Key takeaways:
Long-acting beta agonist inhalers, diuretics, and statin are among the medications most likely to cause leg cramps at night.
Pregnancy, heart conditions, and liver or kidney problems can also make leg cramps more likely. Often, once your health condition is managed, the cramps will improve.
The best way to prevent leg cramps at night is to stay hydrated and incorporate movement into your daily routine. Regular stretching and massage can also help. If you’re experiencing leg cramps at night often, talk to your healthcare team. They can look at your medical history to determine the best course of action.
There’s nothing better than a good night’s sleep. And nothing worse than a sudden, shooting pain in your leg that wakes you up and ruins your slumber. Leg cramps at night — officially known as nocturnal leg cramps — are a common cause of leg pain that disrupts your sleep. About half of all adults over the age of 60 experience them.
Leg cramps are characterized by sudden muscle tightness and pain, typically in the calf, that may last seconds to minutes. They’re also commonly referred to as a charley horse or muscle spasm. In many cases, leg cramps only happen occasionally and go away on their own. But what should you do if they’re a nightly issue?
What causes leg cramps at night?
There’s not always a clear cause of leg cramps at night. They’re more common in older adults and during pregnancy. But they can happen to anyone, even children.
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We do know that certain medications and health conditions make leg cramps at night more likely (more on that next). So if your sleep is often disturbed by leg pain, it’s best to talk to your healthcare team. They can take a look at your overall medical history to see if there’s a likely culprit and figure out next steps to address any issues.
Which medications can cause leg cramps at night?
The first place to look for what’s causing your leg cramps is your medication list. There are several different medications that are associated with a higher risk of nightly leg cramps. Here are some of the common offenders.
Long-acting beta agonists
Long-acting beta agonists (LABAs) are inhaled medications that are used to treat asthma and chronic obstructive pulmonary disorder (COPD). They’re typically combined with an inhaled steroid, as LABAs can have dangerous side effects if used alone.
Leg cramps at night are more likely in people who are using inhaled LABAs. It’s not clear if the medication is a direct cause of nighttime cramps, or the underlying conditions they’re used to treat. But it’s possible that these medications stimulate the beta receptors in leg nerves, leading to pain and cramping.
Some diuretics
Diuretics are medications typically used to treat conditions such as heart failure, high blood pressure, and edema (excess fluid). Two types of diuretics are associated with an increased risk of leg cramps: potassium-sparing diuretics and thiazide diuretics.
Potassium-sparing diuretics include triamterene (Dyrenium), spironolactone (Aldactone) and eplerenone (Inspra). Thiazide diuretics include chlorthalidone and hydrochlorothiazide.
Diuretics can change the levels of electrolytes such as sodium, chloride, and/or potassium. But there isn’t clear evidence that electrolyte changes are connected to nocturnal leg cramps. So we don’t know for sure why leg cramps are more common in people taking these medications.
Iron sucrose
Iron sucrose (Venofer) is an intravenous (IV) medication that treats anemia (low red blood cell count). It’s estimated that up to 23% of people receiving iron sucrose may develop leg cramps at night.
Conjugated estrogens (Premarin)
Conjugated estrogens (Premarin) is a medication used for conditions such as menopause, osteoporosis, and breast cancer. It’s estimated that up to 14% of people taking conjugated estrogens may develop leg cramps at night.
Raloxifene (Evista)
Raloxifene (Evista) is a medication used to treat and prevent osteoporosis and breast cancer. It’s estimated that up to 12% of people taking raloxifene may develop leg cramps at night.
Statins
Statins are medications used to lower high cholesterol levels. Common statins include atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor). While statins are associated with an increased risk of general muscle pain, it’s not clear if this includes leg cramps at night.
That being said, if you’re experiencing nocturnal leg cramps after starting a statin, let your prescriber know. Switching to a different statin may solve the issue.
Miscellaneous medications
Other medications may cause leg cramps at night, but this risk doesn’t seem to be as high as those listed above. Medications with a lower association of causing leg cramps at night include:
Bupropion (Wellbutrin)
Celecoxib (Celebrex)
Cetirizine (Zyrtec)
Fluoxetine (Prozac)
Naproxen (Aleve, Naprosyn)
Pregabalin (Lyrica)
Sertraline (Zoloft)
Ipratropium / albuterol inhaler (Combivent)
Levalbuterol inhaler (Xopenex)
Teriparatide (Forteo)
Zolpidem (Ambien)
Eszopiclone (Lunesta)
What health conditions can raise the risk of leg cramps at night?
There are a number of health conditions that may raise your risk of having leg cramps at night. The most common include:
Heart conditions, such as coronary artery disease and high blood pressure
Arthritis
Depression
Diabetes
Kidney disease, particularly if you receive hemodialysis
Cancer and cancer-related treatments and complications
Cirrhosis (liver damage)
There are several reasons why these conditions may cause leg cramps at night. They may reduce blood flow to the leg muscles, affect the nerves in the legs, or change electrolyte levels in the body. In some cases, once the underlying condition is managed, leg cramps may improve.
What else might cause leg cramps at night?
Aside from the medications and conditions mentioned above, there are other factors that can lead to leg cramps at night. You could be more likely to experience leg cramps at night if you are:
Of an older age
Of the female sex
Have a sedentary lifestyle (lack of regular movement or exercise)
Standing for long periods of time
Performing intense exercise (which affects both leg muscles and electrolyte levels)
Drinking alcohol, especially in older adults
It’s clear that regular movement can help reduce your risk of leg cramps at night. And be sure to stretch and refuel after intense exercise to help prevent cramps from happening.
What can help prevent leg cramps at night?
There are a number of medication-free options you can try to help prevent leg cramps at night. In most cases, these lifestyle changes are more effective than other treatment options.
Proper hydration throughout the day is key — especially after you exercise. Speaking of exercise, do your best to incorporate regular movement into your daily routine. And limit your caffeine intake.
Mild exercise before bedtime (such as a few minutes on a stationary bike or treadmill) can help prevent cramps. You should also try regular stretching and massage of your leg muscles.
How can you treat leg cramps at night?
There isn’t a proven treatment option for nighttime leg cramps. But there are several things you can try to help lessen your symptoms.
As mentioned, if you have a health condition that contributes to leg cramps at night, managing the condition can help reduce cramping. You should also have a healthcare professional review your medication list to see if any of your medications may be at fault for your cramps.
You should also incorporate some lifestyle changes to help prevent leg cramps from happening.
After these steps, if you’re still having leg cramps at night there are some other treatment options you can try. Keep in mind that none of these medications or supplements have strong evidence about their effectiveness. And be sure to get your prescriber’s OK before starting anything new to make sure it’s safe for you. These alternative options include:
Muscle relaxants: Prescription medications such as orphenadrine, carisoprodol (Soma), and cyclobenzaprine (Flexeril) relax the muscles and may help treat leg cramps. But they can be sedating and aren’t recommended for older people. So they may not be a safe option for everyone.
Vitamin B complex: There’s preliminary evidence from one small study of older adults that vitamin B complex can reduce the frequency and duration of leg cramps at night. But this study only included people living with high blood pressure. And symptoms only improved after 3 months of treatment.
Magnesium supplements: Studies have shown that oral magnesium supplements can reduce leg cramps at night during pregnancy. Outside of pregnancy, study results are mixed as to whether or not magnesium is effective. One study found an improvement in leg cramps after 60 days of treatment with magnesium hydroxide. But a review of the available studies found no benefit from magnesium supplements.
Calcium channel blockers: There is very limited evidence that calcium channel blockers such as diltiazem (Cardizem) and verapamil (Verelan) can improve leg cramps. These medications are typically used for high blood pressure and other heart-related conditions. So they have heart-related side effects to consider, and may not be appropriate for everyone.
Gabapentin (Neurontin): Gabapentin is a prescription medication used to treat seizures and nerve pain. There’s some evidence that it can also help relieve symptoms of leg pain at night.
Good to know: Quinine, a medication that treats malaria, was commonly prescribed in the past for leg cramps at night. But it has a high number of serious risks and side effects, such as hearing loss and irregular heartbeats. The FDA warned against taking quinine for leg cramps in 2010. So it’s no longer a recommended treatment option.
The bottom line
Although we don’t know for sure what causes leg cramps at night, there are certain medications and health conditions that can make them more likely. Long acting beta-agonist inhalers, diuretics, and statins are the most common medications that cause leg cramps at night. Pregnancy, heart conditions, and kidney or liver problems can also raise the risk of nighttime leg cramps. In many cases, managing your health condition or changing your medication will resolve your leg cramps.
Steps you can take to prevent leg cramps include proper hydration and regular exercise. Stretching and massaging your legs before bed can also help. There aren’t any proven medications or supplements that treat leg cramps at night. It’s best to talk to your healthcare team to determine the best way to manage them.
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