Why no quinine for muscle cramps

For people who have previously found quinine effective for their muscle cramps at night, new FDA advice may seem unreasonable.

A recent review¹ looked at eighteen randomized clinical trials on this published between 1950 to 2008.

While effective in over a quarter of people, serious harms were reported in 2 to 4%. These included haemolytic uraemic syndrome, thrombotic thrombocytopaenic purpura etc - nasties worth avoiding.

The FDA reported 93 deaths from this treatment.

Small chance of bad outcome, but potentially very bad effect then.


What to do instead, for your cramps

STRETCHING

First of all, if it hurts to attempt a stretch, it needs stretching.
This applies nearly anywhere, anytime.
Stretch very gently, or cramps will happen right now!
Spend a long time if needed and gradually, little by little, strrretch it out to full length.

VITAMIN E

A 2010 Cochrane review³ found 4 trials involving 543 people in total, where vitamin E and quinine were found to have comparable results in all respects.

Incidentally in 23 trials with a total of 1586 participants, in dosages between 200 and 500 mg/day, they found "moderate quality evidence that with quinine use up to 60 days, the incidence of serious adverse events is not significantly greater than for placebo."

MAGNESIUM

This is always worth trying, as often effective and then very important for lots of other parts of our chemistry as well.

To quote Dr. Jonathan Wright...

"Magnesium treatment for muscle spasms of all kinds is so often effective that it should not be abandoned until injections have been tried."


Our Western Australian Post Polio Network people suggest people try increasing oral doses until just under that causing diarrhoea.

CALCIUM

In Pregnancy cramps, calcium plus a little vitamin D, is often effective.

AKINETON

An anticholinergic prescription drug which can be used, and best started with 1/4 of a tablet.

DILTIAZEM

A dose of 30 mg prior to bedtime, reduced the frequency but not the severity of cramps, without any side effects, in one small trial².

Trigger points in muscles

Your muscle cramping may be helped by treating these small areas of spasm.

If you can get at the area involved, press in with your fingertips as you move the skin backwards and forwards across the muscle belly.

Muscles are nearly all running up and down in limbs, so this will be across the limb. Elsewhere you may need to consult a picture of the muscles to see which way they run.

Feel around all the muscle, for bits that seem firmer or easier to feel. They are likely to feel like tight cords in the muscle, which you can twang under your fingertip (if you press more firmly as you move across the line of the muscle fibres.)

If such a tight band is tender to pressure, it is probably worth treating.

Professional trigger point therapy may be done with needles or lasers, but you can just continue pushing on the spot until it relaxes under your finger pressure.

If over a solid bone, you can press straight down on it, splaying the muscle fibres out sideways from you fingertip.
In other areas you may need to angle your pressure so as to bow the bit of muscle sideways in just one direction (keeping enough pressure on it so that it doesn't just slip back under you finger.)

At least a couple of minutes pressure is likely to be needed. If the pain stops before this you have probably slipped off the sore spot and need to reposition your pressure.

This is quite convenient for leg muscle cramps with tender spots in your calf, and probably not very good for neck muscle spasms (where there are lots of things you shouldn't push on.



References for muscle spasms page

1. Katzberg et al, Assessment, symptomatic treatment for cramps (not in established diseases nor pregnancy.) Neurology 2010; 74: 691-96.

2. Voon et al, Diltiazem for nocturnal leg cramps. Age Ageing 2001;30:91-92.

3. Sherif El-Tawil et al, Quinine for muscle cramps Cochrane Neuromuscular Disease Group. Cochrane Database of Systematic Reviews 2010, Issue 12




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