Q: Many nights, I wake up once, twice, or several times with leg cramps. The only medications I take are a statin, niacin, Plavix and baby aspirin. Are any of them causing these aggravating cramps?
A: It’s possible. But there are other causes you might want to consider, too.
Let’s start with the medications you are taking. Muscle pain is the most common side effect of the cholesterol-lowering statins. Although it is usually a constant pain or ache, it may appear as nighttime cramps. Two reports in the past 20 years have described a half-dozen people who developed leg cramps after starting niacin, suggesting that this is an uncommon side effect but a possibility nonetheless. I don’t know of any evidence linking aspirin or clopidogrel (Plavix) to leg cramps.
Up to half of older adults have nocturnal leg cramps. Some get them once in a while; others suffer with them almost nightly. No one knows exactly why they occur. Overexertion, flat feet, prolonged sitting, dehydration, diabetes, anemia, and too little potassium or magnesium in the bloodstream have been linked with leg cramps, as have drinking alcohol and the use of diuretics, albuterol, and some antipsychotic medications.
As you may have already discovered, stretching can ease these cramps after they start. A good calf stretch involves straightening the leg and flexing the foot toward the knee, then grabbing the toes and pulling them toward the knee. Some people get relief by applying a heating pad or taking a hot shower; others prefer ice. Gently massaging the affected area can also help.
Calf stretch. Standing in front of a wall, stretch out your arms so that your palms are flat against the wall and your elbows are almost straight. Keeping your left knee slightly bent, step back a foot or two with your right leg, positioning the heel and foot flat on the floor. Hold for 30 seconds. Now bend your right knee while still keeping the heel and foot flat on the floor. You should feel these stretches in your calf and Achilles’ tendon; if you don’t feel a stretch, move your foot back a bit farther. Hold for 30 seconds. Switch legs and repeat.
Preventing cramps is a matter of trial and error. Here are the most common suggestions:
Tight bedcovers can tense the calf and foot muscles. Try loosening your covers or sleeping on your back with your feet hanging over the edge of the bed.
Stretch your calf and foot muscles before you go to bed.
Make sure your shoes fit and support your arches.
Drink enough water throughout the day to avoid dehydration, but don’t overdo it.
Eat foods rich in potassium and magnesium (tomato juice, pumpkin seeds, bananas, raisins, beans) but stay away from supplements unless you have your doctor’s OK.
A couple of small clinical trials suggest that taking extra B vitamins (B1, B2, B6, and B12) may help.
Don’t use quinine. This anti-malaria medication used to be prescribed to ease nocturnal leg cramps. But in late 2006, the FDA warned against using quinine for leg cramps, citing potentially deadly side effects, including abnormal heart rhythms, problems with blood platelets, and severe hypersensitivity reactions.
If none of these work, in consultation with your doctor try switching to a different statin. If that doesn’t help, try stopping your niacin for a while. As a last-ditch effort, you could try stopping the statin altogether, and switching to Zetia or WelChol to keep your cholesterol in check. The downside of that option is that these medications haven’t yet been shown to prevent heart attacks or save lives, as statins have.
Dr. Richard Lee, associate editor, Harvard Heart Letter
