Since quinine is no longer recommended for leg cramps, what do you suggest as an alternative? The patient had no success with gabapentin (Neurontin).—PAMELA P. JONES, MSN, FNP-C, Hornell, N.Y.

What recommendations do you have for treatment and prevention of painful leg cramps at night? What, if any, laboratory testing should be done?—CAROL HENNESSY, ANP, Littleton, Colo.

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For decades, the gold standard for treating nocturnal leg cramps was quinine sulfate, which acts by decreasing the excitability of the muscles. This age-old remedy was even available OTC. However, due to rising numbers of serious adverse drug effects, it was totally withdrawn from the U.S. market in 2006. Currently, the only available source of quinine is tonic water, which contains about one-tenth of a prescription dose. Drinking 8 oz to 16 oz at night can be a simple remedy. However, quinine can interact with medications, including digoxin and warfarin. Other treatments that may be helpful—but have little or no clinical data supporting their use—include muscle relaxants, vitamin B complex, magnesium, and calcium. Some studies indicate regular calf-stretching exercises done before going to bed can prevent night cramps. One very old but simple study found significant efficacy with the calcium channel blocker verapamil. For more information, see Arch Intern Med. 1988;148:1969-1970.—Sherril Sego, FNP-C, DNP (140-5)