Nighttime Leg Cramps: Meds That Hurt, Meds That Help

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Nocturnal leg cramps are a common cause of pain in the legs that can disrupt sleep. They are present in nearly 50 percent of those over the age of 50. Leg cramps are characterized by sudden muscle tightness, most commonly in the foot, thigh, or calf, that may last from seconds to minutes. Forceful stretching of the affected muscles usually relieves these leg cramps. For some reason, the vast majority of people have these cramps only at night.

What is unhelpful to hear is that for most cramps, we have no idea why they happen. Patients sometimes wonder if their medication is leading to their nighttime leg cramps and well, yes, some medications can.

Here are the players that may contribute to nocturnal leg cramps:

1) Inhalers: long-acting beta agonists salmeterol (Serevent, and also present in Advair HFA and Advair Diskus) and formoterol (Foradil) are common examples.

2) Potassium-sparing diuretics: triamterene (Dyrenium, present in Dyazide and Maxzide), spironolactone (Aldactone, present in Aldactazide) and eplerenone (Inspra).

3) Thiazide-like diuretics: chlorthalidone and hydrochlorothiazide.

4) Other meds that pose a small risk: furosemide (Lasix) and statins like atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor).

There are of course other causes of nocturnal leg cramps. Two major culprits are prolonged sitting and volume depletion (due to diuretics or excessive sweating without sufficient salt replacement). Leg cramps at night are more common with diabetes, hypoglycemia, alcoholism and hypothyroidism.

So, what medications HELP for nighttime leg cramps?

1) Vitamin B complex, including vitamin B6, 30 mg per day.

2) Calcium channel blockers, including diltiazem (30 mg per day), which has also been used in a dose of at bedtime.

3) Diphenhydramine (Benadryl) 12.5 mg to 50 mg nightly (available over the counter).

4) Plaquenil (hydroxychloroquine sulfate) daily for two weeks, then once per week.

5) Quinine is the best-studied drug for nocturnal leg cramps and has been found effective in some studies. Yet quinine is no longer routinely recommended for treatment due to the potential for serious and/or life-threatening side effects.

Lastly, there are some non-pharmacologic solutions to nighttime leg cramps:

1) Walking or leg jiggling followed by leg elevation.

2) A hot shower with the stream directed at the cramp area of the body, usually for five minutes, or a warm tub bath.

3) Ice massage.

3) If you are sedentary, riding a stationary bicycle for a few minutes before going to bed HELPS.

4) Keeping the bed covers at the foot of the bed loose and not tucked in.

5) Maintaining adequate hydration, particularly if you are on diuretics.

Hope this helps!

Dr. O.

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