Leg problems keeping you up at night?

Q: I used to take quinine sulfate for nighttime leg cramps. I stopped because I didn’t think it was really helping.

A: Unfortunately, I’m not convinced that any medication, including quinine, is effective for nighttime (nocturnal) leg cramps. Although nighttime leg cramps are common, the cause is unknown. Besides aging, they are associated with flat feet, a sedentary lifestyle, dehydration and diabetes.

Options for treatment include: stretching; regular exercise; drinking plenty of fluids, especially around the time of exercise; applying heat (before or just after a cramp); and changing footwear, including using arch supports and good cushioning. Although unproven, a number of medications are often tried: quinine; muscle relaxants, such as cyclobenzaprine; diphenhydramine (Benadryl and many others); Verapamil; and Gabapentin.

The U.S. Food and Drug Administration took action in late 2006 to limit the use of prescription quinine so that it is used only as a treatment for malaria. That’s because studies suggest it does little to improve night cramps and it has some serious potential side effects, including an unstable heart rhythm, low blood counts and allergic reactions.

Q: I have restless legs, especially at night. My doctor prescribed clonazepam (Klonopin). It has not helped yet.

A: Restless legs syndrome is a relatively common condition marked by a bothersome urge to move the legs while resting. Stretching or other movements of the legs can relieve this urge but only temporarily. Stretching before bed and avoiding alcohol, nicotine and caffeine may be helpful. Yoga, homeopathy and acupuncture are of uncertain benefit.

While a number of medications may be helpful, only one is FDA-approved: ropinirole (Requip) was approved in 2005 for moderate to severe symptoms of restless leg syndrome. Other medications that may help include: Pramipexole, a medicine that works in a similar way as ropinirole; Clonazepam (Klonopin), triazolam (Halcion), zolpidem (Ambien) or related sedatives; Levodopa/carbidopa (Sinemet); Gabapentin (Neurontin); Opiods, such as codeine or propoxyphene (Darvon), though generally as an option only if other medicines have failed. Combinations of one or more of these medicines may be needed. The effects of clonazepam can generally be assessed within a few days of starting the medication. If you’ve been taking it for a week or two without benefit, talk to your doctor about adjusting the dose or considering another treatment option.

Today’s Medicine Cabinet was written by Robert H. Shmerling, M.D., an associate physician at Beth Israel Deaconess Medical Center, Boston, Mass. The Medicine Cabinet is distributed by Tribune Media Services Inc. and published Tuesdays in the TimesDaily. For additional consumer health information, visit health.harvard.edu.