a glass of tonic water with a slice of lemon

People took quinine pills for decades to prevent leg cramps. Quinine comes from the bark of the cinchona tree in South America. The dose was substantial–200 to 300 mg. Researchers have described the mechanism of quinine’s action as “unclear” or “obscure” (Journal of Clinical Pharmacology, June, 1995). In other words, they really don’t know how, or even if, it works (Consultant Pharmacist, Feb., 2008).

One theory has it that a high dose of quinine makes muscles less “excitable.” We have come up with a novel new theory that would explain why a tiny “dose” of bitter tonic water might in fact work to prevent or ease leg cramps (see below for details).

Doctors Prohibited from Prescribing Quinine:

The Food and Drug Administration banned quinine in over-the-counter pills because of fears of serious side effects. Later, the FDA advised physicians that they should never prescribe quinine for anything but malaria. Not surprisingly, the agency was loathe to ban tonic water. The public backlash would have been fierce. After all, the amount of quinine in tonic is small. (A glass of tonic has one tenth the prescribed leg cramp dose of quinine.) Recommending quinine to patients with leg pain or cramps might be considered malpractice. That left people like this reader in a terrible quandary.

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.”

What’s the Right Dose of Quinine vs. Leg Pain & Cramps?

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 and may not be necessary.

A New Explanation for Tonic Water’s Effectiveness:

We used to wonder why some people would report success with a small glass of tonic water to prevent or treat muscle cramps. It defied pharmacologic logic. They also reported fast action. Too fast! It takes time to absorb the quinine from the stomach, get into the blood stream and affect the muscle. We suspected it might be a placebo effect.

Well, we have changed our minds thanks to a whole new understanding of leg cramps. Here are some stories from readers that opened our eyes to a new explanation:

Earlene in Washington reports amazingly fast results with tonic water:

“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 2 diabetes and a sip or two doesn’t affect my blood sugar levels.”

B. in the U.K. also uses a small amount of tonic water:

“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!”

Salome in Australia shares her success in treating RLS:

“I was suffering from restless leg syndrome (RLS)  for over 6 years. It’s worse at night, but I also suffer during the day. Going to the movies it was shocking.

“I am 66 yrs old. Last weekend I started looking on the web and came across someone who was using tonic water. I tried it. I began drinking a 3/4 glass of Schweppes Tonic just before I sleep. What a find. What a gem. I sleep like a baby. No more restless legs at night nor during the day

“I had pain down my leg in front and that’s gone too. My hubby is happy, I am happy and a HUGE thanks to Schweppes for putting some quinine in the tonic. If you know of anyone who has RSL tell them to give it a go. I am loving my legs now.”

Is There an Explanation for Quinine’s Effectiveness?

Until recently we thought about quinine’s action as pharmacological. We assumed someone would have to swallow a fairly big dose (200 to 300 mg) to achieve an effect. As mentioned, that would require at least 10 glasses of tonic water and take a long time to go to work.

More recently we have come up with a whole new theory to explain the benefits of quinine. It involves TRP (transient receptor potential) channels. These channels are found throughout the body and respond to sensations such as taste, heat, cold and pain. They can be activated by a variety of flavors including vanilla, cinnamon, ginger, garlic or chili peppers. Bitter flavors can also stimulate TRP channels. Guess what? Quinine is about as bitter a taste as you can get.

There are TRP channels in the mouth, throat and stomach. When they are stimulated they immediately impact nerves in the spinal cord. These messages in turn can affect the neurons that are overwhelming muscles and triggering cramps or possibly restless leg sensations. Because this is a neural pathway, the effect is very fast compared to a classic drug effect. That would require a medication be absorbed from the stomach into the blood stream and eventually reach the cramping muscle. That can take 20 to 30 minutes. People report that a sip or two of tonic or a spoonful of mustard goes to work in under two minutes.

To read more about TRP channels you may wish to read this article and listen to our streaming audio interview with Dr. Bruce Bean. Just click on the green arrow in the black circle above his photograph:

Show 1054: The Scientific Explanation for a Weird Remedy

Other Remedies for Leg Cramps:

What else can you do to prevent those excruciating leg cramps? We recognize that some people cannot tolerate tonic water. Others find the taste unacceptable.

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.

Revised 5/4/17

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  1. Golda B
    Florida
    Reply

    I find the an eight ounce glass of V-8 Juice every other day can be a real preventative for my 4-5 hour sessions of leg cramps. it really does work!

  2. Gary
    Nevada
    Reply

    I have severe cramping after I drink diet coke or most diet sodas the cramps come on at night time while watching tv about 11 pm. I make a glass of warm water with couple table spoons of apple cider vinegar and table spoon of honey.

    This takes a min or two tho relieve the cramping. I’ve taken the mustard, which helps faster. I think ill try the tonic water my friend takes 3 ounces of the tonic water with quinine and he claims this work’s for him really fast.

  3. ron
    alaska
    Reply

    3 oz. of diet tonic water before sleep, and I don’t get the leg cramps. If I stop doing the tonic water the cramps come back in 3 or 4 days. Tonic water, they disappear that night. Might not work for everyone but for me, tonic is the stuff.

  4. Helen L.
    PA - Pennsylvania
    Reply

    Hello everyone. I am a 76 year-old woman who has suffered for more than 20 years with leg cramps. Twenty years ago they started in my calves and now have migrated to my thighs. I do use leg cramp pills, and they do seem to help. But I have noticed that the leg cramps seem to be worse the more I sit and watch TV prior to going to bed. Has anyone else seen any corrolation to more severe cramps when sitting before bedtime? I also have neuropathy. And cannot take statin medication for long periods of time without the cramps worsening. Please give me feedback.

  5. Margie J.
    Missouri
    Reply

    I had severe leg cramps at night and sometime while driving in my toes or fingers. I tried tonic water, and it works, however one of the side effects is itching. Maybe I’m drinking too much. I consume one small bottle daily. I’m going to cut it down to 3 oz daily. Hopefully it works as well.

  6. Linda
    Spokane, WA
    Reply

    OK, maybe this is a wild hare (hair??)!. But I just read your article about stopping a migraine by putting ice on one’s head or against the back upper palate – it works by stimulating the TPR channel. Now I read about stopping leg cramps by drinking something salty or bitter – it works by stimulating the TPR channel. So!! Could someone test? Would it work to take mustard or pickle juice for a migraine?! Or put ice on your head for a leg cramp?! Just wondering! I don’t get either although I am susceptible to leg cramps if I quit putting 1/4 tsp potassium chloride (650 mg potassium) in the V-8 juice that I use to take my vitamins with).

  7. Betty
    Reply

    Maybe one simply needs more water! Go for water for a couple weeks, lots of water. Google water and leg cramps. There is a strong connection.

  8. Robert
    Reply

    I don’t know about anyone else, but I have had terrible leg cramps at night for years. I have only found that eating one or two bunches of bananas a month appear to keep the leg cramps away. Then if I forget to eat any for six weeks or so the cramps come right back just as bad as before. I ,at night, sometimes yell for my wife to help press down from the back of the knee to my heel as hard as she is able to and when I am able to I stand up to walk around. If I think the cramps may be gone for a little while I then do some leg stretching to help ease the pain. I almost had a cramp while stretching once when I went to bend the leg, but immediately stood up and started to walk around again. My wife just got me a bottle of tonic water with quinine and after reading about it I will stick to the bananas.

  9. Cheryl
    Orange Ca.
    Reply

    I drink 3 oz tonic water mixed with 3 oz apple juice. I have no leg cramps at night. When I used to get them I woke up screaming in pain.

  10. Jan
    Texas
    Reply

    I was recently put on low sodium diet for my heart and a diuretic pill. I very soon started with severe leg cramps. The pill and diet was lowering my potassium drastically so instead of taking another pill, I chose to eat food very high in potassium; dates, avocado and bananas.

    Four dates a day will supply me enough potassium that I have no leg cramps and can even give a good stretch in the morning. I cannot miss a day without one of the above (bananas are not enough) are the leg cramps will start that night.

  11. Blance
    North Carolina
    Reply

    reading this as I sit here with a glass of tonic water. When I notice I’m at the point of getting leg cramps again, I will get a 16 oz bottle of tonic water and drink it over a two days. That seems to take care of the cramping for about two weeks. I never drink a whole bottle in a day. Maybe some people do, I don’t. Also keep packets of mustard by my bed just in case I waited to long to drink some and a packet with a cramp will stop it very quickly.

  12. Lyn
    Reply

    Please use caution when using Quinine in any form. I am very much allergic to quinine, as well as Fluoroquinolone antibiotics, and are on my list of allergy meds.

  13. Phyllis
    VA
    Reply

    So glad to see all this information on leg cramps. My husband suffers from them often in the summer after playing golf. The soap under the sheets or liquid glycerin on his legs seem to help the most. We might also try tonic water. Your soap sounds wonderful because it is flat, and I am sure it helps many people. Not many would be allergic to fragrance, even natural like lavender oil, which means I could not use it. But thanks to you and everybody who participated in the discussion, we can choose which remedies to try which will not affect my allergies!

  14. Carol
    Charlotte
    Reply

    I’ve pretty much eliminated leg cramps at night by the soap-under-the-sheet method. I still don’t understand why it works, but it does. A tip for keeping it in place: cut the toe off an old stocking (not a sock) a couple of inches longer than the soap. Put the soap in and gather & twist the stocking around it. Use a small safety pin to pin it to the bed pad, then cover with the sheet. No more sliding around! I use two, one on each side. I also occasionally get painful hand cramps, mostly during the day. I place a bar of soap in the hand … cramp is gone in about a minute. Wish someone could explain why soap works!!

  15. Sandee
    Reply

    The best and simple way I have found for leg and foot cramps is to cut a bar of lavender soap (not deoderant soap) in half and put it under the sheets. I have to make sure the soap is down around my legs or I will have problems again. I have two other people I recommended this to, and they thought I had lost my mind, but it worked for them as well. Thanks for the tip People’s Pharmacy!

  16. Margaret
    Sedona AZ
    Reply

    I have had a problem with leg cramps for years. The bar of soap in bed was helpful, but this was frequently only after I already had a cramp and put my foot on the bar of soap to eliminate the pain.

    The best solution for me has been to take a walk every morning and make sure there are hills on that walk. As long as I walk up hills I have found I have been able to eliminate the leg cramps completely. If I skip a few days of walking hills the leg cramps come back. Fortunately here in Sedona we have lots of hills. When in Florida where it is fairly flat I used to walk over a bridge that was high in the middle for the boats to go through.

  17. Rich C
    NC
    Reply

    My cramps are foot and ankle and night time only. A magnesium supplement helped but did not completely eliminate them. The bar of soap and mustard did not work for me. Pickle juice would stop the cramping but was a temporary fix. What has worked for me is to pour sea salt into a small glass of water (2-3 oz) and drink it. I don’t measure the salt, just dump it in and stir. All of it does not dissolve so I would estimate at least a tablespoon. For the past 6 weeks I have not had ANY cramps and will continue this routine. I find it interesting there is no literature about the onset of night time cramping; only several home remedies for its relief.

  18. Cindy M. Black
    Reply

    “Sam” said Magnesium Malate helps the cramps and I’d agree. Ever since I switched to mag. malate from mag. oxide (the malate doesn’t cause such loose stools), I’ve had almost no leg cramps. I didn’t have many anyway, because I use the soap under the sheets! Funny, in all these comments, I didn’t see that mentioned once… weird!

    ALSO, Hylands (and probably others) makes a homeopathic med for leg cramps; you just put it under your tongue… that also works well! Then there’s also yellow mustard. I was camping in my van the other night and didn’t have anything but a packet of mustard. Got a cramp (no soap in my sleeping bag, d’oh!), and bingo, the cramp went away. SOOO many options….

  19. Brenda
    Hertfordshire
    Reply

    Hi. I have leg cramp at night in bed. Putting soap under the bed sheet works for me. If I get cramp it is because the soap has fallen out, so I feel for it every night as a habit. It is worth it so I get a peaceful nights sleep. I change every couple of months or just cut it up if big enough. I think it is mad, but it is preventative and I don’t get cramp anymore or even worry about it.

  20. Nick
    Redondo Beach, CA
    Reply

    I am drinking the equivalent of two 1 liter bottles of Tonic water with quinine a day mixed with two parts water one part tonic water. I also mix it with juice as well. The night time cramps have subsided more than 90% and sometimes have none at all due to this mixture. I have mentioned this to others to much success.

  21. PattyPR
    Reply

    I have a history of severe leg cramps that could last up to two hours, causing loss of sleep for both me and my husband when I woke us both, screaming in pain. First solution was a “karate chop” my chiropractor taught my husband to do on the calf because nothing else would stop it at the time. The alternative was crying and holding back screams for hours. Two primary care doctors I’ve told my experience to would say, “It’s just a cramp. It will go away.” Many have never had such a severe one like I have experienced. Those who have, reading here, can probably sympathize.

    Later, quinine was the solution for me for years, and I still use Hyland’s Leg Cramp and NatraBio Leg Cramp remedies along with sugar free tonic water. I know now it is probably the bitterness of the tonic water that stopped the cramps. It’s very rare for them to start up again on the same night, once I use the Natra-Bio and tonic water. Neither soap nor mustard worked for me, but pickle juice gave relief in less than a minute. I tried those after reading these newsletters.

    Mind you, I almost never have cramps as severe as I had thirty years ago because I am very proactive. I don’t allow myself to become dehydrated, and make sure I don’t strain my calves by standing on tip-toe or by pushing anything heavy with my body, straining my calves. I also take action at the least hint of an impending cramp, any tiny pain or twinge so I can head off a painful wakening in the night.

    With all the above, I usually avoid most any cramp or quickly head them off. Recently though, I had cramps threaten every night for over a week and saw my primary care doc. She has me taking 500 mg potassium gluconate once daily and one to two 400 mg Magnesium Glycinate morning and night, depending on need. That stopped the problem quickly. She said that that form of magnesium works better for cramps than others.

    BTW, the pickle juice I prefer is a natural Bubbie’s Pickles with a cloudy “mother” floating around in it, made the old-fashioned way. Bubbies is available at some health food stores or other health food retailers that deliver monthly to certain cities and towns like Azure Standard. Cheap store brand pickles probably work just as well, not sure.

    Thanks to everyone for sharing and good luck!

    • Ali
      australia
      Reply

      thankyou for telling your symptoms & perspectives, I think we share similar cramps – so painful sometimes I feel like ive near gone into shock … clamminess ,faint waves of nausea… all concurrent with unrelenting agony. I think if you experience this you would never refer to them as ‘just a cramp’ I get where your coming from also re the tippy toes, stretching etc causing aggravation – I just tried to put a ugg boot on and it hit !
      tonic water chilling & I best get moving again !

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