a glass of tonic water with a slice of lemon

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.

The People’s Pharmacy Quick and Handy Home Remedies

Share your own solutions to leg cramps and your experience with tonic water in the comment section below.

Revised: January 5, 2017

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  1. Dr@ftyBeer
    Ohio
    Reply

    Magnesium tablets work..

  2. Cheryl
    Reply

    Quinine is not recommended for people with myasthenia gravis, as it tends to aggravate symptoms like ocular myasthenia (drooping eyelids and double vision).

  3. Diane M.
    Montana
    Reply

    I work at a health food store. I have many customers, as well as my husband, who have taken magnesium/calcium supplements for leg cramps: 1,000 mg of ea. once a day and the cramps have stopped very quickly. A glass of Emergen-C works well also….immediately. Best to do both preventatively to not have to endure the pain. These cures also work for dehydration caused leg cramps especially in older people.

  4. Rosie
    Virginia
    Reply

    I’m one of those people who like tonic water by itself. But I had to cut it out entirely after it was discovered my liver enzymes were off the chart (literally!). The doc was really concerned but I remembered decades ago hearing that a G&T the night before a blood panel could give some false positives. Since I’m otherwise in perfect health, I was able to convince doc to let me quit tonic and re-test a month later. The liver enzymes were going back to normal. So no more tonic water for me.

  5. Kathleen
    Sea Girt, NJ
    Reply

    I have Myasthenia Gravis, a neuromuscular disease. Quinine is ABSOLUTELY contraindicated. However, I also have Fibromyalgia which can cause severe muscle cramping. I have found that taking a teaspoon of yellow mustard works wonders for the muscle cramps. It’s almost like a miracle how quickly the muscle cramps are relieved. I highly recommend it.

  6. Kevin
    Canada
    Reply

    “blood disorder called idiopathic thrombocytopenic purpura (ITP). My hematologist said it was triggered by the quinine water.”

    If it was diagnosed as ‘idiopathic’…how would your hematologist know the cause or the trigger?
    It’s like saying that because you drank a glass of wine it was the trigger that caused cirrhosis of your liver.
    One must be careful of these terms.

  7. Earlene
    Washington
    Reply

    I use regular tonic for occasional leg cramps. I keep a single serving bottle in the refrigerator, take a swallow or two as needed and the cramp stops in seconds. I tried the routine without the swallow of tonic and the cramp persisted. So it seems to be that tiny amount of quinine that does the trick. i have type two diabetes and a sip or two doesn’t make a difference. I don’t use sugar substitutes.

  8. Pam
    Reply

    I have Restless Leg Syndrome plus Proctalgia Fujax (extremely anguishing rectal spasms).
    Did not want to deal with side effects of prescription meds for the RLS. Have been taking magnesium for the RLS which has done away with them. I take enough magnesium until I reach a level which works for me. I take the magnesium at night before bedtime.
    Now the only time I get hit with Proctalgia Fujax is when extremely exhausted.

  9. Sue
    WA
    Reply

    I get leg cramps at night if I don’t thoroughly stretch my hamstrings and other leg muscles everyday (when they are warmed up). There’s even an exercise for stretching the ligaments that cause shin splints. I exercise everyday and makes sure to stretch when finished otherwise I will get cramps at night.

  10. Barbara
    Reply

    Twelve or fourteen ozs. of tonic water is too much to drink before going to bed, or at any time I think. I drink about 4 oz. with an oz. or less of Gordon’s gin. Sometimes I add a few ground juniper berries. Some people add a little honey.
    I figure this covers muscle cramps and arthritis pain. And I sleep well!
    Don’t overdo anything!!! Use common sense.

  11. Larry M
    Reply

    Isn’t banning quinine because a few people have a toxic reaction akin to banning peanuts because a few people have a toxic reaction? Or banning all flashing warning lights because a few people get seizures?

    You can’t ban everything that has a beneficial effect because a small segment of the population reacts badly.

  12. Bob C
    Virginia
    Reply

    I have been following conversations regarding nightly leg cramps for awhile now as I recently was having a problem with them to the degree I dreaded going to bed at night.
    Over the past 8 months or so, I have intentionally been drinking – at minimum- half of my body weight in ounces of water daily. Rather than coffee in the am, I now start my day with a 16oz glass of water to get me underway. Then throughout the day, this is the only liquid I consume – water. Since I have been on this regimen, I have not experienced any more nights being awaken by leg cramps. Not sure if there is anything to this or not but it seems to be working for me. Just thought I would share…..

    • Will
      Florida
      Reply

      Absolutely agree Bob! I have to wonder if there is definitely more to banning quinine than the given reason. Maybe keeping it from people helps feed the medical and big pharma industry from people looking for other solutions. Easier to control people distracted with debilitating cramps. If it was as simple as explained then shouldn’t many drugs, food additives and products made for human consumption be banned?

  13. Shirley
    St. Louis, Mo.
    Reply

    As soon as I get a cramp I take a teaspoon of plain yellow mustard as suggested in one of your articles. My cramp is gone by the time I leave the kitchen a minute later. It’s amazing. I have told innumerable people about this but nobody has tried it. Foolish people!!

  14. ISABEL
    California
    Reply

    I had an Arterial Study and a Venous Duplex sonogram today and found out that circulation is perfect. My potassium is fine, so the doctor told me to drink tonic water which contained a small amount of quinine. I am reading this article and the side effects coincide with my daughter’s who never had a drink of tonic water. However, she has ringing in the ears, rash, itching or blurred vision, so it is probably a coincidence that some one had some of those same symptoms the day they drunk a glass of tonic. They took the quinine pills out of the drug stores, per doctor quote “they were no making enough money and was not profitable”.

  15. Dave
    florida
    Reply

    I thought i would add my piece to this conversation. I have a condition where my muscles have very low reserve energy. This condition causes me to cramp when i have expended all the stored energy. I’ve had a muscle biopsy and every test available to determine the underlying cause without positive results. Finally i got an appointment to the MAYO clinic. The point! My doctor suggested i try TONIC WATER W/ quinine to relieve the cramping.

  16. Toni
    Maryland
    Reply

    My doctor told me to get tonic water yesterday for leg cramps. But after reading all these side affects. I don’t think I want to drink it at all. I’ll deal with the cramps.

  17. Janet
    Hawaii
    Reply

    My legs really ached so I had about 12 ounces of straight tonic water last night. Five minutes later I thought I was going to vomit. I resisted the urge to throw up then felt like I was dying! Seriously, I felt that bad. I fell asleep on the sofa at 6:30pm woke up at 8:00pm and crawled to bed. I woke at 2 and again at 4 when I decided to take allergy medicine. I will NEVER touch anything with QUININE in it again. After reading online about the serious side effects it can cause it should be banned in drinks.

  18. nana
    Washington state
    Reply

    One Dr. ays its safe to drink qunine water and the other says it will kill your kidneys.Now which it ?

  19. Don
    San Diego
    Reply

    There is a distinct resemblance in flavour of quinine and grapefruit.

    Is there any connection in the two, with reference to how grapefruit shouldn’t be taken as it affects certain prescription medications?

    Ought quinine have the same/similar restriction?

  20. Susan
    PA
    Reply

    I have tarsal tunnel syndrome in my right foot which I get toe cramp spasms at anytime. I was told both from my podiatrist and at the time my physical therapist drink tonic water reduce toe cramp spasms. Personally tonic water helps me I drink 1-2 bottles a day. I stock up when it’s on sale at my local grocery store. Wish I was informed of tonic water yeaes ago.

  21. Arnold
    N-Australia
    Reply

    Cramps could be an indication of Magnesium deficiency. Try Mg tablets instead of Tonic, might be a healthier option.
    If you have Tinnitus, it is likely to be associated with lack of Oxygen.
    Try to breathe heavily for a few minutes and watch your Tinnitus disappear. Worked for me many times.

  22. james
    MARYLAND
    Reply

    I started using tonic water as a biting insect repellant a week ago. As zika virus has been reported in Maryland, I am looking for my edge and so far, no bites. I have had no adverse reaction to drinking ten ounces of tonic before walking.

  23. gipsy
    kentucky
    Reply

    been having leg cramps at night for amonth and a half . dr. told me to drink tonic water i thought he was crazy.i bought it, tried it,leg cramp free all night.

  24. Herby
    South Africa.
    Reply

    I drink Instant Chicory Drink daily , the ingredients are as follows , Corn syrup solids , chicory extracts ,caramel and Quinine . Is it safe ??.
    I haven`t experienced any side effects .I feel great .
    Each 100mg servings contains 30kj energy , 0g sugar , 0g fat , 0g saturates and 0.1g of salt .
    Could this be dangerous ?
    Herby Albert

  25. Rebecca
    NC
    Reply

    My husband has advanced bladder cancer. He sometime loses a bit of blood in his urine. His doctors want him to drink lots of liquids. Recently,he started asking for tonic water with lime and ice. I was happy to see him drinking and refilled his glass any time he asked. After a few glasses, there was a dramatic increase in the bleeding from his bladder. He developed clots with urinary blockage and received treatment in an emergency room. I just happened to read somewhere that quinine interferes with platelet function and can contribute to bleeding. This must be the case, because when he stopped drinking the tonic water,the bleeding slowed and his urine returned to near normal.

  26. brian
    ghana
    Reply

    Add your thoughts to the conversation. what is the side effect of drinking club tonic water or quinine tonic.

  27. Jim
    MN
    Reply

    Jim: To certain people quinine is a deadly poison! It should NEVER be included in any food or food product of any type without CLEAR warning that quinine is present!!

    My wife’s last encounter with it (June 6,2016) nearly killed her: Emergency Room personnel did not think she would survive! The source of the quinine was either a bowl of soup or a cup of fountain coke, her meal 45 to 60 minutes before admission to the emergency room.

    The effect of the quinine was more than half an hour of violent vomiting.

  28. James
    Bolton
    Reply

    I suffered from leg cramps due to type 2 diabetes. I only drank tonic water as an alternative drink and did not know until I read this article on quinine that it helps with leg cramps. Looking back, my leg cramps would ease off and stop for periods of time when I bought tonic water. They should advertise this on the table. Their sales would go through the roof ?

  29. Deborah
    Margate Florida
    Reply

    I live in Florida and I drink tonic water and lemon all the time to help cool down on very hot days. Could this be dangerous?

  30. B
    U. K
    Reply

    Tonic water has been and is a great remedy for my nighttime leg cramps.
    I drink about 3 fluid ounces before bed and have no side effects. It’s a great relief!

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