Cramps, those annoying contractions of muscles, particularly in the legs, may not be lethal, but they can be extremely painful. Surprisingly, there are no really good treatments for them, according to new guidelines issued Tuesday by the American Academy of Neurology in the journal Neurology. But one treatment that should be avoided, except as a last resort when nothing else works, is quinine, according to the guidelines developed by Dr. Hans D. Katzberg of the Stanford University School of Medicine and his colleagues.
Quinine, the essential ingredient in tonic water, has long been the preferred treatment for cramps. Studies have shown that it can reduce the incidence and severity of cramps by one-third to one-half. The problem is that, in as many as one in 25 cases, quinine can produce serious adverse effects, including blood irregularities. In 2006, the Food and Drug Administration warned against the use of quinine for treating cramps because of the large number of adverse event reports it had received, and the drug is not readily available in this country -- although it is still sold over the counter in many foreign countries.
And no, you can't get useful amounts of the drug by drinking tonic: It would require at least a few liters.
"Quinine should be considered only when cramps are very disabling, when no other drugs relieve the symptoms and when side effects are carefully monitored" by a physician, Katzberg said in a statement. "It should also be used only after the affected person is informed about the potentially serious side effects."
Other agents that are sometimes used to treat cramps include the anti-spasmodic drug naftidrofuryl, the anti-hypertension drug Diltiazem and vitamin B complex. These drugs may be safely used, the guidelines say, but there is surprisingly little data about whether or not they work. There is also almost no data about the value of stretching calves to reduce cramps or drinking large quantities of water, both frequently offered as remedies. But both are considered safe if done in moderation.
The review covered only studies of cramps unrelated to any underlying medical condition. Muscle cramps can be an indicator of kidney or liver disease as well as neurological conditions, such as amyotrophic lateral sclerosis (Lou Gehrig's disease) or complications of diabetes. For that reason, anyone suffering from severe cramps should consult a doctor.
-- Thomas H. Maugh II