A quinine a day keeps the leg cramps away? Br J Clin Pharmacol. Warburton A, Royston JP, O’Neill CJA, et al. Placebo-controlled trial of quinine therapy for nocturnal leg cramps. 1993 41:498–500.Ĭonnolly PS, Shirley EA, Wassen JH, Nierenberg DW. Quinine sulfate for leg cramps: does it work? J Am Geriatr Soc. Meta-analysis of efficacy of quinine for treatment of nocturnal leg cramps in elderly people. Current controversies over the use of quinine. To minimize the possibility of this bias, persons performing medication-related meta-analyses should seek high-quality unpublished data from drug regulatory agencies and pharmaceutical companies. Publication bias is present in this area even though there is controversy about the role of quinine in the treatment of leg cramps. Prescribing physicians must closely monitor the risks and benefits in individual patients. For persons who find this ineffective and whose quality of life is significantly affected, a trial of quinine is warranted. Given the side effect profile of quinine, nonpharmacologic therapy (e.g., regular passive stretching of the affected muscle) is the best first-line treatment. However, its benefit may not be as large as reported from the pooling of published studies alone. Publication bias is present in the reporting of the efficacy of quinine for this indication, as almost all published studies reported larger estimates of its efficacy than did unpublished studies.ĬONCLUSIONS: This study confirms that quinine is efficacious in the prevention of nocturnal leg cramps. Compared with placebo, the use of quinine was associated with an increased incidence of side effects, particularly tinnitus. The corresponding relative risk reductions were 21% (95% CI 12%, 30%) and 43% (95% CI 21%, 65%), respectively. This compared with an estimate of 8.83 fewer cramps (95% CI 4.16, 13.49) from pooling published studies alone. MAIN RESULTS: When individual patient data from all crossover studies were pooled, persons had 3.60 (95% confidence interval 2.15, 5.05] fewer cramps in a 4-week period when taking quinine compared with placebo. SUBJECTS: Ambulatory patients (659) who suffered from regular nocturnal leg cramps. SETTING: Randomized trials that were available as of July 1997. OBJECTIVE: With respect to the use of quinine for the treatment of nocturnal leg cramps, to determine whether the findings of a previously performed meta-analysis of published data are altered with the addition of unpublished data, and whether publication bias is present in this area.ĭESIGN: A meta-analysis of eight (four published and four unpublished) randomized, double-blind, placebo-controlled trials, seven of which had a crossover design.
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