CNS OTC - Cramps

Question 1

Give e.g. of drugs causing cramps.

Answer 1

Salbutamol and Terbutamline (hypokalaemia)
Raloxifene
Opiate withdrawal
Diuretics (electrolyte loss)
Nifedipine
Phenothiazines
Penicillamine
Nicotinic acid
Statins (myopathy)

Question 2

Explain the management of cramps.

Answer 2

Review drugs e.g. diuretics and electrolyte imbalances.
Severity of symptoms/impact on sleep, mood and QOL will determine whether tx is required.
Passive stretching and massage of affected muscle.
Using pillow to raise feet through the night or raising the foot of the bed may help to prevent attacks.

Question 3

What tx options are given for cramps?

Answer 3

Quinine sulfate (POM) not recommended (poor evidence)
- Rx 200-300mg nocte for 4-6 weeks.
- Keep symptom diary.
- Continue tx for 3 months, stop to reassess ongoing need.
- If ongoing tx is required, regular meds review should occur every 3-6 months. LT tx - reviewed/stopped.

Crampex (GSL) = Poor evidence
- Increases calcium levels in the blood as low levels of calcium can contribute to muscle cramps. Also has nicotoninc acid to improve circulation.