Muscle cramps in liver cirrhosis: Pathophysiology, burden, and emerging therapeutic approaches

Table 2 Summary of therapeutic studies for muscle cramps in liver cirrhosis

Therapy	Study design	Sample size (n)	Duration	Key outcomes	Major limitations	Strength of evidence
Taurine	Randomized crossover + open-label studies	9-30	4-8 weeks	↓Cramp frequency, severity, and duration	Small samples; subjective outcomes; short follow-up	Moderate
L-carnitine	Prospective observational study	42	8 weeks	↓Cramp frequency; ↓VAS scores	Non-randomized; placebo effect possible	Low
BCAA	Randomized trial (timing regimens)	37	3 months	↓Cramp frequency; ↑QoL	No placebo control; nutritional confounding	Low-Moderate
Baclofen	Randomized open-label placebo-controlled	100	3 months	↓Frequency, severity, duration	Open-label; sedation risk	Moderate
Methocarbamol	Randomized controlled trial	100	1 month	Marked ↓cramps and pain scores	Short duration; limited replication	Moderate
Albumin (intravenous)	Randomized crossover	12	4 weeks	↓Cramp frequency during treatment	Very small sample; intravenous burden	Low
Zinc	Uncontrolled pilot study	12	12 weeks	Symptom improvement in majority	No control group; selection bias	Very low
Vitamin E	Case series + RCT crossover	9-23	4 weeks	Conflicting results	Underpowered; inconsistent design	Very low
Quinine/quinidine	RCT	31	4 weeks	↓Cramp frequency	Serious adverse effects	Low

BCAA: Branched-chain amino acids; RCT: Randomized controlled trial; VAS: Visual Analogue Scale; QoL: Quality of life.