Tonic Water, Quinine Side Effects & Tinnitus

There was a time when you could buy quinine tablets over the counter in the United States. That was so long ago that very few people remember brands such as Legatrin, Quinamm or Q-vel. People took this bitter pill to prevent nighttime (nocturnal) leg cramps. But because of serious quinine side effects, the FDA banned OTC sale in 1994. You can read about quinine dangers and the FDA ban at this link. Doctors can still prescribe quinine, but only for the treatment of symptoms of malaria.

What About Tonic Water? Is It Safe?

Most people don’t think twice about drinking tonic water. It has a distinctive flavor. Some might call it bitter. Others might describe it as citrusy, especially when combined with gin and a little lime juice. The classic gin and tonic drink contains 2 ounces of gin, 4 ounces of tonic water and a lime wedge. If no lime is available, a squeeze of lemon will do in a pinch.

But if quinine is so dangerous in pill form, why would it be safe in tonic water? Part of the answer lies in the dose. Doctors prescribed anywhere from  200 to 300 mg of quinine to prevent leg cramps. A 6 ounce glass of gin and tonic would have less than 20 mg of quinine. But some people are so sensitive to quinine that even that amount might pose problems.

A reader wants to know if tonic water could trigger tinnitus:

Q. Is it possible that the tonic water I drink every day to prevent leg cramps could be causing tinnitus? I would hate to give up tonic because it works so well for me against cramps. But the ringing in my ears is driving me nuts. Help!

A. Some people are actually quite sensitive to the quinine in tonic water that gives tonic water its distinctive flavor.

Several years ago we heard from one person who reported:

“I have just developed a hissing sound in my ears. The onset was very rapid!

“The doctor diagnosed it as tinnitus, but would give me no reason for the problem. He said there wasn’t anything I could do. I’ve noticed some days it is less disturbing than others but some nights it awakens me because it has become so loud.

“I was drinking large quantities of tonic water, which contains quinine, when this started. Do you have any suggestions to help me?”

Our recommendation is to quit the tonic water. Although quinine has been used for hundreds of years to control symptoms of malaria, some people are very sensitive to side effects, even in the low doses found in a glass of tonic water (20 mg or less).

Another reader reported:

“I have been suffering with leg cramps for years and years. Recently my doctor told me about tonic water with quinine. It does help the leg cramps, but it is making me feel ill. My symptoms include fatigue, nausea and vomiting. I have been very tired and want to sleep all the time, which isn’t like me. I am desperate to try something that works without side effects.”

For those who are super sensitive to quinine, the complications can be life threatening as they were for this reader:

“Quinine in tonic water proved almost fatal for me. Nighttime leg cramps have been an ongoing problem, so I bought a bottle of tonic water.

“On Saturday I had a 5-ounce glass before supper. Sunday morning by 9 am I was in the emergency room with a frightening skin reaction. I was hospitalized for many days and diagnosed with a dangerous blood disorder called idiopathic thrombocytopenic purpura (ITP). My blood doctor said it was triggered by the quinine water.”

ITP can be fatal in extreme cases. It is a good thing this person acted so promptly. Other complications o fquinine include:

QUININE SIDE EFFECTS:

• Digestive upset, nausea, stomach cramps, vomiting
• Ringing in the ears, hissing, buzzing (tinnitus)
• Headache, anxiety, confusion, drowsiness
• Visual disturbances, blurry vision, double vision
• Irregular heart rhythms
• Fever, flushing, fatigue
• Skin rash
• Unusual bleeding

Other Leg Cramp Remedies:

There are lots of other ways to prevent or treat leg cramps.

• Soap under the bottom sheet
• A teaspoon of yellow mustard
• A jigger of pickle juice

Learn More:

Anyone who loves home remedies in general or is seeking leg cramp solutions in particular, may find our book, The People’s Pharmacy Quick & Handy Home Remedies, quite helpful.

Please share your own quinine story in the comment section below. And please pass this article on to friends and family. You never know who might be sensitive to quinine side effects.