OTC treatment of leg cramps

[tompharm]

Hi, I was wondering what would be the best recommendation for someone with leg cramps OTC. The only thing I see in the pharmacy is Hyland's leg cramps which is homeopathic. In my best judgment I would probably recommend capsaicin cream or tell the patient to take an analgesic like ibuprofen or acetaminophen. However, I have also heard Vitamin B-complex can be used to prevent.

Can't find any reliable sources on the internet for this. Anyone have any input.

Also there is nothing in my opinion that can be used for muscle spasm otc right they need Rx like baclofen.

---

Members don't see this ad.

 

[SClENCE]

Potassium?

 

[BMBiology]

Go see a doctor

 

[zelman]

Tonic water

 

[Promethean]

Tonic water is supposed to work because of the trace of quinine, but it doesn't have nearly enough to have an effect.

Because leg cramps can be a signal of a much bigger problem, a new onset case shouldn't just be treated OTC without physician advice. If there is a known etiology, I recommend a hot water bottle and the oral or topical OTC pain reliever of choice. So, just as you thought.

EDIT: You are also right that there isn't any OTC muscle relaxant. Maybe a few supplements have slight efficacy. But the best muscle relaxant you will find on the customer's side of the counter is going to be a hot water bottle or a heating pad. Maybe massage oil and a sympathetic spouse.

 

[trailerpark]

I recommend avocado and a glass of milk to replenish K, Mg and Ca in the short term then tell them to stretch the muscle before bed then ask if they're on a diuretic and to make sure at their next doctor visit to get a blood test to look for a true nutritional deficiency, but then they ignore me and start popping potassium pills until they get a heart arrhythmia and I say f#ck it, leave me alone I'm busy...

 

[BidingMyTime]

You know, my personal feeling is homeopathic stuff is crap....but I have to say, the placebo effect is strong and well. People swear to me that Hylands homeopathic stuff is the only thing that helps their leg cramps. It has been an ethical dilemma for me, do I recommend something that I know is only a placebo, knowing that many people will be helped with a placebo effect? I have started telling people the truth, I haven't seen any studies showing this product works with leg cramps, but I have had several customers tell me it has helped them.

 

[Ackj]

Not sure if it's a wive's tale or what (certainly no RCT), but I've heard that folks who have a leg cramp can eat a spoonful of spicy mustard (namely Weber's) and it relieves the cramp. Haven't heard anything about taking it prophylactically, however, which is probably what most would rather have.

 

[Gombrich12]

You know, my personal feeling is homeopathic stuff is crap....but I have to say, the placebo effect is strong and well. People swear to me that Hylands homeopathic stuff is the only thing that helps their leg cramps. It has been an ethical dilemma for me, do I recommend something that I know is only a placebo, knowing that many people will be helped with a placebo effect? I have started telling people the truth, I haven't seen any studies showing this product works with leg cramps, but I have had several customers tell me it has helped them.

Same here, one day I was at my PCP and asked him what he recommended for leg cramps and he said Hylands. I said the homeopatheic stuff? He said yea, lots of his patients have a good response to it. I've had customers tell me the same.

 

[gwarm01]

Could be a situation like when "natural" workout supplements end up comtainining anabolic steroids. I feel like that has happened more than once.

 

[knight on horse]

Hyland's has cinchona which is the source of quinine

Homeopathic doesn't mean fake, just alternative and not well studied and regulated

 

[zelman]

Hyland's has cinchona which is the source of quinine

Homeopathic doesn't mean fake, just alternative and not well studied and regulated

Homeopathic means there is no chemically active ingredient. Manufacturers take the "energy" from plants and put it into water. They then sell that water. And because of lobbying back in the day, they can make health claims that herbals cannot.

However, products like Zicam combine homeopathic zinc (aka water plus energy) with actual zinc gluconate and are allowed to make claims about shortening colds that someone selling just zinc gluconate lozenges could not. It a shady loophole used by underhanded businesses.

Alternative is very different from homeopathic.

 

[Old Timer]

You need to determine the cause of the leg cramps. If it is muscular in nature the treatment is heat and rest. If not. you need to refer. It could be a DVT, it could be a superficial vein blood clot, it could be phlebitis, it could be hypokalemia or it could be hypomagnesemia. Any of those could be serious and some of them can be life threatening. It would unethical to recommend anything other than a referral to a PCP.

 

[HelpfulPharmer1]

Homeopathic doesn't mean fake, just alternative and not well studied and regulated

Politically correct, we don't call it fake. We know it is super diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted ....
to the point that real herb is nearly gone.

As seen on BBC investigation in UK:
Link is here for video with title:
"BBC Horizon - Homeopathy The Test"
:

Homeopathic means there is no chemically active ingredient. Manufacturers take the "energy" from plants and put it into water. They then sell that water.

BBC is saying the same thing.

That video was well worth 40 minutes of my life to help my patient. I explained to many patients the number 12X, 24X, 36X, which shows in the back of Homeopathic products, really mean number of dilutions, not concentrations and most of patients stopped buying it.

Please spare a moment and watch that video before it's gone.
Link is here for video with title:
"BBC Horizon - Homeopathy The Test"
:

 

[zelman]

Politically correct, we don't call it fake. We know it is super diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted diluted ....
to the point that real herb is nearly gone.

As seen on BBC investigation in UK:
Link is here for video with title:
"BBC Horizon - Homeopathy The Test"
:





BBC is saying the same thing.

That video was well worth 40 minutes of my life to help my patient. I explained to many patients the number 12X, 24X, 36X, which shows in the back of Homeopathic products, really mean number of dilutions, not concentrations and most of patients stopped buying it.

Please spare a moment and watch that video before it's gone.
Link is here for video with title:
"BBC Horizon - Homeopathy The Test"
:

I know all about it. However, none of us can prove that it doesn't work. All we know is that there is no chemically active ingredient. If I have a patient who really wants to try it, I just let them know that and let them know that the sugar pills are intended to contain the energy of a plant. Most do not buy the product, but some do. As long as they are informed, it's their choice.

I haven't read any of these studies personally, but it is my understanding that there are some studies showing positive results for homeopathy in veterinary medicine. I assume they are lousy, but it's my assumption that other animals have less of a placebo effect than humans. So, who knows? I don't want to be the guy who told Marie Curie that there was no way a rock could make you sick before radiation was discovered. But I'm happy to be the guy who might have said that there was no scientific explanation for it as of yet.

 

[trailerpark]

How can you be a pharmacist and not know the strength of the ingredients in homeopathy are dilutions.

 

[Sparda29]

Deep tissue massage.

 

[Ackj]

How can you be a pharmacist and not know the strength of the ingredients in homeopathy are dilutions.

Some of them are outright impossible, like "one atom in the entire Pacific" levels of concentrate. It's clearly fraudulent marketing. I wonder if they even bother having any of the original herbs at all during the manufacturing process, or if it's just 100% fillers and binders.

 

[Ackj]

.

 

[gwarm01]

Some of them are outright impossible, like "one atom in the entire Pacific" levels of concentrate. It's clearly fraudulent marketing. I wonder if they even bother having any of the original herbs at all during the manufacturing process, or if it's just 100% fillers and binders.

Good question. Do they actually have a factory somewhere that crushes up a few mg of some herb into a giant vat of water, takes a single mL of that water and then mixes into another giant vat of water?

 

[Vain Brother]

I know all about it. However, none of us can prove that it doesn't work. All we know is that there is no chemically active ingredient. If I have a patient who really wants to try it, I just let them know that and let them know that the sugar pills are intended to contain the energy of a plant. Most do not buy the product, but some do. As long as they are informed, it's their choice.

I haven't read any of these studies personally, but it is my understanding that there are some studies showing positive results for homeopathy in veterinary medicine. I assume they are lousy, but it's my assumption that other animals have less of a placebo effect than humans. So, who knows? I don't want to be the guy who told Marie Curie that there was no way a rock could make you sick before radiation was discovered. But I'm happy to be the guy who might have said that there was no scientific explanation for it as of yet.

you mean other than doing research? https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02a_information_paper.pdf

there's no way homeopathy can "work", because there's no medicine in the pills! any evidence suggesting otherwise is due to the placebo effect or random chance

 

[owlegrad]

Some of them are outright impossible, like "one atom in the entire Pacific" levels of concentrate. It's clearly fraudulent marketing. I wonder if they even bother having any of the original herbs at all during the manufacturing process, or if it's just 100% fillers and binders.

It actually goes below one atom in the entire Pacific. There isn't enough water on earth to describe the level of concentrate.

But let's forget about the water for a second. Let's pretend water does have a memory. You aren't buying water after all. You are buying a pill. So...does the water pass the memory onto the tablet?

 

[owlegrad]

I don't want to be the guy who told Marie Curie that there was no way a rock could make you sick before radiation was discovered.

Good point.

 

[zelman]

you mean other than doing research? https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02a_information_paper.pdf

there's no way homeopathy can "work", because there's no medicine in the pills! any evidence suggesting otherwise is due to the placebo effect or random chance

Read my radiation metaphor again.

 

[Vain Brother]

Read my radiation metaphor again.

it sounds like you're open to the idea that homeopathy might somehow be efficacious. but that's impossible, so you'll have to clarify

 

[zelman]

it sounds like you're open to the idea that homeopathy might somehow be efficacious. but that's impossible, so you'll have to clarify

The energy from the plant goes into the diluent and affects the Chi of the individual who takes it. Just because science can't explain how that might happen does not mean that it doesn't...or some other equally implausible mechanism.

 

[Vain Brother]

i see...

 

[Corpseman]

Can anyone explain this "energy"?

 

[Old Timer]

Can anyone explain this "energy"?

The active ingredient is OBECALP.

 

[zelman]

Can anyone explain this "energy"?

Not scientifically, no.

 

[Vain Brother]

it's called the placebo effect, FFS

 

[Vain Brother]

it would be one thing if we were still in the prescientific era and we had people claiming homeopathy had helped them with something. then you could actually say that maybe there is something that we don't understand going on here. present-day? the research has been done and it's no different than placebo. there's no mystery, there's no maybe, it's a placebo. end of story. any pharmacist that tells a patient anything different is a snake oil salesman

 

[Old Timer]

OBECALP = PLACEBO

 

[zelman]

it would be one thing if we were still in the prescientific era and we had people claiming homeopathy had helped them with something. then you could actually say that maybe there is something that we don't understand going on here. present-day? the research has been done and it's no different than placebo. there's no mystery, there's no maybe, it's a placebo. end of story. any pharmacist that tells a patient anything different is a snake oil salesman

Yup. Everything has been discovered. Everyone! Stop the science! Time to close up shop!

 

[Vain Brother]

here's the thing: if homeopathy were shown to work any better than placebo, then there would be sufficient reason to believe that something was going on that we don't fully understand. but it hasn't. how can we even bother giving credence to the homeopathy theory when there is no effect to speak of?

 

[zelman]

here's the thing: if homeopathy were shown to work any better than placebo, then there would be sufficient reason to believe that something was going on that we don't fully understand. but it hasn't. how can we even bother giving credence to the homeopathy theory when there is no effect to speak of?

So the studies here that had positive results are all because of random chance? Probably. But neither you nor I can prove that.

As I said above, I recommend pharmaceuticals to my patients (when appropriate) and if they ask about homeopathic products, I explain that the "energy of a plant was allegedly put into water to make this, but it has no chemically active components, so I recommend not using it" and most go with my recommendation.

 

[Corpseman]

So the studies here that had positive results are all because of random chance? Probably. But neither you nor I can prove that.

As I said above, I recommend pharmaceuticals to my patients (when appropriate) and if they ask about homeopathic products, I explain that the "energy of a plant was allegedly put into water to make this, but it has no chemically active components, so I recommend not using it" and most go with my recommendation.

"The review found no convincing evidence for the effectiveness of any therapeutic or preventive homeopathic interventions for the treatment of childhood and adolescent ailments."

How do you remove the "energy" of a plant?

 

[zelman]

"The review found no convincing evidence for the effectiveness of any therapeutic or preventive homeopathic interventions for the treatment of childhood and adolescent ailments."

How do you remove the "energy" of a plant?

How do you know plants have "energy" in the first place?

 

[knight on horse]

Cinchona is quinine

I know all about it. However, none of us can prove that it doesn't work. All we know is that there is no chemically active ingredient. If I have a patient who really wants to try it, I just let them know that and let them know that the sugar pills are intended to contain the energy of a plant. Most do not buy the product, but some do. As long as they are informed, it's their choice.

I haven't read any of these studies personally, but it is my understanding that there are some studies showing positive results for homeopathy in veterinary medicine. I assume they are lousy, but it's my assumption that other animals have less of a placebo effect than humans. So, who knows? I don't want to be the guy who told Marie Curie that there was no way a rock could make you sick before radiation was discovered. But I'm happy to be the guy who might have said that there was no scientific explanation for it as of yet.

 

[zelman]

Cinchona is quinine

I know. What's your point? There is no cinchona in this product.

Hyland’s Leg Cramps contains the homeopathic medicine Cinchona Officinalis HPUS, which is made from the bark of the Cinchona tree, commonly called “Quinine Bark”. This bark is the source ingredient for quinine as well as the source of the ingredient in our homeopathic medicine. Homeopathically prepared Cinchona Officinalis is a safe and extremely effective ingredient to relieve leg cramp pain.

Non-homeopathic quinine, quinine sulfate or any salts of quinine are not found in ANY Hyland’s product. The Food & Drug Administration does not permit allopathic quinine in any OTC medicines, and limits its use in prescription medications as well.

Hyland’s Leg Cramps is a safe product because the active ingredients are present in microdoses. By contrast, a 6 ounce serving of tonic water has up to 4000 times the amount of quinine found in one HYLAND’S Leg Cramps caplet.

 

[knight on horse]

I know. What's your point? There is no cinchona in this product.

Actually there is. You need to read carefully, like a lawyer

 

[zelman]

Actually there is. You need to read carefully, like a lawyer

Cinchona bark is approximately 5% quinine.

Hyland's Leg Cramps treatment has Cinchona Officinalis 3X.

So, if there was 1 mL of diluted preparation used to make each dose, we'd see...

1 mL * 5 g/100 mL * 1/10^3 * 1000 mg/1 g = 0.05 mg = 50 mcg of quinine in the product.

However, per the manufacturer, a 6 ounce serving of tonic water has up to 4000 times the amount of quinine found in one HYLAND’S Leg Cramps caplet.

And there's a federal standard for the use of quinine in carbonated beverages, specifically that it cannot exceed 83 parts per million in the final tonic water (that ends up being 2.48 mg of commercial quinine per ounce of tonic water).

6 oz = 6 * 2.48 mg = 14.88 mg

1/4000 * 14.88 mg = 0.00372 mg = 3.72 mcg

That means there was only 0.0744 mL used in the first place.

So, yes. A lawyer could say there is quinine in the product. But 3.72 mcg of quinine has the same therapeutic effect as zero quinine.

 

[trailerpark]

So does it work?

 

[zelman]

So does it work?

Unlikely.

 

[BidingMyTime]

So does it work?

People swear to me it does, but I have my doubts that this is anything more than a placebo effect. The people who buy it once and find it doesn't work, aren't going to talk about it.

 

[knight on horse]

Cinchona bark is approximately 5% quinine.

Hyland's Leg Cramps treatment has Cinchona Officinalis 3X.

So, if there was 1 mL of diluted preparation used to make each dose, we'd see...

1 mL * 5 g/100 mL * 1/10^3 * 1000 mg/1 g = 0.05 mg = 50 mcg of quinine in the product.

However, per the manufacturer, a 6 ounce serving of tonic water has up to 4000 times the amount of quinine found in one HYLAND’S Leg Cramps caplet.

And there's a federal standard for the use of quinine in carbonated beverages, specifically that it cannot exceed 83 parts per million in the final tonic water (that ends up being 2.48 mg of commercial quinine per ounce of tonic water).

6 oz = 6 * 2.48 mg = 14.88 mg

1/4000 * 14.88 mg = 0.00372 mg = 3.72 mcg

That means there was only 0.0744 mL used in the first place.

So, yes. A lawyer could say there is quinine in the product. But 3.72 mcg of quinine has the same therapeutic effect as zero quinine.

Hmm interesting
That does seem unlikely.
To be sure of we'd have to investigate the kinetics, and the possibility of other therapeutically active compounds in the formulation

However, I find it more interesting to show work on the 83 parts per million than on the trivial conversions. 1 fluid oz = 29.5735 g, (29.5735/1000000) x 83 = 0.00245 or 2.45 mg, less than the stated 2.48. Though even estimating 83 parts per million is trivial with a little thought

 

[zelman]

However, I find it more interesting to show work on the 83 parts per million than on the trivial conversions. 1 fluid oz = 29.5735 g, (29.5735/1000000) x 83 = 0.00245 or 2.45 mg, less than the stated 2.48. Though even estimating 83 parts per million is trivial with a little thought

It all depends on if you're using the imperial fluid ounce, US fluid ounce or the fluid ounce defined by US regulation 21 CFR 101.9(b)(5)(viii) and the number of significant figures you opt to use from the first two. The clinical significance remains the same, regardless.

 

[piccolochimico]

You need to determine the cause of the leg cramps. If it is muscular in nature the treatment is heat and rest. If not. you need to refer. It could be a DVT, it could be a superficial vein blood clot, it could be phlebitis, it could be hypokalemia or it could be hypomagnesemia. Any of those could be serious and some of them can be life threatening. It would unethical to recommend anything other than a referral to a PCP.

Probably the best answer

How old is this guy?
extensively workout?
are the legs hot, red?
most of time, the easiest answer is likely the right one.
magnesium + potassium supplements

 

[RxPreceptor]

Is it just me or do patients seem to believe that OTC Mg2+ fits the description of a Skeletal Muscle Relaxant? I personally blame all these modern day internet Hippies for their blatant disregard of facts, level of evidence, scientific data, misinterpretations (especially on topicals vs. systemics), & labeling everything that isn't "natural" as "toxic". The internet's greatest source of misinformation