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



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