Quinine for leg cramps has a boxed warning in the U.S. due to potential for serious side effects like arrhythmias and thrombocytopenia.  In studies, it has been shown to be ineffective for leg cramps in addition to the risks of adverse effects.  I do see it used from time to time.  I’d focus on trying to identify if the cramps are due to another identifiable cause like an electrolyte imbalance (potassium, magnesium etc.), which we can check labs for (patient is on furosemide).  If the pain is more muscle soreness versus cramping, certainly the statin should be ruled out, and I might be inclined to see if a trial of scheduled Tylenol if having pain at night would work.  Seeing the alprazolam at night makes me think the patient has trouble sleeping – another reason to rule out the pain issue, but certainly we need to assess this with the patient.  – Plenty of other things to consider here…feel free if you have something to add!

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