How Much Tonic Water Must You Drink to Ease Leg Cramps? - The People's Pharmacy Loading... How Much Tonic Water Must You Drink to Ease Leg Cramps? People with leg cramps sometimes suffer excruciating pain, but what can be done to alleviate it? For some, home remedies like tonic water may be the answer Joe Graedon The People's Pharmacy January 23, 2014 Cramps (hands, legs) 115 Comments Q. For years I have suffered with leg cramps, debilitating, put-you-on-the-floor leg cramps. I used to be able to buy a leg cramp medicine in pill form from the pharmacy. The medicine was a complete success. On a trip to Walgreens I purchased another bottle of the leg cramp medicine. After taking it for a few days, I noticed I was getting those leg cramps again. I went back to the pharmacy and told the pharmacist the pills were worthless. His answer was, ‘that’s because the FDA made them take the quinine out of it.’ They still sell leg cramp medicine, but it does not work at all. I just love it when some government agency decides what’s best for me.

If you watch virtually any commercials on TV about virtually any drug, you will hear the magic words that XYZ med is not meant for everybody. You can bet your life that one of the side effects is death, in rare instances of course. The thing is that the FDA has approved all these dangerous drugs that are advertised, but we can no longer get quinine. I have read that mustard will take care of the problem of leg cramps. It’s probably the salt in the mustard that does the job. It takes about 4 pain-filled minutes to work. Pour a little salt in the palm of your hand, lick it off and chase it with a little water. It works. With so many new drugs coming on the market, how much money did that drug manufacturer have to pay to get it approved? I guess there wasn’t enough money in quinine. By the way, if you’re thinking of getting your quinine by drinking tonic water, you would have to drink two litres a day. This will probably not be posted, we don’t want to upset the FDA. It might give them cramps. A. The FDA banned quinine because it does occasionally cause serious adverse reactions in susceptible people. Such individuals can develop a deadly blood disorder.

As little as one 5-ounce glass of tonic water can be disastrous for these vulnerable people, though we hope that the FDA never bans tonic water. Other quinine side effects may include nausea, stomach cramps, ringing in the ears, headache, anxiety, blurry or double vision, irregular heart rhythms, skin rash and fever. We do understand your point. The FDA allows many dangerous drugs on the market. Watching drug commercials on television is a scary proposition, especially when the announcer says things like: “Call your doctor if you have high fever, stiff muscles and confusion to address a possible life-threatening condition or if you have uncontrollable muscle movements, as these can become permanent. High blood sugar has been reported with Abilify and medicines like it and in extreme cases can lead to coma or death.” So how much tonic water would you have to drink to get a pharmacological dose of quinine? The doctor-prescribed dose to prevent leg cramps has been between 200 and 300 mg. A liter of tonic contains around 83 mg of quinine. That means one eight-ounce glass has about 20 mg.

You would have to drink about 10 glasses to get the dose of quinine that doctors used to prescribe to prevent leg cramps. That’s not practical. What else can you do to prevent those excruciating leg cramps? Visitors to this website and readers of our newspaper column sing the praises of soap as a preventive. They also like magnesium or potassium, pickle juice, V-8 Juice, turmeric, yellow mustard and apple cider vinegar. Salt may work, but many people are on low-salt diets, which is why pickle juice is probably out for such folks. To learn more about how to use any of these these alternate approaches you may find our book, The People’s Pharmacy Quick & Handy Home Remedies, of great value. You will also find a list of our favorite foods for good health. Remember, Mother Nature’s medicine can frequently be found in your kitchen cabinet! For more information about these and thousands of other remedies, check out our publications . You may also find “ Bed Soap ” or “ Leg Soap ” worth considering. Share your own leg cramp remedy below. Advertisement Cancel Reply We invite you to share your thoughts with others, but remember that our comment section is a public forum.

Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions . Comments that do not follow these policies will not be posted. Name List of Foods That Contain Quinine | LIVESTRONG.COM List of Foods That Contain Quinine by SHARON PERKINS Last Updated: Apr 23, 2015 Sharon Perkins A registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology, Sharon Perkins has also coauthored and edited numerous health books for the Wiley "Dummies" series. Perkins also has extensive experience working in home health with medically fragile pediatric patients. A glass of tonic water with lemon slivers on a bar.

Photo Credit Jupiterimages/Photos.com/Getty Images Overview Quinine, a bitter tasting powder made from the bark of the cinchona tree, is known mainly for its use in malaria treatment. Quinine has been used to treat nocturnal leg cramps, but the Food and Drug Administration states that the potential side effects outweigh any potential benefits of prescription quinine for this purpose. Side effects of quinine include a decrease in platelets, which is a condition called thrombocytopenia that can cause serious bleeding and kidney disease. Several drinks also contain small quantities of quinine. Tonic Water Tonic water, a bitter liquid sometimes used as a mix for alcoholic drinks, contains only a small amount of quinine compared to quinine medications. The FDA reports that prescription quinine sulfate capsules contain 324mg compared to 20mg of quinine in a 6 oz. glass of tonic water. While this amount is small, one pregnant woman who drank more than a liter of tonic water every day while pregnant delivered a child with tremors. The infant had quinine in his urine. People with an irregular heartbeat, ringing in the ears or damage to the optic nerve should not drink tonic water before discussing this with their physician.

Quinine can worsen all these effects. People with bleeding disorders or those taking blood thinners should also avoid tonic water unless allowed by their physician. Bitter Lemon and Lime Several companies produce bitter lemon or lime drinks, which contain tonic water and lemon or lime flavoring. Because bitter lemon and lime products contain tonic water, the same restrictions that apply to plain tonic water apply to bitter lemon and lime. Considerations Quinine has a number of potentially life-threatening side effects. Even though tonic water and flavored drinks containing tonic water contain only a fraction of the quinine found in prescription medications, they can cause problems. People who drink large quantities of tonic water or who have health problems that could be potentiated by quinine should be aware of possible side effects, including visual disturbances. Quinine can also cause hypoglycemia, confusion, rash, seizures, nausea, hearing disturbances, vision changes, chest pain or bleeding. Related Searches Lose Weight.

Feel Great Change your life with MyPlate by LIVESTRONG.COM GOAL Gain 2 pounds per week Gain 1.5 pounds per week Gain 1 pound per week Gain 0.5 pound per week Maintain my current weight Lose 0.5 pound per week Lose 1 pound per week Lose 1.5 pounds per week Lose 2 pounds per week GENDER Should people with nocturnal leg cramps drink tonic water and bitter lemon? - PubMed - NCBI Should people with nocturnal leg cramps drink tonic water and bitter lemon? 1Babies and Children's Hospital of New York, College of Physicians and Surgeons of Columbia University, USA. jrb71@columbia.edu Abstract A literature search from 1993 to 1997 using MEDLINE and key-words beverages, muscle cramp, and quinine was performed. Three beverages containing quinine were examined in grocery stores. Analysis indicate that leg cramps are a common phenomenon associated with many comorbid disorders especially peripheral vascular and neurologic disorders. Thus, evaluation of a patient's complaining of leg cramps appropriately includes vascular, neurologic, and musculoskeletal examinations.

Laboratory investigation of the symptom of leg cramps warrants as a minimum, assessment of thyroid function and determination of platelet counts and serum levels of electrolytes, calcium, and magnesium. A few small studies suggest that quinine is effective in decreasing the frequency of nocturnal leg cramps but not their severity or duration. Quinine consumed in commercial beverages has been reported to cause potentially fatal immunologically mediated hypersensitivity reactions. The concentration of quinine in commercial beverages varies greatly. Although commercial beverages containing quinine generally are labeled "Contains quinine," they typically lack both nutritional information about the amount of quinine and warnings of the health risks. It appears that 325 milligrams of quinine taken by mouth at bedtime typically relieves nocturnal leg cramps, but lower starting doses are appropriate for senior citizens and individuals with impaired renal function. In general, quinine in any form should be avoided by pregnant women and people with hepatic failure. Quinine consumed for the treatment of leg cramps should be prescribed and monitored by physicians, and people who consume quinine in commercial beverages must be warned of the health risks. PMID: Is Quinine in Tonic Water Safe? - The People's Pharmacy Loading... Is Quinine in Tonic Water Safe?

The pros and cons of quinine make tonic water a challenging choice for many people in their fight against leg cramps. What else works for muscle cramps? Terry Graedon The People's Pharmacy October 11, 2010 Alternative Health 200 Comments Quinine is bitter. It gives tonic water a distinctive flavor. Not that long ago you could buy quinine pills over the counter in most pharmacies under brand names like Legatrin, Quinamm and Q-vel. But the Food and Drug Administration banned the use of OTC quinine to treat leg cramps in 1994. Although this drug has been available for centuries, the FDA has determined that it is far too dangerous to use for anything but malaria. See this link for more information on the ban. Quinine Dangers The trouble is that some people are extremely sensitive to quinine’s toxic effects. This drug can cause headache, rash, ringing in the ears, nausea, dizziness and blurred vision. The most serious reactions are rare but can be life threatening. Blood disorders can lead to hemorrhaging. Dozens of hospitalizations and two deaths are linked to the drug.

The FDA ordered drug companies to stop selling quinine for anything but malaria in 2007. Only one product was allowed. Qualaquin can be prescribed by physicians but the cost is high. One pill of Qualaquin could cost over $6. That could make sense for a drug to treat malaria, which is rare in the US. Muscle cramps are anything but rare. Any physician who prescribes Qualaquin for leg cramps could risk the wrath of the FDA. On July 8, 2010, the agency issued the following warning. “The U.S. Food and Drug Administration today warned that the unapproved use of the malaria drug Qualaquin (quinine sulfate) to treat night time leg cramps has resulted in serious side effects and prompted the manufacturer to develop a risk management plan aimed at educating health care professionals and patients about the potential risks. “Qualaquin is not FDA-approved to treat or prevent night time leg cramps. “A review of reports submitted to the FDA’s Adverse Event Reporting System (AERS) between April 2005 and Oct. 1, 2008, found 38 U.S.

cases of serious side effects associated with the use of quinine, the active drug in Qualaquin. “Quinine use resulted in serious and life-threatening reactions in 24 cases, including low level of platelets in the blood (thrombocytopenia), and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura, a blood disorder that results in clots in small blood vessels around the body that can be accompanied by kidney impairment. “In some patients, these side effects resulted in permanent kidney impairment and hospitalization. Two patients died. Most of those reporting serious side effects took the drug to prevent or treat leg cramps or restless leg syndrome.” What about Tonic Water? Clearly, quinine can be dangerous for certain people, but the FDA has not banned quinine from tonic water. To do so would make the FDA a laughing stock. It would also aggravate millions of people who like gin and tonic…or just plain tonic. It is an acquired taste, but some people really like it. It’s also possible that the FDA doesn’t consider tonic water a danger to public health. Because of this loophole, many people have discovered that drinking tonic water can help prevent muscle cramps.

One reader related her experience: “I suffered with nightly leg cramps until one magic day on the Greek island Santorini. I had gone on tour as a guest singer of the New York Choral Society. One free afternoon, a group of us went to a black sand beach where I swam. The only other member of the group who also swam was a New York trauma surgeon. I developed a cramp and was trying to walk it out when he told me about Schweppes tonic, which contains a very small amount of quinine. “I couldn’t find any tonic on Santorini or in Athens, but as soon as I returned home I started drinking a large glass (diet, with cranberry) every night. It has worked for me for several years, but I definitely know if I skip a dose! “I asked a pharmacist friend to search the literature to see if anything else contains a small amount of quinine. She couldn’t find anything and told me the dangers of using high-dose quinine. I have checked with my doctors and have heard nothing against my practice of drinking Schweppes.” Tonic contains 83 mg. of quinine in a liter.

An eight-ounce glass of tonic would only have about 20 mg of quinine, considerably less than the dose that used to be prescribed by doctors for leg cramps (200 to 300 mg). Tonic Water Works for Muscle Cramps Despite the low dose, however, many readers maintain that it works: “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.” Carmel in New York reports: “I had horrible cramps in my legs. I have been drinking several glasses of tonic water for the past 3 or 4 weeks and surprisingly the cramping has subsided. At least now I can sleep the night. It’s not too bad tasting with lime.” Mariza in Los Angeles shares this experience: “I too used to have such intense legs cramps leaving me writhing in pain. They could occur daily, day or night. I couldn’t even flex my leg muscles.

I learned to deal with it by drinking a glass of tonic water, but only after the pain had already started.” Even Tonic Water Has Some Hazards Some people find even the small amount of quinine in tonic water can pose problems. These folks may experience ringing in the ears, rash, itching or blurred vision and should steer clear of tonic water altogether. There are those who are so sensitive that even a little bit of quinine could prove life threatening. “Quinine in tonic water proved almost fatal for me. Nighttime leg cramps have been an ongoing problem, so I bought a bottle of tonic water. “On Saturday I had a 5-ounce glass before supper. Sunday morning by 9 am I was in the emergency room with a frightening skin reaction. I was hospitalized for many days and diagnosed with a dangerous blood disorder called idiopathic thrombocytopenic purpura (ITP). My hematologist said it was triggered by the quinine water.” We have also heard from people who developed tinnitus after drinking tonic: “I have just developed a hissing sound in my ears. The onset was very rapid! The doctor diagnosed it as tinnitus, but would give me no reason for the problem.

He said there wasn’t anything I could do. I’ve noticed some days it is less disturbing than others but some nights it awakens me because it has become so loud. “I was drinking large quantities of tonic water, which contains quinine, when this started. Do you have any suggestions to help me?” The quinine in tonic is the likely culprit. Ringing or hissing in the ears can be a complication of quinine. Tonic water should be discontinued completely. What Else Can You Do for Leg Cramps? For people who cannot tolerate or stand the taste of tonic water, there are alternatives. The FDA has approved no medications for easing leg cramps. That means most doctors have very little to offer patients in pain. Judy in Issaquah, Washington did get some intriguing advice from her doctor: “I was prescribed quinine tablets 5 years ago for my leg cramps. I had to get them from a Canadian pharmacy and they worked wonders. However, one should not take this drug forever and my doctor didn’t want to renew the prescription. “When I ran out of pills, I immediately starting having leg cramps again. Some nights I would have as many as 10. Horrible, horrible.

“Then another doctor suggested putting Irish Spring hand soap under my bottom sheet. It works wonders. The only problem is that after about 5 days, I might get a tiny little cramp and I know it is time to shave the soap bar. I prefer this to taking more pills like the quinine or magnesium (which did not ever work for me).” We were fascinated to read that a physician would recommend soap under the bottom sheet to prevent leg cramps. Most health professionals scoff at this home remedy. We have received numerous comments that this must be a placebo effect. That’s because these people have not considered a possible mechanism. We recently explained how soap could work to prevent leg cramps in this article . How to Stop Hand Cramps with a Bar of Soap Other Ways to Overcome Leg Cramps: Thanks to a Nobel prize winner (Rod MacKinnon, MD) and his neurobiologist colleague Bruce Bean, PhD, we now have an explanation for how things like a spoonful of mustard make muscle cramps go away within a couple of minutes. How Does A Teaspoon of Mustard Cure Muscle Cramps? It all has to do with stimulating sensory nerves in the mouth, throat and stomach.

That probably explains why mustard, quinine and pickle juice are so effective at relieving muscle cramps promptly. If you would like to learn a lot more about how to get relief from nocturnal leg cramps, our Guide to Leg Pain has instructions on stretching as well as a range of remedies. You will also find lots of suggestions in our 264-page book from National Geographic, The People’s Pharmacy Quick & Handy Home Remedies: Q&As for Your Common Ailments . Share your own solutions to leg cramps and your experience with tonic water in the comment section below. Revised: January 5, 2017 Cancel Reply We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions .

Comments that do not follow these policies will not be posted. Name Treating leg cramps with tonic water with quinine can be fatal - Houston Chronicle Treating leg cramps with tonic water with quinine can be fatal By Joe Graedon, M.S., and Teresa Graedon, Ph.D. Published 10:18 am, Friday, July 5, 2013 Q: I have been suffering with leg cramps for years and years. Recently, my doctor told me about tonic water with quinine. It does help the leg cramps, but it is making me feel ill. My symptoms include fatigue, nausea and vomiting. I have been very tired and want to sleep all the time, which isn't like me. I am desperate to try something that works without side effects. A: Please seek immediate medical attention. You may be suffering from quinine toxicity. Symptoms include abdominal pain, nausea, vomiting, rash, flushing, fever and fatigue. Quinine comes from the bark of the cinchona tree. This bitter compound was used for centuries by the native people of Peru and Bolivia to fight fevers.

Jesuit missionaries brought it back to Europe in the 17th century as an anti-malarial drug. Quinine was available in the U.S. in over-the-counter and prescription products that were used for treating leg cramps. In 1994, the Food and Drug Administration banned OTC sale of quinine, and in 2007 restricted prescription quinine exclusively to the treatment of malaria. The agency took this action because some people have life-threatening responses to quinine. Q: You have written about a drugstore product to stop bleeding. Instead of WoundSeal, we use finely ground black pepper on bleeding cuts. My old friends tell me that is what they used in World War II. It is cheap and handy, and we have used it to great effect. A: Don't forget first aid: Apply direct pressure on the cut for several minutes. After that, black pepper makes a great home remedy. For those who don't respond to black pepper on a cut, WoundSeal is a good choice. Some blood-thinning medicines (including aspirin) or supplements may make it harder to stop bleeding. Even people on such pills can benefit from WoundSeal.

Q: I have started drinking hibiscus tea. The last time I went to the doctor, my blood pressure was 10 points lower. I hate taking pills and was pleased when my doctor said, "Whatever you're doing, keep it up!" A: Tea made from the beautiful red flowers of Hibiscus sabdariffa is valued all around the world. In the Caribbean, it is called sorrel, and in Mexico, it is agua de Jamaica. A recent review notes that daily consumption of hibiscus-flower tea lowers blood pressure about as well as the medication captopril (Fitoterapia, March 2013). That may be because red compounds in this tea inhibit an enzyme (ACE) in a similar manner to many popular antihypertensive medicines (Journal of Ethnopharmacology, Jan. 8, 2010). Q: I have two friends who have developed severe red-meat allergies, one of whom was told by his doctor that it was likely tick-bite-related. What can you tell us about this?

A: The condition your friends have developed is called "alpha-gal allergy." It is triggered by a reaction to a tick bite (Current Opinion in Allergy and Clinical Immunology online, June 5, 2013). Eating beef, pork, lamb, rabbit, venison or buffalo meat can result in a delayed anaphylactic response (three to six hours later). Read more about this mysterious but potentially life-threatening allergy on our website, . Children are increasingly susceptible and may be hard to diagnose. Latest from the Chron.com Homepage Click below for the top news from around the Houston area and beyond. Sign up for our newsletters to be the first to learn about breaking news and more. Go to 'Sign In' and 'Manage Profile' at the top of the page. There's Quinine In Your Tonic, But What The Heck Is It, Anyway? | The Huffington Post There's Quinine In Your Tonic, But What The Heck Is It, Anyway? 10/15/2014 10:03 am ET | Updated Oct 15, 2014 Julie R.

Thomson Food writer We've ingested many hard-to-pronounce ingredients in our lives, and quinine is definitely one of them. Pronounced kwahy-nahyn, this bitter alkaloid isn't one of those suspicious, scary ingredients lurking in your favorite gummy candies -- actually, we have quinine to thank for our favorite cocktail, the gin and tonic (among other things). Quinine was originally used as a malaria treatment during the days of colonial India. Naturally found in the bark of the cinchona tree found in the Peruvian Andes, one legend of its discovery claims that a South American Indian suffering from malaria took a drink from a pool of water contaminated with cinchona tree and it cured his fever. Regardless of exactly how it was discovered, the first documentation of its use as malaria is recorded in 1630 in Peru. It continued to be used for its antimalarial properties until the 1920s , when other drugs with fewer side effects took its place, like chloroquine. That's almost 300 years of use. And somewhere along the way, quinine found its way into our cocktails.

We spoke to Jordan Silbert -- founder of the fancy soda and tonic company, Q Drinks -- and here's how he recounts quinine's transition from treatment to cocktail: In 1825 clever -- or drunk, depending on how you look at it -- British officers in the Indian Army improved this bitter medicine by mixing it with soda water, sugar, and gin. Instead of drinking the medicine with their troops at dawn, the officers figured out how to enjoy it at cocktail hour. The original gin and tonic was born, and it soon became the quintessential drink of the British Empire. Today, quinine is rarely used for medicinal purposes. The FDA recently banned its use as a cure for leg cramps due to the negative side effects that can result from ingesting large amounts, such as headaches and fever. Some bad reactions to quinine have even been fatal. Scary, we know. But don't let that deter you from ordering a gin and tonic next time you're at the bar, because tonic water contains very low levels of quinine. A glass of tonic water holds roughly 20 mg of quinine, whereas a dose for the treatment of leg cramps would be in the 200 to 300 mg range.

What you should do instead is find a bar near you that has a black light and order yourself a tonic cocktail to revel in its beautiful, iridescent blue glow thanks to its fluorescence quantum yield. (You'll have to look that one up .) That's right folks, not only does quinine treat malaria, but it knows how to party, too. Want to read more from HuffPost Taste? Follow us on Twitter , Facebook , Pinterest and Tumblr . Related on HuffPost: Quinine Uses, Benefits & Dosage - Drugs.com Herbal Database Quinine can cause cinchonism, hypoglycemia, serious hematologic disorders, urticaria, contact dermatitis, and other hypersensitivity reactions. Toxicology Quinine is rapidly absorbed from the GI tract and toxicity is dose related. Treatment of an overdose is generally supportive. Botany The cinchonas are evergreen shrubs and trees that grow to heights of 15 to 31 m. 10 They are native to the mountainous areas of tropical Central and South America, including regions of Bolivia, Costa Rica, and Peru. The oblong seed capsule is about 3 cm long and, when ripe, splits open at the base.

Each capsule contains 40 to 50 slender seeds that are so light that approximately 75,000 seeds equal 30 g. 11 In addition, these trees are found in cultivation in Africa and Southeast Asia. 10 , 12 At least one other genus ( Remijia ) of the same family has been reported to contain quinidine. 13 History The dried ground bark of the cinchona plant has been used for centuries for the treatment of malaria, fever, indigestion, mouth and throat diseases, and cancer. 10 , 11 , 12 The name cinchona is said to be derived from the Countess of Chinchon, the wife of a viceroy of Peru, who it was long believed was cured in 1638 from a fever by the use of the bark; 13 however, the story has been widely disputed. Formal use of the bark to treat malaria was established in the mid-1800s when the British began the worldwide cultivation of the plant 11 in order to assure the continuing availability because the plant was in danger of extinction in some regions because of the harvesting of wild populations.

13 Extracts of the bark have been used to treat hemorrhoids, to stimulate hair growth, and to manage varicose veins. Quinine has been used as an abortifacient. 11 Extracts of cinchona have a bitter, astringent taste and have been used as flavoring for foods and beverages. Although the use of quinine for the treatment of malaria has been largely supplanted by semisynthetic antimalarials, its use persists in some regions of the world. Chemistry Typical cinchona bark contains about 16% of quinoline alkaloids consisting mainly of quinine, quinidine, cinchonine, and cinchonidine. The primary component of this mixture is quinine. Quinidine is the dextrorotatory isomer of quinine. Approximately 35 additional minor compounds related to quinine have been identified in the plant. 10 , 11 As a rule, the yellow cinchona has a higher alkaloid content than other varieties. Commercial formulations of quinine contain about 10% of dihydroquinine as an impurity. 3 The cinchona alkaloids are extremely bitter tasting.

Concentrations in the 100 to 300 ppm range are used to flavor beverages such as tonic water. Tonic water contains about 15 mg of quinine per bottle. 14 Quinine may have tumor necrosis factor (TNF)-suppressive activity as demonstrated in one small study. 8 Uses and Pharmacology Quinine is eliminated mainly by hepatic metabolism with very little excreted unchanged in the urine. 4 , 5 , 15 Cytochrome P450 3A4 has been shown to be important in the metabolism of quinine. Seven metabolites have been identified with 3-hydroxyquinine being the major metabolite. 3 , 4 , 5 , 16 In patients with acute renal failure who are infected with Plasmodium falciparum , up to 12% of antimalarial activity is due to the 3-hydroxyquinine metabolite. 16 Antimalarial Quinine is among the most potent of the cinchona alkaloids with respect to antimalarial activity. 10 Resistant strains of Plasmodium have been identified.

A small, in vitro study showed potential of phenobarbital to partially reverse quinine resistance. 17 Calcium antagonists and other agents (eg, prochlorperazine) are being studied for reversing P. falciparum resistance to quinine. 18 Various antibiotics (ie, artemisinin, artemether, clindamycin, doxycycline, mefloquine) in combination with quinine are being tested and used to treat resistant strains of P. falciparum . 19 , 20 , 21 , 22 , 23 , 24 If the oral route is not available for administration of quinine in children, effective alternate routes (ie, IM, intrarectal, IV) can be used. 25 , 26 , 27 , 28 Close monitoring for adverse reactions is advised, especially in young children who are more susceptible to quinine toxicity. 26 The combination of quinine and clindamycin has been safely and effectively used in Thailand for the treatment of uncomplicated malaria. 29 Antipyretic Quinine has been thought to have antipyretic action.

1 Although quinine administered before acetaminophen produces a more rapid drop in temperature than administration after acetaminophen, quinine alone has no effect on fever. 30 Leg cramps Another common use of quinine has been for the treatment of leg cramps caused by vascular spasm. For more than 50 years, quinine, quinidine, and hydroquinine have been used to prevent muscle cramps. 31 However, because 157 adverse drug reactions attributed to quinine were reported from 1969 to 1992, the Food and Drug Administration (FDA) concluded that quinine was not safe for use in this condition. 32 In 1994, the FDA prohibited the marketing of quinine for nocturnal leg cramps and discontinued its availability and the labeling of products for this use in prescription and nonprescription form. 32 , 33 However, a quick search of the Internet found a multitude of quinine preparations available and advertised for leg cramps. 34 Clinical data Various crossover, randomized trials, and 2 meta-analyses have confirmed that quinine is effective in the prevention of nocturnal leg cramps.

31 , 35 , 36 , 37 Other uses Quinine is bacteriostatic, highly active in vitro against protozoa, and inhibits the fermentation of yeast. 11 Quinine and quinidine have cardiodepressant activity. The latter compound is used for its antiarrhythmic activity. A mixture of quinine and urea hydrochloride is injected as a sclerosing agent in the treatment of internal hemorrhoids, varicose veins, and pleural cavities after thoracoplasty. 11 Quinine has been used to reverse multidrug resistance in patients with acute leukemias who express a higher incidence of P glycoprotein expression in blast cells. A high cure rate and better survival were shown in patients treated with combined quinine and chemotherapy when compared with chemotherapy alone. Although a higher incidence of side effects occurred, this combination has potential in treating acute leukemias. 6 , 38 Dosage Quinine has been widely studied as an antimalarial, and has been used at doses of 325 mg to 1 g as the sulfate salt. Classical doses of the crude bark were approximately 1 g.

Pregnancy/Lactation Quinine has been previously listed as being contraindicated during pregnancy because of fetal and abortifacient effects. 1 A review of the safety of antimalarial drugs in pregnancy state that standard (antimalarial) doses of quinine showed no evidence of increased risk of abortion or preterm delivery. Quinine has been shown to be secreted into breast milk, but insignificant amounts are ingested by the infant. However, high doses of quinine can cause uterine stimulation in pregnant women and deafness and optic nerve hypoplasia in children. 2 Interactions Amantadine In a randomized crossover study, administration of a single oral 200 mg dose of quinine decreased the renal clearance of a single oral dose of amantadine (3 mg/kg), increasing the plasma concentrations, in men but not women. 39 Carbamazepine The effect of a single 600 mg oral dose of quinine on the pharmacokinetics of a 200 mg oral dose of carbamazepine was studied in 6 healthy volunteers.

40 Compared with giving carbamazepine alone, quinine administration increased the carbamazepine area under the plasma concentration-time curve (AUC) and peak plasma concentration 51% and 36.5%, respectively. Nondepolarizing muscle relaxants A 47-year-old patient receiving quinine (1800 mg daily) developed recurarization after reversal from anesthesia and administration of pancuronium (6 mg). 7 Phenobarbital The effect of a single 600 mg oral dose of quinine on the pharmacokinetics of a 120 mg oral dose of phenobarbital was studied in 6 healthy volunteers. 40 Compared with giving phenobarbital alone, quinine administration increased the phenobarbital AUC and peak plasma concentration 45% and 35%, respectively. Warfarin There is no report of an interaction occurring with coadministration of quinine and warfarin.

However, in healthy subjects, quinine (330 mg) administration prolonged the prothrombin time (form 5 to 11.8 seconds) 41 and reduced the prothrombin content in blood in a patient receiving dicumarol (not available in the US). 42 A similar interaction may be expected to occur with coadministration of quinine and warfarin. Adverse Reactions Quinine exhibits considerable inter- and intraindividual variations in metabolism and elimination, with differences also seen in healthy compared with malaria-infected patients. Adverse effects are dose-related. 43 Cardiac events Because quinine is related to quinidine, ventricular fibrillation, prolongation of the QT c interval, and other adverse cardiac events can occur. 18 Administration of IV quinine within 72 hours of mefloquine may cause QT c prolongation. 22 Closely monitor patients with a cardiac history if quinine is given. Cinchonism The ingestion of these alkaloids can result in the clinical syndrome known as cinchonism .

People who are hypersensitive to these alkaloids also may develop the syndrome, which is characterized by severe headache, abdominal pain, convulsions, visual disturbances and blindness, auditory disturbances such as ringing in the ears, paralysis, and collapse. 10 Hematologic disorders Therapeutic doses of quinine have resulted in acute hemolytic anemia, 12 a limitation for its use in patients who are glucose-6-phosphate dehydrogenase deficient. 3 Quinine also has been associated with other serious hematologic disorders such as agranulocytosis, disseminated intravascular coagulation, 44 , 45 hemolytic uremic syndrome (HUS), 16 , 44 , 46 , 47 , 48 , 49 neutropenia (leukopenia), 50 pancytopenia with coagulopathy, 51 , 52 and thrombocytopenia (the most common hematologic adverse effect). 50 , 53 , 54 , 55 Patients may present with one or several concomitant hematologic adverse events. Two deaths have been attributed to quinine-induced thrombocytopenia.

53 , 55 Hypersensitivity reactions Ground cinchona bark and quinine have been reported to cause urticaria, contact dermatitis, and other hypersensitivity reactions. These reactions also may occur with the use of topical preparations containing cinchona extracts or quinine. 11 Systemic hypersensitivity reactions can present as HUS, with acute renal failure and simulating sepsis. 16 , 49 Hypoglycemia Children with severe malaria often present with hypoglycemia. 56 Quinine has been shown to increase insulin secretion. 57 , 58 Quinine-induced hypoglycemia has been documented in patients with and without malaria. 59 , 60 Quinine-stimulated insulin release may be amplified in pregnancy, aggravating hypoglycemia. 2 Monitor plasma glucose levels. Toxicology Quinine and related alkaloids are rapidly absorbed from the GI tract; a single 2 to 8 g oral dose of quinine may be fatal to an adult. 3 , 11 , 12 Treatment of an overdose is generally supportive. Urinary acidification can be employed if necessary. 1 Quinine is not eliminated by hemofiltration or hemodialysis.

15 Bibliography 1. Krishna S, Supanaranond W, Pukrittayakamee S, et al. Fever in uncomplicated Plasmodium falciparum infection: effects of quinine and paracetamol. Trans R Soc Trop Med Hyg . 1995;89:197-199. 2. Phillips-Howard PA, Wood D. The safety of antimalarial drugs in pregnancy. Drug Saf . 1996;14:131-145. 3. Krishna S, White NJ. Pharmacokinetics of quinine, chloroquine and amodiaquine. Clinical implications. Clin Pharmacokinet . 1996;30:263-269. 4. Mirghani RA, Hellgren U, Westerberg PA, Ericsson O, Bertilsson L, Gustafsson LL. The roles of cytochrome P450 3A4 and 1A2 in the 3-hydroxylation of quinine in vivo. Clin Pharmacol Ther . 1999;66:454-460.

5. Wanwimolruk S, Wong SM, Zhang H, Coville PF, Walker RJ. Metabolism of quinine in man: identification of a major metabolite, and effects of smoking and rifampin pretreatment. J Pharm Pharmacol . 1995;47:957-963. 6. Wattel E, Solary E, Hecquet B, et al. Quinine improves the results of intensive chemotherapy in myelodysplastic syndromes expressing P glycoprotein: results of a randomized study. Br J Haematol . 1998;102:1015-1024. 7. Drug Interactions Facts on Disc . [CD-ROM]. St. Louis, MO: Facts and Comparisons; July 2002. 8. Ittarat W, Udomsangpetch R, Chotivanich KT, Looareesuwan S. The effects of quinine and artesunate treatment on plasma tumor necrosis factor levels in malaria-infected patients. Southeast Asian J Trop Med Public Health . 1999;30:7-10. 9.

Wanwimolruk S, Kang W, Coville PF, Viriyayudhakorn S, Thitiarchakul S. Marked enhancement by rifampicin and lack of effect of isoniazid on the elimination of quinine in man. Br J Clin Pharmacol . 1995;40:87-91. 10. Leung AY. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics . New York, NY: J. Wiley and Sons; 1980. 11. Morton JF. Major Medicinal Plants . Springfield, IL: C.C. Thomas Publisher; 1977. 12. Duke JA. Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 1985. 13. Evans WC. Trease and Evans' Pharmacognosy . 13th ed. Philadelphia, PA: W.B. Saunders, 1989. 14. Aster RH. Quinine sensitivity: a new cause of the hemolytic uremic syndrome [letter]. Ann Intern Med .

1993;119:243-244. 15. Sharma AM, Keller F, Boeckh M, Heitz J, Borner K. Quinine dosage in severe malaria with renal failure necessitating haemodialysis. Eur J Clin Pharm . 1989;36:535-536. 16. Newton P, Keeratithakul D, Teja-Isavadharm P, Pukrittayakamee S, Kyle D, White N. Pharmacokinetics of quinine and 3-hydroxyquinine in severe falciparum malaria with acute renal failure. Trans R Soc Trop Med Hyg . 1999;93:69-72. 17. Mangou F, Platel DF, Haumont G. Plasmodium falciparum : modulation by phenobarbital of sensitivity to quinine, chloroquine and mefloquine in vitro. Trans R Soc Trop Med Hyg . 1998;92:561-562. 18.

Watt G, Na-Nakorn A, Bateman BN, et al. Amplification of quinine cardiac effects by the resistance-reversing agent prochlorperazine in falciparum malaria. Am J Trop Med Hyg . 1993;49:645-649. 19. DeVries PJ, Bich NN, van Thien H, et al. Combinations of artemisinin and quinine for uncomplicated falciparum malaria: efficacy and pharmacodynamics. Antimicrob Agents Chemother . 2000;44:1302-1308. 20. Kremsner PG, Radloff P, Metzger W. Quinine plus clindamycin improves chemotherapy of severe malaria in children. Antimicrob Agents Chemother . 1995;39:1603-1605. 21. Metzger W, MordMüller B, Graninger W, Bienzle U, Kremsner PG. High efficacy of short-term quinine-antibiotic combinations for treating adult malaria patients in an area in which malaria is hyperendemic.

Antimicrob Agents Chemother . 1995;39:245-246. 22. Na-Bangchang K, Tan-Ariya P, Thanavibul A, Riengchainam S, Shrestha SB, Karbwang J. Pharmacokinetic and pharmacodynamic interactions of mefloquine and quinine. Int J Clin Pharmacol Res . 1999;19:73-82. 23. Na-Bangchang K, Karbwang J, Ubalee R, Thanavibul A, Saenglertsilapachai S. Absence of significant pharmacokinetic and pharmacodynamic interactions between artemether and quinolone antimalarials. Eur J Drug Metab Pharmacokinet . 2000;25:171-178. 24. Pukrittayakamee S, Chantra A, Vanijanonta S, Clemens R, Looareesuwan S, White NJ. Therapeutic responses to quinine and clindamycin in multidrug-resistant falciparum malaria. Antimicrob Agents Chemother .

2000;44:2395-2398. 25. Barennes H, Pussard E, Mahaman Sani A, et al. Efficacy and pharmacokinetics of a new intrarectal quinine formulation in children with Plasmodium falciparum malaria. Br J Clin Pharmacol . 1996;41:389-395. 26. van Hensbroek MB, Kwiatkowski D, van den Berg B, Hoek FJ, van Boxtel CJ, Kager PA. Quinine pharmacokinetics in young children with severe malaria. Am J Trop Med Hyg . 1996;54:237-242. 27. Krishna S, Nagaraja NV, Planche T, et al. Population pharmacokinetics of intramuscular quinine in children with severe malaria. Antimicrob Agents Chemother . 2001;45:1803-1809. 28. Schapira A, Solomon T, Julien M, et al.

Comparison of intramuscular and intravenous quinine for the treatment of severe and complicated malaria in children. Trans R Soc Trop Med Hyg . 1993;87:299-302. 29. McGready R, Cho T, Samuel. Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. Trans R Soc Trop Med Hyg . 2001;95:651-656. 30. Olin BR, Hebel SK, eds. Drug Facts and Comparisons . St. Louis, MO: Facts and Comparisons; 1993. 31. Jansen PH, Veenhuizen KC, Wesseling AI, de Boo T, Verbeek AL. Randomised controlled trial of hydroquinine in muscle cramps. Lancet . 1997;349:528-532. 32. U.S. Food and Drug Administration Updates: FDA orders stop to marketing of quinine for night leg cramps. Available at: . Accessed April 15, 2004. 33.

Nightingale SL. Quinine for nocturnal leg cramps. ACP J Club . 1995;123:86-87. 34. Hyland's Leg Cramps with Quinine. Product Search. Available at: . Accessed September 6, 2002. 35. Connolly PS, Shirley EA, Wasson JH, Nierenberg DW. Treatment of nocturnal leg cramps. A crossover trial of quinine vs vitamin E. Arch Intern Med . 1992;152:1877-1880. 36. Man-Son-Hing M, Wells G, Lau A. Quinine for nocturnal leg cramps: a meta-analysis including unpublished data. J Gen Intern Med . 1998;13:600-606. 37. Man-Son-Hing M, Wells G. Meta-analysis of efficacy of quinine for treatment of nocturnal leg cramps in elderly people. BMJ . 1995;310:13-17. 38. Solary E, Witz B, Caillot D, et al.

Combination of quinine as a potential reversing agent with mitoxantrone and cytarabine for the treatment of acute leukemias: a randomized multicenter study. Blood . 1996;88:1198-1205. 39. Gaudry SE, Sitar DS, Smyth DD, McKenzie JK, Aoki FY. Gender and age as factors in the inhibition of renal clearance of amantadine by quinine and quinidine. Clin Pharmacol Ther . 1993;54:23-27. 40. Amabeoku GJ, Chikuni O, Akino C, Mutetwa S. Pharmacokinetic interaction of single doses of quinine and carbamazepine, phenobarbitone and phenytoin in healthy volunteers. East Afr Med J . 1993;70:90-93. 41. Pirk LA, et al. Hypoprothrombinemic action of quinine sulfate. JAMA . 1945;128:1093-1095. 42. Jarnum S.

Cinchophen and acetylsalicylic acid in anticoagulant treatment. Scand J Clin Lab Invest . 1954;6:91-93. 43. Sowunmi A, Salako LA. Effect of dose size on the pharmacokinetics of orally administered quinine. Eur J Clin Pharmacol . 1996;49:383-386. 44. Morton AP. Quinine-induced disseminated intravascular coagulation and haemolytic-uraemic syndrome. Med J Aust . 2002;176:351. 45. Spearing RL, Hickton CM, Sizeland P, Hannah A, Bailey RR. Quinine-induced disseminated intravascular coagulation. Lancet . 1990;336:1535-1537. 46. Glynne P, Salama A, Chaudhry A, Swirsky D, Lightstone L. Quinine-induced immune thrombocytopenic purpura followed by hemolytic uremic syndrome. Am J Kidney Dis .

1999;33:133-137. 47. Gottschall JL, Elliot W, Lianos E, McFarland JG, Wolfmeyer K, Aster RH. Quinine-induced immune thrombocytopenia associated with hemolytic uremic syndrome: a new clinical entity. Blood . 1991;77:306-310. 48. Story D, Hall A, Older P. Quinine-induced haemolytic uraemic syndrome. Anaesth Intensive Care . 1994;22:114-115. 49. Schattner A. Quinine hypersensitivity simulating sepsis. Am J Med . 1998;104:488-490. 50. Chuah TL, Denaro C. A case of quinine-induced thrombocytopenia and neutropenia. Aust N Z J Med . 2000;30:96. 51. Maguire RB, Stroncek DF, Campbell AC.

Recurrent pancytopenia, coagulopathy, and renal failure associated with multiple quinine-dependent antibodies. Ann Intern Med . 1993;119:215-217. 52. Schmitt SK, Tomford JW. Quinine-induced pancytopenia and coagulopathy. Ann Intern Med . 1994;120:90-91. 53. George JN, Raskob GE, Shah SR, et al. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med . 1998;129:886-890. 54. Brasic JR. Quinine-induced thrombocytopenia in a 64-year-old man who consumed tonic water to relieve nocturnal leg cramps. Mayo Clin Proc . 2001;76:863-866. 55. Freiman JP. Fatal, quinine-induced thrombocytopenia [letter]. Ann Intern Med . 1990;112:308-309. 56.

Agbenyega T, Angus BJ, Bedu-Addo G, et al. Glucose and lactate kinetics in children with severe malaria. J Clin Endocrinol Metab . 2000;85;1569-1576. 57. Davis TM, Karbwang J, Looareesuwan S, Turner RC, White NJ. Comparative effects of quinine and quinidine on glucose metabolism in healthy volunteers. Br J Clin Pharmac . 1990;30:397-403. 58. Davis TM. Antimalarial drugs and glucose metabolism. Br J Clin Pharmacol . 1997;44:1-7. 59. Limburg PJ, Katz H, Grant CS, Service FJ. Quinine-induced hypoglycemia. Ann Intern Med . 1993;119:218-219. 60. Harats N, Ackerman Z, Shalit M. Quinine-related hypoglycemia [letter]. N Engl J Med . 1984;310:1331.

Copyright © 2009 Wolters Kluwer Health Quinine for Night-Time Leg Cramps - Consumer Reports Stop taking Quinine for night-time leg cramps Last updated: April 2009 If you have nocturnal (nighttime) leg cramps, your doctor might prescribe quinine (Qualaquin)-even though the U.S. Food and Drug Administration has approved it for only one purpose: to treat malaria (although doctors can legally prescribe most medications for any type of treatment they deem appropriate). Leg cramps are uncontrolled muscle contractions that can be so painful they can waken you from sleep. They occur in many adults and are reported more often by women, and especially pregnant women. Since the 1940s, doctors have been prescribing quinine for leg cramps because there are no other reliable treatments. The practice has continued despite multiple alerts from the FDA about the risks of quinine and its limited effectiveness. Prescribing remains high despite warnings The FDA has issued warnings about quinine since 1994 and more recently about its minimal effectiveness in treating leg cramps.

In 2006, it banned the sale of all unapproved drugs that contained quinine except the branded drug, Qualaquin, because of the risk of serious side effects or death. Yet in the first six months of 2008, more than 124,000 people in the U.S. received close to 300,000 prescriptions for Qualaquin, according to the FDA. Since the Centers for Disease Control and Prevention reports that only about 1,500 individuals were diagnosed with malaria last year, it appears that quinine is still frequently prescribed off-label. Indeed, from January 2006 to June 2008, 62 percent of Qualaquin prescriptions were for musculoskeletal symptoms, mainly for nocturnal leg cramps. Of the 38 reports of serious adverse events received by the FDA in roughly the same time period, over half (55 percent) were from people who had taken quinine for leg cramps. What is the evidence for use of quinine to treat leg cramps? There is little convincing scientific evidence for prescribing quinine for leg cramps.

Studies of patients with nocturnal leg cramps have been small, were not randomized, controlled trials, and had other shortcomings. Not surprisingly, the FDA recently reported again that the risk of severe side effects from quinine outweighed any potential benefit for the following conditions: Nocturnal leg cramps. Two meta-analyses (results pooled from a number of studies) were completed before the FDA ban addressed the lack of efficacy and safety issues of quinine for leg cramps. The first, from 1995, using published studies from 1964 to 1994, found that although taking quinine resulted in decreased frequency of leg cramps, it did not reduce the severity or duration of a given episode. Since longer use seemed to produce a greater reduction in the number of cramps, the authors concluded that quinine must be taken for at least four weeks on a regular basis before its effectiveness could be evaluated in a patient. But the second meta-analysis, which included the earlier studies plus additional, unpublished research from the FDA, found that while quinine use did reduce the number of leg cramps, it didn't occur as often as previously reported-only 3.6 fewer instances in a four-week period vs.

8.83 instances. The FDA recently reiterated that "there are no data indicating that quinine is effective for the treatment of nocturnal leg cramps or other musculoskeletal disorders, and given the potential for life-threatening adverse events, [practitioners] should use extreme caution in off-label prescribing." Some doctors do suggest a carefully monitored four- to six-week trial of quinine for patients whose leg cramps are not relieved by other means. If your doctor does, and you decide to try quinine, make sure that you're not at increased risk for serious side effects because of your health or other medications you may be taking (see risks and precautions below). Also be aware that the appropriate dosage for leg cramps is unknown, though it is typically much lower than that recommended for the treatment of malaria. The typical dose of quinine used in studies to treat leg cramps is about 300 mg at bedtime. And since only one prescription version of the drug is available in the U.S., you should consider the cost (the retail price for 90 324 mg capsules could run as high as $370), particularly since it may not be covered by your insurance for off-label use. Restless Legs Syndrome.

Unlike leg cramps, RLS is a neurological disorder characterized by an uncontrollable impulse to keep moving your legs even when you are sitting trying to go to sleep. Drugs originally developed to treat Parkinson's disease, including ropinirole (Requip and generics) and pramipexole (Mirapex), are generally prescribed to treat moderate to severe forms of this condition. But, no evidence suggests that quinine is effective for RLS. Other cramping conditions. Some evidence suggests that quinine can reduce the severity and occurrence of leg cramps in people on dialysis for kidney disease. But there is no evidence to support use of the drug to treat diarrhea cramps, muscle cramps, or neuropathy (nerve pain). Additional considerations Before starting any treatment for nighttime leg cramps, your doctor should rule out any underlying diseases or drug side effects that might be causing them. Conditions such as movement disorders (dystonia); problems with the amount of minerals and fluids in the body (electrolyte imbalance); diabetes; nerve damage or pain; inflammation in various parts of the body; liver or thyroid disease; or disease of the blood vessels can trigger leg cramps.

Cramps can also be caused by certain medications or entire groups of drugs including: Individual drugs nifedipine (Adalat, Nifedical, Procardia and generics) raloxifene (Evista) Classes of drugs statins—used to treat high cholesterol (e.g. atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin) corticosteroids—such as prednisone, used to reduce inflammation for conditions like arthritis, asthma lupus, and rashes diuretics—such as hydrochlorothiazide and furosemide (Lasix and generics) used to treat high blood pressure and heart failure phenothiazines—tranquilizing drugs Drinking alcohol can also trigger leg cramps. Other potential treatments Botulinum toxin (Botox); carisoprodol (Soma and generics); gabapentin (Neurontin and generics); orphenadrine (Norflex and generics); verapamil (Calan, Verelan, and generics); and even vitamin E have also been tried, but there is limited evidence to support their use.

Drinking tonic water, which contains quinine, is unlikely to trigger the worrisome adverse effects that may occur when you take Qualaquin pills. Even if you choose a tonic water high in quinine, however, you'd have to consistently drink almost two liters a day to reach an effective level. If the cause of your leg cramping isn't clear, you can try stretching your calf muscles before bedtime. Although a few small studies suggest that stretching may not reduce the recurrence or severity of leg cramps, some people do find them helpful. You can also try using a pillow to prop up your feet, or dangling your feet over the edge of your bed at night. What are the risks of using quinine for leg cramps? Most of the serious side effects reported from the use of quinine have been in patients taking it off-label to treat leg cramps or RLS.

Some of the more serious ones that can result in hospitalization, serious illness, and death include: thrombocytopenia—decreased blood platelets (cells that help the blood to clot) cardiac problems, including an abnormal heart rhythm (too fast, too slow or irregular) rashes and other allergic reactions thrombotic thrombocytopenic purpura—a rare, often fatal blood condition that causes clotting throughout the body hearing problems electrolyte imbalance (the amount of minerals and fluids in the body) kidney failure lung toxicity Quinine can also interact with other medications, including antiarrhythmics (e.g. amiodarone, disopyramide, dofetilide, quinidine, sotalol); digoxin; blood thinners; drugs to control seizures; and neuromuscular-blocking drugs (used during surgery).

You should not take quinine if you have certain hereditary heart conditions, such as a prolonged QT interval (a rare problem that may cause fainting or an irregular heartbeat); an abnormal electrocardiogram (ECG; a test that measures the electrical activity of the heart); or if you have or have ever had G-6-PD, or glucose-6-phosphate dehydrogenase, deficiency (an inherited blood disease). Additionally, you should avoid quinine if you have myasthenia gravis (a condition that causes weakness of certain muscles), or optic neuritis (inflammation of the optic nerve that may cause sudden changes in vision), or if you have had an allergic reaction to quinine or similar medicines such as mefloquine or quinidine.

Side effect symptoms to watch out for: Indicating low blood sugar (hypoglycemia) shakiness sudden changes in behavior or mood headaches numbness or tingling around the mouth weakness Severe symptoms related to low blood sugar (hypoglycemia) confusion Call your doctor immediately if you experience any of the following: rash swelling of the face, throat, lips, eyes, hands, feet, ankles, or lower legs fever blurriness or changes in color vision inability to hear or see faintness Tell your doctor if any of these symptoms are severe or do not go away: nausea difficulty hearing or ringing in the ears confusion nervousness Bottom line. Quinine is widely prescribed to treat leg cramps (and less frequently, other cramping disorders) even though the FDA and the drug's prescribing information specifically caution that it should not be prescribed for those conditions. CR medical advisers suggest: Talk with your doctor about all drug and nondrug treatments for leg cramps. The risk of serious or life-threatening side effects from quinine and the lack of convincing evidence for its use outweigh the potential benefit of the drug for any condition except malaria.

This off-label drug use report is made possible through a collaboration between Consumer Reports Best Buy Drugs and the American Society of Health-System Pharmacists. This is the eighth in a series based on professional reports prepared by ASHP. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin). The Truth About Tonic Water The Truth About Tonic Water By Luke Yoquinto, MyHealthNewsDaily Contributor | July 6, 2012 04:59pm ET MORE Credit: Gin and tonic photo via Shutterstock Summer is a time for popsicles and corn on the cob, watermelon and ice cream, and for some, beverages prepared with clear liquors. It’s well known that alcohol affects the body and mind in profound ways, but there’s more to a mixed drink than meets the liver. What about tonic water, that bitter, effervescent liquid so often called upon during the warmer months to serve as the yin to the yang of gin?

Tonic water originally existed as a way to deliver quinine, an antimalarial drug derived from the bark of the South American cinchona tree. In the early 1800s, a British officer in colonial India invented the venerable gin and tonic when he realized that alcohol helped the medicine go down in the most delightful way. Today, tonic water still contains quinine, but the roles are reversed: a diluted, sweeter formulation of tonic water helps guide gin and vodka past the tonsils instead. Among foods and drinks that are ingested solely for reasons of taste, tonic water is unique in that it was first and foremost a medicine. Since medicines tend to have side effects, is it possible that a hidden health risk is swirling around in tonic water? The answer is yes, with some caveats. Quinine is still used to treat malaria today, although doctors typically reserve it for cases when the pathogen responsible for the disease displays resistance to newer drugs. However, you'd have to drink almost 20 liters of today's dilute tonic water daily to achieve the daily dose typically prescribed for malaria.

That may come as bad news for anyone hoping to cure the deadly infection with a nightly tippling session , but it should come as a relief to the rest of us, because quinine comes with side effects. Side effects so serious, in fact, they were the reason the Food and Drug Administration banned doctors in 2010 from prescribing the drug to treat nighttime leg cramps, a frequent off-label usage. The most serious of the common side effects is thrombocytopenia, a drop in the blood's platelet count that can lead to internal and external bleeding, as well as a related condition that can cause permanent kidney damage. Worse, these and other side effects occur to some degree in up to one in 25 patients treated with medicinal doses of quinine. Happily, the low dose of quinine found in a glass or two of tonic water isn't enough to trigger these issues in most people. However, for the unlucky few, even the small amount of quinine in tonic water can cause thrombocytopenia (doctors call this rare occurrence a "gin and tonic purpura").

People may also develop sensitivities and allergies to quinine as a result of occasional tonic water consumption, only to experience a full-blown reaction years later, upon taking a medicinal dose of quinine. Quinine can pass through the placenta from mother to fetus and there is some limited evidence that it can cause birth defects, so pregnant women should avoid the drug unless a doctor prescribes it to fight malaria. People with the metabolic disorder glucose-6-phosphate dehydrogenase deficiency (G6PD) should also avoid it. For the rest of us, from a health perspective, alcohol is a much more worrisome mixed-drink ingredient than tonic. Pass it on: People may want to avoid tonic water if pregnant, or sensitive or allergic to quinine. Food Facts explores the weird world of the chemicals and nutrients found in our food, and appears on MyHealthNewsDaily on Fridays. Follow MyHealthNewsDaily on Twitter @ MyHealth_MHND . We're also on Facebook & Google+ . More Food Facts columns:

Question: Which kind of water contains quinine?
Answer: Tonic Water