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Quinine

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jennyjoan | 16:03 Tue 22nd May 2018 | Body & Soul
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Anybody tell me what it is really for - have looked it up and it is supposed for Malaria
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It's no longer the first line treatment for Malaria but may be used in some circumstances, also it's use for leg cramps has fallen away too.

I'm sure someone will know more.
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No it's ok Mamy - neighbour is on 12 medications and she didn't know what any of them were for.

So I googled them all and they are mostly related to her diabetes, etc. Quinine was at the top. What I got on google was for Malaria but now leg cramps cold be the reason. According to google the quinine was supposed to be off the market but I wouldn't get involved in her medications so if she asks me again - will say it is relevant to her leg cramps.
Are you getting quinine mixed up with quinidine?

Quinidine is still used for certain irregular heart conditions.
I had severe nightly leg cramps a couple of years back and asked the doctor about quinine tablets.I was asked to consider the possible side effects before being prescribed them . Some of the side effects were very serious and although I know that what affects one person may well not do the same to another I did not want to take the risk. I decided against taking quinine tablets.
It's true that quinine was once the principal treatment for malaria, but this is no longer the case. In the UK, the drug watchdogs, MHRA and NICE do not approve the prescribing of quinine. The reasons for their decisions are manyfold, but do include such things as quinine's ability to cause heart rhythm disturbances and no clear evidence that it is of any use for one of it's historical uses, the treatment of leg cramps and restless legs.

All the same, millions of prescriptions for quinine are issued each year in the UK to treat leg cramps etc usually when other treatments have failed.

The inclusion of quinine in foodstuffs is probably one of the biggest uses of quinine today. Historically, it was used to impart bitterness to a product and it's used for the purpose in Indian Tonic Water and Bitter Lemon mixers. In the UK, Indian Tonic Water contains about 90mg of quinine per liter with Bitter Lemon slightly less. So every time you have your G nd T, you're taking in a small amount of quinine. Natural quinine is derived from Cinchona tree bark, also known as The Fever Tree and that's where the premium tonic water called Fever Tree got it's name.
Quinine has a very interesting molecular structure and Indian Tonic Water glows brightly when exposed to UV light due to fluorescence. In fact, quinine is used as a type of standard in laboratory photochemistry.

Quinine is also used in some very specialised chemical synthesis reactions during the manufacture of certain other chemicals produced in industrial quantities. However, virtually all the quinine used in these reactions is synthesised and doesn't originate from the Cinchona tree.

Years ago, a condition called Cinchonism was common in those taking quinine and to some degree, you can still get mild symptoms of it nowadays from prolonged or excessive use of Indian Tonic Water or Bitter Lemon mixers. Symptoms include blurred vision, headache, sweating, heart rhythm disturbances and hearing problems so if you notice any of these, cut back on the mixers! I speak from experience about this as a distant uncle of mine drank Indian Tonic Water instead of tap water for years - he even made tea out of ITW by boiling it in a kettle instead of tap water and yes, he had all the symptoms described.
Crikey prof
My wife and myself drink a bottle each of Indian tonic water per day- 250 ml

Is that too much from an health point of view?

Also why do they deliberately add it to Indian tonic water to give it the bitter taste ?
Bazile, I don't know about you, but I glow more brightly after a G&T.

I take quinine pills very sparingly if I've had a bad cramp and don't want another one the next night. I also have tinnitus, and apparently quinine can make that worse, so that's why I don't take them often.
You're fine Bazile. A 250 ml bottle contains no more than about 23mg of quinine which is perfectly OK. You need not worry about ingesting that amount.

ITW was originally formulated as a prophylactic for malaria in the Africa and Southern Asia. The quinine it contained was intended to treat mild malaria in those that had succumbed to it. Pure quinine powder is extremely bitter so it became commonplace to mix the quinine with carbonated beverages such as soda water in these countries. This mix became Indian Tonic Water. The bitterness of ITW was missed by those that returned to the UK from these countries so Schweppes and other manufacturers continued to include quinine in the UK versions of ITW. Bitter Lemon has a similar history.

The quinine content of ITW nowadays is far less than it used to be in those days. Typically, it was not unknown for locally produced versions of ITW to contain around 400mg of quinine per litre. This dosage can cause major heart arrhythmias along with heart block, both of which were potentially fatal.
The problem with quinine is that there is no official toxic dose. Standard toxicity handbooks such as Sittig emphasise the issue and concede that some people are more sensitive to quinine than others. Certainly drinking litres of ITW daily would be risky but the European food authorities don't have any major concerns.

The situation in the USA is completely different and quinine is largely discouraged by the FDA with restrictions on prescribing and the banning of OTC preparations in the majority of States. Many pharmaceutical preparations containing quinine have been banned in the USA in the last twenty years.

I'm a visiting professor at 5 of the 8 Ivy league universities in the USA and I'm fond of the odd G&T myself. I have had some odd experiences when trying to purchase ITW when I'm over the pond - some major stores ban home delivery of ITW and you have to pick the stuff up in person at the supermarket.

Ok ,thanks for that , prof
So, prof, if I was or drink say between half a litre and a litre of ITW a day, would that potentially have an effect on my heart?
>>> All the same, millions of prescriptions for quinine are issued each year in the UK to treat leg cramps etc usually when other treatments have failed

Relevant to that:
https://www.gov.uk/drug-safety-update/quinine-not-to-be-used-routinely-for-nocturnal-leg-cramps

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