Quinine and Muscle Cramps
Sunday, February 28, 2010
Quinine and Muscle Cramps
Leg muscle cramps, aka 'charlie horses' and painful contractions of skeletal muscles elsewhere in the body, are really not a lot of fun, striking mostly in the middle of the night, disrupting sleep and necessitating rather bizarre nocturnal gyrations to alleviate. As a very regular, and Rick might even say manic, exerciser, my own experience with these cramps is unfortunately extensive. I am not alone; a United Kingdom study of adult outpatients found that 50% reported cramps at least once per week, with the number of patients reporting them increasing with age.
Is there any relief for this type of muscle cramping? A review in this issue of Neurology takes an exhaustive look at many of the studies available and concludes that quinine isn't a good choice and moreover, is associated with a range of side effects, including death. Yikes. While I am usually averse to revelation of personal information, I feel obliged to admit that I do use quinine regularly for this purpose, although I take a very small dose, such as is found in a quart of diet tonic water. I'm happy to say it helps a lot in preventing these cramps. Yet the majority of pill forms of quinine have been unavailable in the US since 2006, when the FDA cited 665 adverse event reports and 93 deaths as compelling evidence to remove them from the market.
If not quinine, then what? The review also looks at various other drugs as well as supplements and vitamins. Here's what they conclude: a daily vitamin B complex including 30 mg per day of vitamin B6 helped almost 90% of patients, an agent called gabapentin helped some people, as did verapamil. Both are drugs you'll have to ask your physician about if you want to give them a try.
Things that didn't help: muscle stretching, hydration (operating on the idea that cramping is the result of dehydration, which often follows exercise), and a host of other drugs. The authors conclude that additional research is indeed indicated given that the condition is so common, a perennial favorite conclusion of mine. Other topics this week include the FDA report on Avandia and its implications, cognitive decline in elderly people following hospitalization, and the Institute of Medicine report on the sorry state of diagnosis and treatment of hypertension or high blood pressure in the US. Rick and I also have to say mea culpa; we erroneously reported the quinine study as the Lancet so we apologize. Until next week, y'all live well.