When should I consider prescribing medication for a patient with recurrent nocturnal leg cramps?

Consider prescribing medication for recurrent nocturnal leg cramps only if:

• Treatable causes of cramps have been excluded.
• The cramps are very painful and frequent.
• The cramps significantly affect the person's quality of life, for example by regularly disrupting sleep.
• Self-care measures such as stretching exercises have failed to provide relief.
• The person has no medical conditions or drug interactions that increase the risk of medication side effects.
• Adverse effects and risks of the medication have been discussed and the patient is willing to be carefully monitored.

Specifically for quinine: A trial of quinine may be considered at a dose of 200–300 mg at bedtime for 4 weeks, with benefit monitored using a sleep and cramp diary. If no benefit is seen, treatment should be stopped. If beneficial, treatment can continue for up to 3 months, then stopped to reassess ongoing need. If further treatment is required, review every 3 months and consider trial discontinuation. Patients should be advised not to exceed the recommended dose due to risk of serious adverse effects, including thrombocytopenia.

Other pharmacological treatments are not routinely recommended due to insufficient evidence of benefit and potential risks.