Treatment can be difficult and often requires trying different drugs and dosage regimens. Other choices are oxycodone, carbamazepine, and gabapentin. Benzodiazepines taken at bedtime prevent awakening but not nocturnal movements. Nocturnal leg cramps commonly occur in otherwise healthy middle-aged and elderly patients during sleep. They affect the calf or foot muscles, causing forceful plantar flexion of the foot or toes.
Diagnosis is based on the history and lack of physical signs or disability.
Stretching the affected muscles for several minutes before sleep often helps prevent cramps. Stretching immediately after cramping usually relieves symptoms and is preferable to empiric drug treatment. Quinine sulfate 200 to 300 mg at bedtime is used, but recent studies claim that it is not effective for night cramps. In large doses, it can cause a bitter taste, tinnitus, flushing, pruritus, and GI disturbances, and it interacts with many other drugs. Drugs used with quinine and calcium include diphenhydramine 50 to 100 mg at bedtime, magnesium oxide 100 to 200 mg bid, and low doses of benzodiazepines.