Nocturnal leg cramps

Although patient response may vary, overall efficacy is modest, the frequency of nocturnal leg cramps is reduced by about 25% in ambulatory patients - around one episode a week difference.

The MHRA advises that quinine is not a routine treatment for nocturnal leg cramps and should only be used if cramps cause regular disruption of sleep. Consider quinine only when cramps are very painful or frequent; when other treatable causes of cramp have been ruled out, and when non-pharmacological measures have not worked, (e.g. passive stretching exercises). After an initial trial of 4 weeks, treatment should be stopped if there is no benefit.

Initially patients should be monitored closely for adverse effects as well as benefit. Treatment should be interrupted at 3-monthly intervals to assess the need for further quinine. In patients taking quinine long-term, a trial discontinuation may be considered.

Please note that quinine bisulphate 300mg is approximately equivalent to quinine sulphate 200mg, so the salt should always be specified.