Key Considerations

• Muscle cramps are a common issue in patients with liver disease, and can significantly impact quality of life, as noted in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1.
• The exact mechanisms of muscle cramps are unclear, but correction of electrolyte alterations, such as hypokalemia and hypomagnesemia, is important, as mentioned in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1.
• Other treatments, such as albumin infusion, may also be effective in managing muscle cramps, as recommended in the 2018 EASL clinical practice guidelines for the management of patients with decompensated cirrhosis 1.

Additional Recommendations

• Patients with severe, persistent, or concerning symptoms, such as fever or vomiting, should seek medical attention, as these may indicate a more serious condition.
• Staying hydrated by drinking plenty of water and applying heat with a heating pad or warm bath may also help relax muscles and alleviate cramping.
• Gentle stretching of the affected area and considering potassium-rich foods like bananas or electrolyte drinks may also be beneficial in addressing electrolyte imbalances that contribute to cramping.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions For cramping associated with muscle spasm, cyclobenzaprine hydrochloride tablets may be given as an adjunct to rest and physical therapy.

• The medication is intended for short-term use (up to two or three weeks) 2
• It is used for relief of muscle spasm and its associated signs and symptoms, such as pain and tenderness.

From the Research

Treatment Options for Cramping

• Ibuprofen is a commonly used medication for relieving pain and cramping, with a smallest clinically useful dose of 200 mg 3
• The combination of ibuprofen and hydrocodone is more effective than either drug alone in patients undergoing abdominal and gynaecological surgery 3
• Cyclobenzaprine, a muscle relaxant, can be used in combination with naproxen, a nonsteroidal anti-inflammatory agent, to relieve muscle spasm associated with acute low back strain 4
• Ibuprofen is consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, and osteoarthritis 5
• Oral ibuprofen at doses of 400,600, and 800 mg has similar analgesic efficacy for short-term pain relief in adult patients presenting to the emergency department with acute pain 6

Considerations for Treatment

• The absorption of ibuprofen acid is influenced by formulation, and certain salts of ibuprofen and solubilised formulations have an enhanced onset of activity 3
• Combination therapy with cyclobenzaprine and naproxen may be associated with more side effects, due primarily to drowsiness from the cyclobenzaprine 4
• There is no systematic assessment of harm associated with the use of ibuprofen and paracetamol for pain relief 5