Muscle cramps

The long-term epidemiology of muscle cramps has not been well studied for either idiopathic (ordinary) cramps or those associated with organic diseases or other conditions. Virtually no data exist for follow-up of >12 weeks, whether treated or otherwise. Many patients report a waxing and waning course lasting years.[3]American Academy of Sleep Medicine. International classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun ​2023 [internet publication].​ Only with pregnancy-associated cramps is an excellent prognosis virtually assured (delivery ameliorates cramps).

Data regarding the times to onset and peak response are generally limited to data with quinine. The onset of therapeutic effect (if quinine is going to work) is within the first 3 days and maximal effects generally occur within the initial 2 to 3 weeks after starting therapy or dosage adjustment. Quinine is not recommended for leg cramps in countries such as Australia. In the US, the Food and Drug Administration has issued a warning against using quinine for this purpose. FDA: drug safety information for quinine sulfate Opens in new window The American Academy of Neurology recommends that quinine use should be considered only if symptoms are very disabling, no other agents have relieved symptoms (or can be tolerated), and where adverse effects can be carefully monitored. The patient must be informed of the potentially serious adverse effects before consenting to treatment.[98]Katzberg HD, Khan AH, So YT. Assessment: symptomatic treatment for muscle cramps (an evidence-based review): report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2010;74:691-696. http://www.neurology.org/content/74/8/691.long http://www.ncbi.nlm.nih.gov/pubmed/20177124?tool=bestpractice.com In other countries, quinine preparations may be more readily available, but the safety concerns are such that quinine should not be considered the drug of choice for idiopathic cramps.