Ask the Pharmacist

Q: I get these brutal leg cramps right out of the blue some nights and they completely wreck my sleep. Why do I get these, and more importantly, what can I do to get rid of them?

A: Nighttime leg cramps are a very painful tightening of the muscles in your lower extremities that occur often without any warning. They most commonly occur in the calf but may also be felt in the thigh or foot.

While most people experience these at night while they are sleeping, they have been known to also occur while you are awake during periods of inactivity.

Symptom duration varies greatly, ranging from a few seconds to several minutes, and there is the possibility of residual soreness in the affected muscles after the cramp has gone away.

Nocturnal leg cramps may occur at any age but are most common in adults over the age of 50. Both sexes seem to be equally likely to be affected.

The actual reason they occur remains a bit of a mystery for most who suffer from them, but some cases have been attributed to activities such as improper sitting posture, over-exertion of the affected muscles, sitting for long periods of time or standing/working on hard concrete floors.

These cramps have also been associated with numerous medical conditions, including pregnancy, Parkinson’s Disease, assorted neuromuscular disorders, endocrine system disorders (diabetes, hypothyroidism), alcoholism, dehydration (and the electrolyte imbalances associated with this), and structural disorders such as flat feet.

Medications may also be a cause, with diuretics (furosemide, indapamide, hydrochlorothiazide) being a common trigger, and statins (used for cholesterol such as rosuvastatin and atrovastatin, among others), beta blockers (used for a variety of conditions and ending with “lol” such as metoprolol or atenolol), the drug nifedipine, and inhalers which use beta-agonists (e.g. salbutamol/Ventolin) also implicated.

If you experience these cramps frequently enough that they are starting to affect your quality of life, your physician may run some tests to rule out some of the conditions mentioned above, as well as to check out the levels of your electrolytes (such as potassium, magnesium).

If a cramp does occur, the best and quickest remedy is to stretch the painful muscle for a period of at least 30 seconds. The application of ice or heat (even a warm shower/bath may do the trick if you don’t have a heating pad) has also been beneficial for some. Walking around, jiggling your leg or having the area massaged, can be helpful as well.

Most who experience these leg cramps are more interested, however, in learning how to prevent them from occurring in the first place. One key is to ensure adequate hydration with the goal being the consumption of at least six to eight glasses of water each day.

A prolonged, but gentle, stretching of the legs just prior to bedtime has also helped many. Wearing properly-fitted shoes and keeping blankets and sheets loose around your feet so that your toes are not forced into awkward positions, can make a positive impact as well. A light level of exercise, such as riding a stationary bicycle for a few minutes before going to bed, has also been noted to work for some.

When it comes to drug therapy, there are a number of options that have shown some benefit. Before trying different pills and supplements at random, seeing your doctor first to try and discover an underlying cause, may save a lot of time and wasted dollars.

In the supplement area, taking a Vitamin B complex, for example 50-100 milligrams (mg), is a safe (it’s a water soluble vitamin meaning that excess amounts are eliminated in your urine) and inexpensive option that has some science to support its effectiveness.

Magnesium and calcium supplements might help those who are deficient in these minerals or those who are pregnant, but are unlikely to help the rest of us, although they too are both safe and a reasonably-priced option to try.

Traditionally, the drug quinine has been used and prescribed to prevent these cramps but it has recently fallen into disuse due to concerns about its lack of effectiveness and a very nasty side effect potential (heart rhythm abnormalities, blood cell disorders, and, oh yes, death!).

It’s safe to try tonic water (which contains quinine) but you’d have to drink about 15 cups of it per day in order to get the amount found in the prescription capsules, which might well present its own nighttime issues.

There are various homeopathic remedies available as well but there is, as per usual, a lack of evidence to either support or refute their use.

There have been a few small clinical trials that show that the prescription drugs diltiazem (30 mg prior to bedtime) and verapamil (120 mg at bedtime) may work to decrease the frequency of leg cramps in as little as a few weeks' time.

These drugs have traditionally been used to treat high blood pressure, prevent migraines and aid in the management of certain cardiovascular disorders so they are not for everyone but many can take these safely and they seem to work better than quinine, according to at least one trial.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts