Have you ever been awakened from a delightful dream by sudden, excruciating pain in your leg? In an instant, your sleep is interrupted, and you are desperate for relief.

It is not entirely clear why some people are so susceptible to such nighttime misery. One theory is that vital minerals, such as potassium, magnesium or sodium, get out of balance. Another is that muscle fatigue from exercise takes time to make itself known.

Regardless of the cause, doctors have little to offer for relief. In past decades, they were able to prescribe the herbal medicine quinine. Then the Food and Drug Administration banned its use for anything other than malaria.

The agency decided that the risks outweighed the benefits. Some people are exceptionally sensitive to quinine toxicity and may develop tinnitus, nausea, dizziness, headache, blurred vision or rash after they take it. A few develop life-threatening allergies, blood reactions or heart-rhythm changes.

The lack of approved treatments explains why home remedies are so popular for muscle cramps. One reader reported: “For many years I experienced very severe leg cramps. My physician suggested drinking tonic water. For the past year, I have drunk about 3 ounces of diet tonic water every night and have had NO leg cramps.”

It is hard to understand how the very small amount of quinine found in 3 ounces of tonic water would be effective. When doctors prescribed quinine for cramps, the usual dose was 200 to 300 mg in a pill. Tonic water contains approximately 80 mg of quinine in an entire liter, meaning that 3 ounces should have less than 10 mg of quinine.

Still, other readers also have found tonic water helpful. Here is one report: “My doctor recommended tonic water for nocturnal leg cramps. It works every time very quickly. In less than five minutes I get relief and can go back to sleep. I suffer NO pains if I drink half a glass before I go to bed.”

What works for some people, though, does not work for others. Many visitors to our website report that swallowing a teaspoon of mustard relieves muscle cramps almost like magic.

Pickle juice also has its supporters: “Every time I get a charley horse I take a few sips of pickle juice and it is gone within minutes — even the worst leg cramps that wake me up at night.”

Then there are the soap devotees. They swear that putting a bar of soap under the bottom sheet in the neighborhood of their calves staves off nighttime leg cramps.

Here’s one story: “My husband was having severe leg cramps at night. Several times he woke up screaming from the pain. When I read about soap on your website, I thought we had nothing to lose.

“My husband had already gone to sleep when I slid the bar of soap under the sheet near his legs. That night: no cramps. After a few days without cramps, I told him about the soap. He laughed but did not remove it. Since he didn’t know about it, it can’t have been a placebo action.

“I work for six doctors. When I told them about it, five of them laughed at me. I think one went out secretly and bought himself a bar of soap.”

You’ll find more details on these and other ways to quell nighttime leg cramps in our book “Quick and Handy Home Remedies” (available from www.PeoplesPharmacy.com).

Q: My grandchildren started scratching their heads several weeks ago. Upon careful examination, we discovered they had lice.

Their parents have been diligent in using lice shampoo, combing out nits and washing the bedding, to no avail. Are there any more effective strategies besides over-the-counter lice shampoos? My daughter is desperate.

A: Lice in the U.S. have developed some degree of resistance to insecticides such as permethrin and pyrethrin found in many OTC lice shampoos. Relatively new prescription treatments are effective but pricey. They include Ulesfia (benzyl alcohol), Sklice (ivermectin) and Natroba (spinosad). A treatment can run from $250 to $300.

Many visitors to our website report success with alternative approaches. Some drench the hair in old-fashioned amber Listerine for half an hour or so (wrapping the hair in a towel). The dead lice and nits are combed out.

Another option is Cetaphil Gentle Skin Cleanser. One reader shared her technique: “We put Cetaphil in dry hair, comb the excess out and then blow-dry the hair. We leave it in for at least 24 hours and then shampoo it out. We also comb to check for nits, and do a follow-up treatment seven days later to catch any bugs that hatched from eggs.”

Q: My daughter insists that bioidentical hormones are superior to horse-derived hormones, and that they are safe to use over the long term. Every doctor I’ve asked says this is not so. Apparently bioidentical hormones are made in compounding pharmacies that are not Food and Drug Administration-regulated. Dosages may be inconsistent. What do you think?

A: Bioidentical hormones have been promoted as safer than synthetic or equine-derived compounds, but this topic is extremely controversial. The FDA doesn’t always monitor the compounding pharmacies that make them.

Dr. Susan Love has suggested that taking any type of hormone for a long time is more problematic than the specific type of hormone (natural or synthetic) used.

We are sending you our Guide to Menopause, with ways to relieve hot flashes as well as a discussion of bioidentical hormones. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. W-50, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com. Your daughter also may be interested in a CD of our one-hour radio interview with Dr. Love.

Q: I was taking Toprol-XL for an irregular heartbeat. When I was switched to generic metoprolol, I thought nothing of it. Then the irregular heartbeats started again.

I had no idea why the drug wasn’t working until I read about metoprolol problems. I was able to get more brand-name Toprol-XL and now am back to normal. I never dreamed generic drugs could cause such trouble!

A: In the past several years, a number of problems have been uncovered with generic Toprol-XL formulations (metoprolol succinate). In the latest, an Indian manufacturer called Wockhardt recalled almost 110,000 bottles because of a quality problem.

The 50 mg tablets were from Lots LN-10686, 10687, 10688, 10707 and 10708, all expiring in 02/15. Pharmacies rarely put lot numbers on prescription bottles, so it may be hard to tell whether your metoprolol was included in the recall. Nevertheless, you should contact your pharmacist to ask.

“The People’s Pharmacy with Joe and Terry Graedon” airs Saturday at 7 a.m. on WVTF (89.1 FM) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7 FM). Joe and Teresa Graedon’s column runs in Tuesday’s Extra.

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