Cirrhosis-related muscle cramps alleviated by taurine supplementation

Taurine supplements are an effective and well‐tolerated treatment for muscle cramps in patients with cirrhosis, a small Australian trial has shown.

Patients with chronic liver disease had alleviation of the frequency, duration and intensity of painful muscle cramps when they took high dose supplements of the amino acid, a randomised controlled trial conducted at the liver clinical at Sydney’s Royal Prince Alfred Hospital found.

In the study, 49 patients recruited from the liver clinic who experienced three or more muscle cramps per week were randomised to receive either oral taurine supplementation (1 or 2g/day) or placebo for four weeks then crossed to the alternative arm.

The chronic liver conditions associated with cramps included viral hepatitis, nonalcoholic fatty liver disease (NAFLD), cholestatic disease and alcoholic liver disease. At baseline, most of the patients were troubled by muscle cramps on a daily basis, often nocturnally, and most commonly affecting the calves, feet and toes, hands and fingers, and thighs.

Published in Alimentary Pharmacology and Therapeutics, the results showed that after four weeks of treatment, participants receiving 2 g taurine/day experienced a significant reduction in cramp frequency of seven fewer cramps per week (13.2 to 4.2, p = 0.03 vs 9.6 with placebo).

Cramp duration was reduced from 86.5 to 21.1 minutes per week (vs 120.4 minutes with placebo, p = 0.03), and cramp severity was reduced by 1.4 units less on a Likert scale (p < 0.004) compared to placebo. No reduction in muscle cramps was seen with the lower dose (1g/day) of taurine.

The researchers noted that many of the patients with cirrhosis had already been self treating their muscle cramps with over the counter remedies including magnesium supplements, tonic water and sports drinks. There were no adverse events associated with taurine supplementation during the trial.

In their discussion, the researchers said that muscle cramps were experienced by up to 88% of people with chronic liver disease, and the discomfort caused loss of sleep and restrictions on daily activities. Little was know about the mechanism linking cirrhosis with muscle cramps but it did not appear to be due to electrolyte disturbances.

Current treatments included magnesium supplements, for which there was little evidence of efficacy, and also baclofen and orphenadrine.

The researchers said the results from the trial suggested that taurine might be an effective alternative to another amino acid, carnitine, which was widely for muscle cramps despite side effects including nausea, vomiting, diarrhoea, cramps, muscle weakness, and an abnormal body odour.

“Taurine should be considered as a safe and effective intervention in the management of muscle cramps in individuals with chronic liver disease,” they concluded.

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