Quinine

As early as the 17th century, Quinine was determined to be one of the first effective treatments for falciparum malaria. Quinine is available with a prescription in the United States. Quinine is also used to treat nocturnal leg cramps and arthritis.  Quinine is a bitter white powder that is obtained from the bark of the cinchona tree that is found in the Andes mountain range of Ecuador and Peru and is used to make tonic water.

Why Prescribed

Quinine is used to treat malaria.  Although it is often prescribed, the FDA has not approved quinine to treat nocturnal leg cramps and arthritis.

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FDA Approved Uses

Due to fatalities resulting from unapproved quinine products, as of 2007, only one drug containing quinine is FDA approved for the treatment of malaria which is manufactured by Mutual Pharmaceutical Company, Inc. (Mutual), of Philadelphia, PA. It contains quinine sulfate as the active ingredient without any additional active ingredients in 324 mg capsules and is sold under the trade name Qualaquin (quinine sulfate) with the following NDC number: 13310-153-07. At this time, there is no evidence of any shortages or limited availability of quinine. If a pharmacy has difficulty obtaining Qualaquin, they may contact Mutual at 215-697-1900.

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Side Effects

Contact your doctor if these side effects persist: stomach pain, vomiting, dizziness, headache, sweating, restlessness, confusion or apprehension.

Contact your physician immediately if you experience any of the following side effects while taking quinine:

• skin rash
• difficulty breathing
• swelling of the face
• fever
• vision problems or changes
• difficulty hearing or ringing in the ears
• faintness
• easy bruising
• unusual bleeding
• sore throat
• fast heartbeat
• chest pain

Also, tell your doctor if you have ever had any unusual or allergic reaction to quinine, quinidine (e.g., Quinidex), or to dietary items that contain quinine, such as tonic water or bitter lemon. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.^ Back To Top

Warnings and Alerts

The FDA has issued serious safety alerts and concerns, including fatalities, associated with drug products containing quinine. Other documented warnings for symptoms include tinnitus, dizziness, disorientation, nausea, visual changes, and auditory deficits.

There is also evidence that quinine causes serious cardiac arrhythmias including torsades de pointes. People taking quinine are at risk of developing hypersensitivity to the drug and experiencing a serious, life-threatening, or fatal reaction as a consequence. Serious adverse reactions associated with quinine use also include severe skin reactions, thrombocytopenia (a decrease in blood platelets that can cause hemorrhage or clotting problems) and other serious hematological events including permanent visual and hearing disturbances, hypoglycemia, renal failure and generalized anaphylaxis.

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Drug Contraindications

Quinine is not recommended for use with Mefloquine (e.g., Lariam). Although Quinine has been used for the treatment of malaria in pregnant women, it has been shown to cause birth defects in rabbits and guinea pigs and has also been shown to cause rare birth defects, stillbirths, and other problems in humans. In addition, quinine has been shown to cause miscarriage when taken in large amounts.

Those suffering from the following conditions should not take Quinine: Blackwater fever, Glucose-6-phosphate dehydrogenase (G6PD) deficiency or Purpura, history of (purplish or brownish-red discoloration of skin), heart disease, hypoglycemia and Myasthenia gravis.

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FAQ's

Why did the FDA pull Quinine products from the market?

The FDA has gathered dangerous statistics revealing fatalities caused by quinine. From 1969 through September 11, 2006, FDA received 665 reports of adverse events with serious outcomes associated with quinine use, including, 93 deaths. The FDA discovered that many of the adverse events associated with quinine were not caused by the drug itself, but were dose-related. Also many of the adverse events were attributed to age-related issues more commonly seen in the elderly.

Tonic water contains Quinine, is it still safe to drink?

Tonic water contains less than 20 milligrams of quinine per six fluid ounces. The recommended quinine dosage for treatment of malaria is two or three 200-350 milligram tablets three times a day.  Because of its small doses in tonic water, it is considered harmless and has not been recalled by the FDA.

Can I file a lawsuit if I have suffered side effects from Quinine?

Depending on the severity of your symptoms, you may be able to file a lawsuit against a drug manufacturer of quinine. If you are considering legal action, obtain all of your medical records from your primary care physician as well as any specialists you have seen. Write a timeline as best you can with each event that lead up to taking the quinine.

Below is a starter list of questions you should try to answer. Take this information to your attorney and be as detailed as possible.

• When did you first take quinine?
• What symptoms were you having that caused you to take this drug?
• How often and how much did you take?
• Who prescribed quinine to you?
• What side effects have you experienced?
• When did you experience your first side effect?
• What are medications were you taking at the time?
• When did you stop taking quinine? 

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