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Leg cramps - unknown cause - Management
Basis for recommendation
CKS did not identify any national guidelines on the indications for using quinine in the management of leg cramps in primary care. These recommendations are based on expert opinion from review articles [Miller and Layzer, 2005; Shaker et al, 2005].
- Evidence from a systematic review [Man-Son-Hing et al, 1998] and two randomized controlled trials [Diener et al, 2002; Woodfield et al, 2005] suggests a reduced frequency in leg cramps with quinine, compared with placebo over a 4-week period.
- There are no trials which have evaluated the long-term efficacy or safety of quinine use for leg cramps. Observational studies and case reports have raised concerns about the risk:benefit ratio with quinine, mainly at the higher doses used for treating malaria [Mackie and Davidson, 1995; DTB, 1996; Reddy et al, 2004]. Therefore, experts recommend a treatment trial with careful monitoring of efficacy and adverse effects [Butler et al, 2002].
- The Medicines and Healthcare products Regulatory Agency (MHRA) has recently reminded prescribers that quinine is not a routine treatment of nocturnal leg cramps and should only be considered when cramps cause regular disruption of sleep. The MHRA advise that quinine should be stopped if no benefit is seen after 4 weeks of treatment [MHRA, 2010].
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