Bike Rider Routs Cramps with Quinine

Q. I recently heard that the FDA will no longer allow quinine sulfate to be used for treating leg cramps. My internist prescribes quinine sulfate for me. I use the drug only when I go on 90-mile bike rides. If I do not take quinine, I get leg cramps when I am riding and later that night when I am sleeping.

I have found that if I take three 260 mg tablets the leg cramps do not occur. I take one tablet the night before the ride, one tablet the morning before the ride and one tablet after the ride. This a total of 780 mg of quinine sulfate in a 24-hour period. My internist says this is the maximum amount.
Quinine sulfate is the only thing that prevents these cramps. If this drug is unavailable and I cannot figure out some other remedy, I will have to curtail my cycling.
I understand tonic water also has quinine in it, but I don’t know how much. Is it realistic to expect to get 780 mg of quinine from drinking tonic water?
A. The FDA has virtually banned quinine as a treatment for leg cramps. Serious side effects such as headache, nausea, diarrhea, rash, ringing in the ears, liver damage, irregular heartbeats, birth defects and a life-threatening blood disorder convinced the agency that this drug is too dangerous to use for leg cramps.
Tonic water is flavored with quinine, but the amount varies from brand to brand. Some may contain as much as 80 mg per quart. Even then, you would need nearly ten quarts to get 780 mg. That much tonic water would be hazardous to your health.
In the absence of quinine, our Guide to Leg Pain offers many home remedies for cramps. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. RLS-5, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.
Q. I read your column about the problem the man has with his blood pressure pills and his sex life. My cardiologist prescribed Altace and that did the trick.
A. Altace (ramipril) is an ACE inhibitor. Such blood pressure medicines are less likely than many others to cause sexual dysfunction, but not all patients can tolerate these drugs. Thanks for sharing your experience.
Q. My husband is 55 years old, 6 feet tall and 180 pounds. He has been on Lipitor for two years.
His LDL is still above 210. He hasn’t changed his diet of bacon cheeseburgers, steak, French fries, cookies and ice cream, however. He also has two or three drinks a day because he read that this might help lower cholesterol.
I understand that alcohol should be limited for someone who is taking Lipitor, but his physician has mentioned neither diet nor alcohol.
Can you give him some advice as to a healthy diet and recommended alcohol intake?
A. Lipitor is a powerful cholesterol-lowering drug but is no substitute for a sensible diet. The manufacturer clearly states that Lipitor is to be used in addition to a low-fat diet, exactly the opposite of your husband’s eating habits.
As for alcohol and Lipitor, the prescribing information warns: “Atorvastatin should be used with caution in patients who consume substantial quantities of alcohol.” Three drinks daily could be considered “substantial quantities.” The combination could increase the risk of liver damage.