David R.P. Guay, PharmD, College of Pharmacy, University of Minnesota; HealthPartners Geriatrics, Minneapolis, MN, USA.

Symptomatic muscle cramps in older adults can be extremely painful and seriously compromise health-related quality of life. Although numerous etiologies exist for muscle cramps, the majority in older adults are benign in nature (also called ordinary) and of unknown etiology. Serious systemic disorders associated with cramping illness can usually be readily ruled out by obtaining a thorough medical history and performing a targeted physical examination. Active or passive muscle stretching is the treatment of choice for acute ordinary muscle cramps. To prevent recurrent ordinary muscle cramps, drug therapy with quinine has been advocated for many years. However, a critical review of its efficacy and tolerability reveals a compound of questionable efficacy with substantial toxicity risks. Selected muscle relaxants, gabapentin, and verapamil may be preferable to use as initial therapy, but the use of these agents is also not supported by rigorous research data. Modestly effective treatments have been identified for cramps caused by hemodialysis, cirrhosis, and some neurological disorders.
Key words: muscle cramps, cramp syndrome, muscle contraction syndrome, quinine, quality of life.