The People's Perspective on Medicine

Can Quinine Kill?

Q. My niece told me that drinking tonic water helped her restless legs syndrome. I tried sipping some before I went to bed, and it helps.

After I read in your column that the FDA bars doctors from prescribing quinine, I looked on the label. Quinine is listed as one of the ingredients. Is quinine harmful?

A. Some people are susceptible to quinine and develop irregular heartbeats or a life-threatening blood disorder when they consume it. It can also cause birth defects. The FDA banned it for treating leg cramps to prevent the serious side effects it can cause. Doctors are still permitted to prescribe it for malaria.

The dose of quinine found in tonic water is low, but we heard from one reader who suffered a severe reaction from drinking it:

“One evening I drank 5 ounces of tonic water; the next morning I was in the emergency room with a frightening skin reaction. I was hospitalized for many days.

“My platelet count dropped to 1,000. Now it has gradually come back up to 266,000. I was diagnosed with ITP (idiopathic thrombocytopenic purpura), triggered by the quinine in the water. It nearly killed me.”

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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In England, quinine sulfate 300 mg tablets are commonly prescribed and sold for prevention of nocturnal leg cramps, so says the package insert always provided with them. I think the FDA is overly cautious, but then again, it is a political, NOT medical, institution: common sense need not apply. Sure, ITP is dangerous, but the vast majority of users never experience it, because it is a genetic defect, not a hazard of quinine itself.

I have had restleg all my life in moderation. Now I’m past 80 and take gabapenten for neuropathy pain. However I still get restleg at times. I used to take Hyland’s remedy but haven’t had to for a couple of years. My remedy is to get up and make myself about 10 oz. of hot tea. Not just any tea. I buy green powder tea, but not macha. Macha has more caffein than just the powered. They don’t have it in regular stores, but Asian stores do, from Japan. It is not tasty but a little honey makes it ok. This just seems to work. Hope somebody finds this helpful

I must tell you; my husband had pancreatic cancer. He developed a liking for tonic water, and would drink a large bottle every day. I noticed something online that warned against tonic water for people with cancer, because of the quinine content. I asked our oncologist about it, and he said it was alright for my husband to drink it. HOWEVER, he thought my husband was drinking probably a glass a day. Weeks later, I mentioned it again, and when he found out how much my husband was drinking daily, he told him to stop immediately.

My husband died from pancreatic cancer, and I am NOT saying the tonic water caused his death. I am saying that be careful and only drink a small glass daily.

Keep a liter bottle by the bed. Only a couple of swallows as needed for leg cramps, and mine get pretty severe! No problems.

Sweppes tonic water.

Is it possible to be sensitive to it without actually being allergic? I too heard tonic water was good for leg cramps and had a couple of glasses of it that afternoon, while I sipped it I had a bit of a rush (not unpleasant) then a few funny rhythms and then my heart started racing, I was shaking and shivering cold then flushing red, dizzy and it upset my stomach. It did settle down after a few hours but left me feeling like I’d been hit by a truck, it was very frightening.

I was having muscle spasms and one night I read about tonic water and quinine were good for the muscle pain. Let me tell you it works well, the only thing is that makes me go to the bath room at night. My wife is also been taking it for her back pain. It has worked for both of us. So I don’t know what to say I guess things work in different ways for everyone. But I’m afraid for what I just read, I drink like 6 oz every night. I don’t feel any side effects.

I have been taking a glass of low calorie tonic water most nights for some months to prevent nocturnal leg cramps. I have not noticed any side effects yet but I rely on a heart pace-maker to keep my heart beat above 50.
I notice that some days it is 54, 55, 56 and I wonder if this is the result of the quinine in the tonic water. If so, no bad thing, I suppose. I have also tried drinking camomile tea, which is very relaxing, but it does not prevent cramp.

I wish that I had found this forum earlier. Last Tuesday on September 13, I started a medicine called leg cramp by Hyland’s, since I suffer from bad leg cramps, I went to Wallgreen pharmacy and got this “over the counter” medicine, It calls for two capsules every four hours, I only took one pill on Tuesday, next day I fainted, I went to the hospital and they discharged me after a couple of hours.
I didn’t relate my fainting event to the pill so I kept taking it every day, I went back to the hospital on Friday, September 15/2011 my symptoms were: very dizzy, sweating, short of breath and left arm pain, they did blood test and sent me back home after six hours of tests. Last Thursday on September 22, I had a very strong arrhythmic cardiac while I was at college, I started sweating, being cold and hot, very dizzy, and pain in my left arm and ready to faint again, the paramedics took me to the hospital right away for the third time in a week.
When the cardiologist came I showed him the only pill that I have being taking, which was “leg cramp from Hyland’s”, he asked me to stop the medicine immediately, I was hospitalized with extra heart bits and strong arrhythmia, I was sent home on September 23, with a portable monitor to record my heart rhythms, I am still very dizzy, with discomfort on my left arm, unable to drive or function as I usually do.
I am 35 years old very active and healthy woman, I have never suffered from heart diseases and this was the only pill that I am sure that this is a bad side effect from quinine. I cry all day when I get an arrhythmia episode because I get so scared to have a heart attack from this horrible medicine, it shouldn’t be sold “over the counter” at all!!!!

I am a 61 year old female and I have suffered from Sciatica (extreme pain in hip that runs down my leg and sometimes unable to move). For the last couple of years it has progressed from a rare occurrence to all day every day. It had gotten so bad lately that it would take me ten minutes just to stand up because of the shooting pain. I would have to maneuver my right leg all over trying to get up and avoid the shooting pain.
I was told to drink tonic water. Even though I thought it a ridiculous idea I drank about eight ounces one time and five days later the pain is still as good as gone. I only drank it the one time and had no side effects as of yet. I noticed that on the fifth day (yesterday) the pain had returned slightly so I did drink another small glass. I hope I don’t have any side effects because it truly is working. I was fearing having to use a walker or wheelchair because it had progressed so far it would take me forever to stand up from a couch or chair and was starting to be painful to walk.

I have been suffering from pain in the Legs , especially pain in the Right-Leg calf muscles. Homeopathic Medicine with Quinine has a very low Quantity of Quinine, like 0.014 mg of Quinine per caplet… Tonic Water has about 2.0 mg of Quinine per Oz.. So, is the Homeopathic Medicine very safe?

I’ve suffered from terrible leg cramps for years, a side effect of taking statins. Finally found something (besides quinine, which I take every night and still have the cramps) that seems to be helping. It’s called Ionic Fizz with magnesium, and I drink it every night before bed. It cost about $28 for a two month supply, and I bought it at a health food store. If you’re struggling with leg cramps, give this a try.

I too suffer from leg cramps and osteoarthritis along with other chronic pain such as sciatic nerve inflammation. I started drinking Tonic Water on a regular basis on the advice of a registered nurse I met a while back. It really does have an effect. The normal pains I have are greatly reduced if I drink 10 or 12 ounces of it while I wind down getting ready for bed.
I think it’s better to take the risk from it rather than the proven problems of taking 600 to 1200mg of various otc pain relievers every 6 to 8 hours will produce, and on those really bad pain days/nights, throw in a half to 1 vicodin which is very addictive. As with all things in life, tonic water should be used “in moderation.”
Good luck to all and my sympathies to my fellow chronic pain sufferers. Pain like “we” live with can really wear you out, something “normal” people will never understand. Thanks to the people that operate this site and all the commenters who took the time to write of their experiences.

I was writing a research paper on herbal treatments and stumbled across tonic water for leg cramps. The article explained that the FDA had taken Quinine off the market because some people with certain types of anemia had died from large doses. I spoke with my neurologist and who recommended tonic water for me. It has worked wonderfully and this year after a bout w/ shingles I developed extreme nerve pain in my legs and it helped that too.

My 24 year old daughter went for a check up, and her urine protein was elevated, which was attributed to her having a high fever with a virus three days prior to her checkup. However, now we just got a call that although most of her bloodwork was good from the checkup, something was off with the liver test.
I am concerned, and have been wondering what could have changed since a few weeks ago. She had bloodwork with allergy testing several weeks back that was ok. I realized that her eye doctor recommended that she drink tonic water with quinine to possibly relieve a bothersome eye twitch.
She drank 1-liter a day for three weeks, and the bloodwork was taken on the last two days of this regimen. It didn’t help the twitch. Could it have caused irregularities in her blood tests? We are going to repeat the blood test today. She hasn’t been on the tonic water for the past two weeks. Thank you for any input.
Worried Mom.
Proc (Bayl Univ Med Cent). 2003 January; 16(1): 21–26.
Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities
Mark A. Howard, BS,1 Andrea B. Hibbard, BA,1 Deirdra R. Terrell, MPH,1 Patrick J. Medina, PHARMD,1 Sara K. Vesely, PhD,1 and James N. George, MD1

I’ve lived with chronic pain for years. I’ve been taking quinine for a few days. What a wonderful product. I’ve not suffered any side effects and I haven’t had pain in my legs or my back like I normally do. IN FACT, I’ve not been taking any pain medication. I hope this is something that is going to keep from having to take narcotics for pain. I honestly wish I’d found this sooner. I hope it works as good for you as it has me. I’ve been able to sleep without waking up every little bit to toss and turn.

My 24 year old son has had leg pain for the past two years, to the point where he is unable to work. His doctor recently ordered that he takes Vit D, which he takes nightly. Then someone told me that his doctor recommends that he drinks club soda, with quinine for his leg pain. He said that he drinks it when he has a problem with his legs.
Generally, how often and how much, should one drink this, in order to tell if the drink will be helpful for leg pain. What percentage of the people have a severe reaction to the quinine vs those that do not? Is it worth the risk? My son has been taking Vicodin for the pain, for the past 18 months. Quinine vs Vicodin, which is less risky?

For over nine years, I’ve suffered horrible leg cramps as a side effect from taking statins. After much trial and error, I’ve found that avoiding drinking milk is helping me. I went from having two or three episodes a week (the cramps hit almost every muscle, both legs,and are only relieved by getting into a hot tub of water. These are not your typical “charlie horse” cramps) to maybe once or twice a month, if I forget and have something with milk in it.
For some reason, yogurt in the morning doesn’t seem to bother me, but milk taken late at night will almost guarantee an episode. No idea why. I’m not allergic to milk, or lactose intolerant. Hope this information is helpful. I still take one to two qualiquin a night, but they’re so expensive now, I need an alternative. Thank you for your really wonderful site.

Further to my notes on August 23, I did try the tonic water but it didn’t help with the pain in my leg, although it did help with the nausea caused by the various painkillers I was taking. I stopped taking painkillers as they were having no effect and began sitting in a hot bath three or four times a day – especially at night, when the pain was worse. I also, after reading a different section of the People’s Pharmacy, began taking Vitamin D and the pain began to ease. It has now moved from excruciating to bearable. I also find that drinking filter (not instant) coffee has helped remove the pain as well as the numbness in my left foot. In fact, I am now sleeping for about 6 hours a night and am feeling so much better.
I have also acquired Dr. Dowd’s book ‘The Vitamin D Cure’ and started putting it into practice.
Thank you for this excellent website which has been very helpful.

Thank you for all of the above very interesting information. I am just about to go out and buy some tonic water with quinine. For the last month I have been suffering with a pain in my left calf 24/7. I am awaiting x-ray results, but doctor believes it is sciatica caused by a disc problem in my lower spine. I count myself lucky to have got to the age of 63 years before suffering this type of pain, which, so far, no painkiller has got rid of. Have been taking Quinine Sulphate (I live in UK) and it has made no difference whatsoever. I am averaging 2 hours sleep per night.
I know that I don’t have a problem with tonic water because I took it when I was pregnant 33 years ago to stop morning/all day sickness. An elderly neighbour told me about it and it worked almost immediately. I only had to drink a glass per day for a week and the problem was sorted. Two years ago, I recommended this solution to a young friend who was also suffering from morning sickness and within a day the problem was solved.
Has anyone else heard of tonic water being used for this reason?

I have had leg cramps for years. Was on quinine for awhile until FDA took it off the market. My doctor put me on Neurontin (gabapentin) which I think has helped, but not entirely. He put me on Qualiquin last week – upset stomach every night, so I stopped it and went back to gabapentin.

Bought leg cramps with Quinine remedy for sciatica leg pain, from reading webmd, etc. am thinking about returning the product, does anyone have any remedies for my type of leg pain?

I have used quinine Canada Dry for years because it helps my upset stomach. I didn’t know it was good for leg cramps and will continue to drink it for my leg cramps thank you.

I have been drinking 8 ounces of tonic water with quinine each night for restless legs. It helps but since I’ve read side effects I afraid of it. Is there enough quinine in that to be harmful?

Hello- I am research quinine because it was suggested by a friend for leg cramps. I tell you have a lot of pain issues. One of my issues that has bothered me for years is what was diagnosed by the podiatrist as Morton’s Neuroma- many times this feels like a cramp.
I know people with chronic pain can relate but this has been a burden for years- I have used massage, chiropractic, bananas, potassium, etc. Most seems to help some. Now I got a couple of quarts of tonic water. This was several days ago. After the first few hours I swear it kicked in and ever since then it’s almost like a different world.
I have not had that extreme pain now for several days which has prompted me to research this further. As far as I am concerned I’m completely sold. I know that such a low dose does not seem to be recognized as therapeutic but I’m just telling you what happened to me.
I have never used a quinine pill and as long as this low dose keeps working I doubt if I will try one. This is my two cents worth and I am book marking your page to see if anyone has some illuminating comments for me. Thanks.

Since reading about all the reactions to tonic water and the small amount of quinine that is in it I am surprised you have suggested it as a possible remedy for leg cramps. I suffered from extremely painful leg cramps until I began drinking a banana and skim milk milkshake every night. Potassium pills didn’t help at all. A friend of mine takes a few l000mg garlic pills every night for her leg cramps so I tried one 1000mg each night and now I don’t need the banana shake more often than every third or forth night.

I have one more comment to make. I believe your pharmacist should be prescribing medicine, not your doctor. I worked in the medical field for 20+ years, and the doctors openly admitted that pharmacists are the experts on medicine.
I always go to my pharmacists for advice on any new medication, and its effects with other medicine I’m taking. They know more than the doctors about medicine. They are up on the latest studies, side effects, everything.
I don’t know how the physicians update their knowledge. Don’t get me wrong-I absolutely trust my doctors, but I know who is the authority on drugs, and that is the pharmacist!

I want to express my thanks for this web site and those who have sent comments, because now I have some ideas about how to stop those horrible leg cramps. I took quinine for years and it worked well, and now I’m lost without it. I wonder what the average age is of the doctors working for the FDA. They probably haven’t practiced for forever. I just wonder what kind of data helps them make the decision to remove certain drugs, especially those that have been on the market as long as Quinine. Good luck to all.

I have suffered from leg cramps from my early teens and now at age 46 I still suffer greatly from leg cramps. I usually get the cramps during the night while in deep sleep, the cramps are so severe that they wake me up, and sometimes i get them in both legs at the same time.
I try to make it to a very hot bath or shower, but at times I cannot move, so my housemate gets woken up and has to heat a towel to wrap around my legs.I do a lot of walking in my job as a security guard, and stairs are very much a part of the routine.
Years ago i was prescribed (quinine), to treat these symptoms, but after reading all sorts of things that scare me about(quinine), I am very reluctant to take it any more. Are there any other medications that may help stop or reduce the symptoms of severe leg cramps…..?

My dad took quinine regularly for many years. He, as I remember began taking it for his leg cramps (which, I know now, were restless leg syndrome, because my daughter has it). This was when I was a teenager and I am 52 now. He died from a heart attack when I was 35.
I can’t say not to take quinine, but, as a nurse, I would recommend not to take it if you drink alcohol. I really belive this is a bad combination. My dad drank alcohol and that, in itself, may have killed him. However, I think it is possible, the quinine in combination with the alcohol is not a good prescription for leg cramps. If you take quinine by itself, just monitor your reactions, side effects and be sure your doctor is aware you are taking it. My children and I miss my dad. Take care.

I took Quinine for night leg cramps. I was working for a physician who said Quinine might help and wrote me a Rx. I took one pill and within a couple of hours, I was deathly ill, not knowing what was going on. My doctor sent me immediately for blood work. My liver function studies were worse than my husband’s when he died from liver cancer. It took more than two weeks to get my body back on track. I would not recommend Quinine to anyone. It is dangerous.

I, too, had suffered from foot and leg cramps for over 10 years. I had taken quinine for it until it was taken off the market. The doctor put me on gabapentin (generic for Neurontin), and it seems to have eased up some. Now, when I wake up from a sound sleep and move my legs, I have severe spasms, but the cramps are pretty much gone.

I asked my doctor about the quinine in tonic water. I heard quinine can cause heart arythmias. I am a heart patient. I’ve been drinking 7 ounces every night for about a year for leg cramps. IT ABSOLUTELY WORKS. The doctor said there is not enough quinine in that 7 ounces to bother me in any way. He said I would have to drink bottles of it to affect me. My leg cramps are approximately 95% gone.

I miss my RX for Quinine. The pain from leg cramps is
unbearable, especially to the elderly. I would just as soon take a chance on quinine’s side effects than go without the product.
Hylands still carries a product for leg cramps that works within a few minutes.
I suppose this product will be stopped, I hope not.

Good heavens I wonder how many British died in India from drinking their gin and tonics. I wonder how many more would have died if they hadn’t, since Quinine was one of the best protections against malaria.
My mom loved her gin and tonics — she died at 93. I like tonic over ice, very refreshing. I’m sure some people have had a reaction to tonic, but if you read any prescription passed on by the FDA there is an amazing listing of side effects. So I think to scare people off of tonic isn’t necessary… we just need to be aware. Most of us aren’t allergic to bee stings, some are… same kind of scenario. You can’t avoid life.

As a young dancer (in the 70’s) I had often taken quinine for leg cramps w/out any problems. As a result when the pain started again in the 90’s, I tried it again. On the third night I woke up the sickest I’d ever been, was rushed to the hospital, and after much testing was told I had an idiosyncratic reaction to quinine (idiopathic thrombocytopenic purpura) and to never even let tonic water pass my lips. Be very careful…

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