- Muscle cramps are common in patients with cirrhosis and can have a significant impact on quality of life (QoL)
- The underlying cause of muscle cramps is poorly understood. Potential risk factors include ascites, lower mean arterial pressure, and altered energy metabolism
- Identify if there are any modifiable factors that can be treated.
- If symptoms are affecting quality of life and function, a trial of pharmacological therapy is reasonable. At this time, pharmacological management recommendations are based on small trials and expert opinion
There are many non-cirrhosis and cirrhosis causes of muscle cramps.
If non-cirrhosis causes are suspected, consider specialist referral as appropriate.
Characteristics of cirrhosis related muscle cramps:
chronic, involuntary, brief, sudden, intense, worse at night.
Consider non-pharmacological management in all patients where symptoms significantly impact a patient’s quality of life and function.
Caution: Recommendations are based on small trials and expert opinion
|Medication:||Recommended Dose||Additional information|
|Branched chain amino acids||4 grams PO TID||
|Baclofen||5mg PO TID
Titrate to 10mg PO TID after a one week trial
|Taurine||3 grams PO daily||
|IV Albumin therapy||IV 100cc of 25% q weekly||
|NOTE: Quinine sulfate (200-300 mg qhs) is not routinely available or recommended. It has been associated with arrhythmias and thrombocytopenia. Tonic water, although often suggested by clinicians only has 83 mg of quinine per liter.|
This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.
Authors (Alphabetical): Amanda Brisebois, Sarah Burton-Macleod, Ingrid DeKock , Martin Labrie, Noush Mirhosseini, Mino Mitri, Kinjal Patel, Aynharan Sinnarajah, Puneeta Tandon
Thank you to pharmacists Omer Ghutmy and Meghan Mior for their help with reviewing these pages.
- Goals of care: https://www.albertahealthservices.ca/frm-103547.pdf
- Exercise Therapy: https://cirrhosiscare.ca/healthy-living-provider/exercise-therapy-hcp/
- Pain Control: https://cirrhosiscare.ca/symptom-management-provider/pain-hcp/
- Abd-Elsalam Sherief et al. United European Gastroenterology Journal 2018;6(3) 422-427.
- Abd-Elsalam Sherief et al. European Journal of Gastroenterology and Hepatology 2018; 31:499-502.
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