Treatment of muscle cramps in patients with cirrhosis of liver: A systematic review

Abstract Background Muscle cramps are witnessed in 22-88% of patients with cirrhosis of liver and frequently lead to sleep disturbance with an appalling impact on quality of life. Despite such a high prevalence, there is lack of evidence-based management protocol due to scarcity of trials on treatment options in the literature. Aim To review systematically the available therapeutic options for muscle cramps in patients with cirrhosis of liver. Methods A systematic review of the relevant databases (Pubmed, Scopus, Embase and Web of Science) to identify treatments for muscle cramps in patients with hepatic cirrhosis was performed. Studies meeting the selection criteria were reviewed and assessed for risk of bias and analysed. Results 24 publications were identified as eligible for inclusion in this systematic review. 7 RCT and 17 prospective studies were included. Taurine, methocarbamol, baclofen and orphenadrine are relatively safer and effective treatment option for muscle cramps in cirrhosis on basis of recently conducted RCTs. Moreover, L-carnitine, BCAAs, pregabalin, zinc and vitamin D are also safe and showed beneficial effects on muscle cramps. However studies on vitamin E revealed contradictory results. Conclusion Taurine, BCAAs, orphenadrine and baclofen are safe and well tolerated treatment options for muscle cramps in cirrhosis. However, well-designed randomized controlled clinical trials are the need of the hour to determine the most suitable treatment options for skeletal muscle cramps in patients with cirrhosis of liver.