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10.2.3 Nocturnal Leg Cramps

Nocturnal Leg Cramps

Prescribing Notes

    • Quinine should only be used when nocturnal leg cramps regularly disrupt sleep. Trials show patients experience only one less episode per week taking quinine compared with placebo and that cramp duration is not significantly affected.
    • Although well tolerated at doses used for leg cramps, patients should be warned that quinine is toxic in overdose
    • Healthcare professionals are advised to only consider quinine:
      • when cramps are very painful or frequent
      • when other treatable causes of cramp have been ruled out
      • when non-pharmacological measures (e.g. passive stretching exercises) have been ineffective
    • Treatment should be stopped if there is no benefit after an initial trial of four weeks. If treatment continues, benefit should be assessed every 3 months. In patients taking quinine long term, a trial discontinuation should be considered- Quinine Prescribing Review Tool.
    • Quinine should be used with caution in people with risk factors for QT prolongation or in those with atrioventricular block. For further details see MHRA.