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Open Access Publications from the University of California

Mexiletine for muscle cramps in amyotrophic lateral sclerosis: A randomized, double-blind crossover trial

  • Author(s): Oskarsson, Björn
  • Moore, Dan
  • Mozaffar, Tahseen
  • Ravits, John
  • Wiedau-Pazos, Martina
  • Parziale, Nicholas
  • Joyce, Nanette C
  • Mandeville, Ross
  • Goyal, Namita
  • Cudkowicz, Merit E
  • Weiss, Michael
  • Miller, Robert G
  • McDonald, Craig M
  • et al.

Published Web Location


More than 90% of amyotrophic lateral sclerosis (ALS) patients have muscle cramps, but evidence-based treatments have not been available.


A multicenter, double-blind, placebo-controlled crossover trial of mexiletine 150 mg twice daily was conducted in ALS patients requesting treatment of symptomatic muscle cramps.


Muscle cramp frequency was reduced in 18 of 20 patients; 13 reductions were attributed to treatment (P < 0.05). The average reduction, based on t tests, was 1.8 cramps per day (a reduction from 5.3 with placebo to 3.5 with mexiletine). The estimated reduction of cramp severity was 15 units on a 100-unit scale (P = 0.01) from a baseline average of 46. No effect on fasciculations was noted. One patient discontinued the study because of dizziness, and another patient discontinued the study to start open-label mexiletine therapy. No serious adverse event occurred.


Mexiletine is a well tolerated and effective medication for controlling the symptom of muscle cramps in ALS. 

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