AAN guideline evaluates drugs’ safety and efficacy for treatment of muscle cramps

A new guideline from the American Academy of Neurology recommends that the drug quinine, although effective, should be avoided for treatment of routine muscle cramps due to uncommon but serious side effects. The guideline is published in the February 23, 2010, issue of Neurology®, the medical journal of the American Academy of Neurology.

"It's important for people to know that quinine should be avoided since the drug is still available in some countries," said lead guideline author Hans D. Katzberg, MD, of Stanford University and a member of the American Academy of Neurology. "Quinine should be considered only when cramps are very disabling, when no other drugs relieve the symptoms, and when side effects are carefully monitored. It should also be used only after the affected person is informed about the potentially serious side effects."

The guideline found that naftidrofuryl, diltiazem and vitamin B complex may be considered for use in the treatment of muscle cramps, but more research is needed on their safety and effectiveness.

The guideline authors also reviewed studies on the use of calf stretching to treat muscle cramps, but there was not enough evidence to determine whether it is an effective therapy.

Muscle cramps are involuntary contractions, or tightening, of a muscle or muscle group. They are usually painful. Muscle cramps occur with neurologic disorders such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) and peripheral neuropathy. They also occur with other conditions, such as hypothyroidism and low calcium levels in the blood.

The guideline did not evaluate treatments for muscle cramps due to muscle diseases, kidney diseases, menstruation, pregnancy, or excessive exercise, heat or dehydration.

"If you have muscle cramps, you should see your doctor to determine the cause," Katzberg said. "Sometimes the cramps are due to a serious underlying medical condition that needs treatment."

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