Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
14 November 2007

THE PROBLEM OF LEG CRAMPS AND QUININE

            In 1633, an Augustinian monk named Kalancha, in Peru first wrote that a powder of the cinchona tree bark was effective in treating fevers.  At the dawn of the 1700’s, quinine became a standard treatment for malaria and remained so for many years.  Now we have much more effective treatments for malaria and quinine has little application for treating malaria in modern times.

            But the story today has to do with leg cramps.  As many people know, leg cramps (charley horses) are severe cramps that tend to appear especially in the legs after unusual exertion or fatigue.  Leg cramps are also very common in those with chronic heart failure.  The cramp basically occurs because of uncontrolled spasm of the muscle that results from built up of waste products and not enough oxygen getting to the muscle.  Acids that result from heavy  muscular activity are one of the main culprits causing leg cramps.

            A long time ago when someone was being treated for malaria, it was noted that their leg cramps got much better when they were treated with quinine.  Then some “smarty pants” decided to use quinine to just treat leg cramps whether the person had malaria or not and that seemed to work very well.  Many years ago, Pfizer pharmaceutical company released an over-the-counter product called Legatrin.  This had about 300 mg of quinine in each pill and worked very well for a large number of people who took one of these before they went to bed at night to prevent charley horses in the night.  The pill seemed to work remarkably well and there are many people that swear by their use.

            Unfortunately, like any medication, quinine does have side effects.  There is a relatively unusual blood condition called G6PD deficiency in which quinine will result in the breakup of the person’s red blood cells.  Sometimes in pregnancy, quinine can result in very low blood sugars.  Ringing in the ears (tinnitus) is relatively common, even with the small doses of quinine.  This same side effect occurs with aspirin.  Visual disturbances such as blurred vision and disturbed color can also occur in some few people taking quinine.  In larger doses than usually prescribed, nausea, vomiting, abdominal pain and diarrhea occur as a result of the irritation of the gastrointestinal tract.    The usual dose of quinine is 300 mg taken at bedtime.  The toxic or perhaps fatal dose of quinine is 2000 to 8000 milligrams or more than 6 tablets at one time.

            By 1992, the FDA had received a large number (157) reports of health problems related to quinine and elected to remove over-the-counter Legatrin from the market.  Subsequently, they withdrew even the use of quinine as a prescription.  Until recently somehow pharmacies still had the drug available but it appears now that it is not really available in the United States at all.

            Be that as it may, it is available in Canada.  Many of my patients have discovered this and asked for prescription so that they can send them to Canada and obtain the drug there.  All one has to do is pull up your search engine on the internet, type in the word quinine and a dozen Canadian pharmacies will appear for your use.  The price is around $42.00 for 84 pills mailed directly to you.  I have a number of patients that have elected to do this.

            There is a gigantic book called a PDR (physician’s desk reference).  This book lists every commercially available drug in pharmacies in the United States.  No matter which page you turn to or which drug you look at, there is a huge list of side effects.  Some drugs even have “black box warnings”.  But when the disease warrants, the risk of the drug is often worth effectively treating the disease.  It is the physicians and the patients judgement together to decide which drug should be used for which purpose.

            Speaking for myself, I have no problem with people using quinine for leg cramps.  A single pill taken at bedtime can lead to a very nice night’s sleep for those being awakened with severe leg cramps.  Obviously, the medications should be kept out of the reach of children, use only one tablet at a time and if side effects occur, the medication should be stopped.  Short of these precautions, I don’t understand why the FDA decided that this particular drug of all of the many on our market should be removed.

            For those who don’t want to use quinine or are spooked by the side effects, there are other things one can use.  Perhaps the most common one I hear about people using is potassium supplements and I don’t think these work worth a hoot.  The real answer on what causes leg cramps is excessive acid and not enough oxygen getting to the muscle.  One of the best ways to effectively treat leg cramps is with extra Tums (calcium carbonate) taken to the evening prior to going to bed.  Two Tums after supper and another two at bedtime will often be more than enough to turn off leg cramps in many people. For a quicker although somewhat more harsh treatment, the use of plain old Arm & Hammer baking soda can be equally effective by neutralizing the acid in the muscles.  That stuff is really cheap and effective.  The side effect is that it causes fluid retention, a slight increase in blood pressure or maybe a big increase in blood pressure and can contribute to heart failure symptoms.

            Obviously, the best way to avoid leg cramps is not to overexert but as Americans we are just not very good at that.  We go walk pheasant fields six or seven miles one day when we haven’t walked a mile a day for three months.  No wonder we get leg cramps.   Sometimes, big days of exertion are just not avoidable and leg cramps are a predictable likelihood. Any of the steps above, might be some help.  Prescriptions for quinine can be obtained from your local healthcare provider to mail on to Canada if a person were to choose this method of dealing with their problem

This and other columns available at www.macpierre.com.