Treatment Possibilities of Muscle Cramps in Patients with Liver Cirrhosis

Muscle cramps appearing in liver cirrhosis substantially affect the quality of life of these patients. The prevalence of painful muscle cramps can be up to 88%. The exact mechanism by which these muscle cramps occur is unknown. The management of this symptom is not easy because there is no uniformly accepted recommendation about what kind of supplementation or medicine (or both) can be used exactly. The aim of our study is to review the treatment options for muscle cramps in liver cirrhosis.

We found in the literature (using the keywords „liver cirrhosis", „muscle cramps", „treatment" and „quality of life") 32 articles of this topic. Treatment options currently are: vitamin supplementations (vitamin E, 1 - α hydroxy vitamin D), amino acid supplementations (taurine, branched - chain amino acids, L - carnitine, albumin), mixed herbal medicines (Niuche-Shen-Qui-Wan), zinc and medications (eperisone hydrochloride, quinine and quinidine sulphate, baclofen, methocarbamol, orphenadrine). Vitamin supplementations and amino acid supplementations are targeting the possible pathophysiological causes of muscle cramps (nerve function or energy metabolism alterations which are unique to liver cirrhosis). New aspects started to use medications especially antispasmodic agents (methocarbamol, orphenadrine) and antispasticity agents (baclofen) to relieve muscle cramps. We also found a multicenter study and two systematic reviews (performed in 2013 and 2014). From 2014 there is no systematic article appeared in this topic and we considered it important to survey the new treatment options next to the treatment options already known.