Leg Cramps

Non-pharmacological treatments

• stretching and massaging the affected muscle
  • Do stretching exercises of the affected muscle(s) three times a day. If beneficial, continue indefinitely at an acceptable frequency.
  • When sleeping, try to stop toes from pointing downwards. For example, if lying supine prop the feet up (using a pillow), or if prone hang the feet over the end of the bed. Keep blankets loose and avoid heavy bed covers.
• Patient information from NHS 
• Increase water intake
• Some evidence tonic water can help.

Pharmacological treatment

Quinine is generally not recommended for treating idiopathic leg cramps due to the poor benefit-to-risk ratio. However, a trial of quinine may be considered if:

• Treatable causes of cramp have been excluded.
• Leg cramps are very painful and frequent. 
• Cramps affect the person's quality of life (for example regularly disrupt sleep).
• Self-care measures (for example stretching exercises) fail. 
• The person has no medical conditions or drug interactions that increase the risk of quinine use, and adverse effects are discussed before prescribing and are carefully monitored.

• If quinine treatment is thought to be appropriate:
  • Prescribe 200–300 mg (at bedtime) for 4 weeks. 
  • Ask the person to monitor any benefit using a sleep and cramp diary.
  • If no benefit is seen after 4 weeks, stop treatment.
  • If beneficial, continue for 3 months, then aim to stop treatment to reassess ongoing need. If further treatment is required, review every 3 months and consider a trial discontinuation. 
  • If treatment fails refer to neurology or rheumatology
  • Side effect: thrombocytopenia - symptoms: unexplained petechiae, bruising or bleeding

https://cks.nice.org.uk/topics/leg-cramps/management/management/