What do you do for muscle cramp pain? Some people use massage, and others swallow a spoonful of yellow mustard. Even though pharmacies are busting at the seams with medications, there is not one single FDA-approved drug to treat a very common complaint—muscle cramps! By far the most popular preventive used to be quinine tablets. At one time, doctors would prescribe them. However, the FDA has restricted quinine to be used only for the treatment of malaria. After all, quinine can cause a range of very severe reactions, some of which can be lethal (American Journal of Hematology, May 2016). On the other hand, the agency has done nothing to limit access to tonic water. Several brands of the beverage still contain quinine. Can tonic water help ease muscle cramps?
The History of Quinine for Muscle Cramp Pain:
Quinine was one of the oldest drugs in the pharmacy, going back even before the Spanish conquest of the New World. An Augustinian monk wrote about the uses of the “fever tree” in 1633, but he did not discover this miraculous medicine independently. Native healers in Peru had been using cinchona bark to treat fever, especially malaria, for a very long time. The Jesuits recognized cinchona as a good thing and were trading it to Europe by the 1640s.
Quinine was prescribed to help control symptoms of malaria for hundreds of years. By the early 20th century, people in the US were not very worried about malaria. On the other hand, they embraced quinine to ease muscle cramps (Neurology, Feb. 22, 2010). For almost 100 years doctors prescribed this natural compound to ease involuntary painful muscle contractions.
Quinine for muscle cramp pain was even available over the counter as Legatrin, Quinamm and Q-vel. But in 1994 the FDA banned OTC quinine and followed up in 2006 by eliminating prescription quinine for any use other than malaria. The agency was worried about serious side effects including life-threatening anemia, irregular heart rhythms, visual disturbances, rash, headache and digestive distress.
Quinine in Tonic Water:
Banning quinine left patients with no FDA-approved treatment options. As a result, people have come up with their own interesting ways to combat cramps.
One reader shared her approach for cramps from dancing:
“I suffer from cramps quite frequently. Since the pills I used to buy over the counter are no longer available, I now take magnesium supplements daily.
“The worst cramps are usually after we’ve been to a dance (ballroom and Latin), so I started drinking gin and tonics during the evening. That didn’t stop the cramps entirely, but they weren’t nearly so prolonged or vicious.
“Last night we went to a dance and I didn’t have any tonic. I had the worst night of leg cramps ever! Every 45 to 60 minutes it would hit both feet and calves simultaneously. It was excruciating! I had a total of six bouts during the night, so I have sore legs this morning. Of course, I also feel drained from lack of sleep.
“Despite my husband’s skepticism, I’m going back to gin (with plenty of tonic) at the next dance. In fact, the difference was such that I’m planning to drink some tonic every day from now on.”
What is it about tonic that helped this woman with her leg cramps? Quinine, of course. The FDA has not banned quinine from tonic water. The amount you get from half a small bottle would be around 10 mg.
How Quinine Works Against Muscle Cramp Pain:
We even know how quinine works. This bitter compound activates transient receptor potential (TRP) channels in the mouth, throat and stomach. So do vinegar and yellow mustard. When one of these compounds activates the TRP channels, it reverses the inappropriate nerve stimulation causing the cramp. Even a small dose could make a difference through this pathway.
Other readers have also shared their experience with tonic water.
Is Quinine in Tonic Water Effective Against Nighttime Leg Cramps?
Q. I have suffered from nighttime leg cramps for years. This agonizing muscle cramp pain affected my sleeping habits. Recently, I read that quinine contained in tonic water is effective in treating leg cramps.
I’ve been drinking half a small bottle of tonic every night for the past six nights and the cramps have disappeared. Have you had experience with this treatment?
A. Doctors used to prescribe quinine to treat leg cramps. In fact, quinine was once sold over the counter for this purpose. The dose of quinine that many doctors prescribed was 200 to 300 mg.
Many other readers, like the one who follows here, have also shared success stories with tonic water against nighttime leg cramps.
Tonic Water for Muscle Cramp Pain Was a Game Changer:
Q. For years, I’ve suffered severe muscle spasms all over my body. One cramp would begin, and I’d stretch the muscle to try to rid myself of it. No sooner would it start to relax than another would begin. The pain would be excruciating, with tears and exhaustion following.
My doctor did not seem very concerned, although he prescribed muscle relaxers. These never did help, even when he doubled the dose and I took them three times a day. I often wondered how I could continue to live this way.
Finally, someone suggested tonic water, and it changed my life. I can’t believe the relief I’ve gotten. Each night I open a can of tonic water and let it sit because carbonation bothers me. Once it is flat, I drink the full can and haven’t suffered a cramp since.
What Does Quinine Do?
A. We used to think that the small amount of quinine (20 mg) in a glass of tonic water would be inadequate to prevent or treat muscle cramps. That’s because doctors used to prescribe 200 to 300 mg of quinine for patients with leg cramps.
Nonetheless, many readers have stories similar to yours. We now think we have figured out the explanation.
Quinine and TRP Channels:
Quinine stimulates a specialized channel on cell membranes called TRPM7 (British Journal of Pharmacology, June 2012). Such transient receptor potential (TRP) channels are found on nerves throughout the body. Activating them through the TRP channels appears to reverse the nerve hyperactivity that causes muscle spasms and results in muscle cramp pain. In addition, other things can trigger TRP channels. They include vinegar, ginger, garlic and chili peppers. We suspect that tonic water has a more pleasing flavor for managing muscle cramps.
Learn More:
You can learn more about TRP channels and how they can be utilized to reverse muscle spasms by listening to our interview with Dr. Bruce Bean, neuroscientist and co-founder of HotShot. It is Show 1054: The Scientific Explanation for a Weird Remedy. To learn more about the science behind this and many other simple treatments you may also find our eGuide to Favorite Home Remedies of interest.
