![]() ![]() quinine is not a routine treatment for nocturnal leg cramps, and should only be used when cramps regularly disrupt sleep.It also has significant toxicity in overdose, which can result in death or permanent visual loss. Quinine has a number of potentially significant drug interactions, including with digoxin and warfarin. Patients should be instructed to stop treatment and consult a physician if signs of thrombocytopenia occur, such as unexplained petechiae, bruising, or bleeding. Quinine should not be prescribed to patients who have previously experienced any adverse reaction to quinine, including that found in tonic water or other beverages. A small number of deaths linked to thrombocytopenia have been reported in patients taking quinine for the treatment of leg cramps, including two cases in the UK Yellow Card database. Treatment should be stopped if these occur.Ī rarer but more serious adverse reaction is thrombocytopenia, thought to be a hypersensitivity reaction. Quinine tablets are generally well tolerated at the doses used for treatment of leg cramps. Summaries of product characteristics and patient information leaflets are being updated, and should be consulted for safety information. In patients taking quinine long term, a trial discontinuation may be considered. Treatment should be interrupted approximately every 3 months to reassess the benefit. After an initial trial of 4 weeks, treatment should be stopped if there is no benefit. Patients should be monitored closely during the early stages of treatment for adverse effects. when non-pharmacological measures have not worked (eg, passive stretching exercises)Ī reduction in frequency of leg cramps may take up to 4 weeks to become apparent. ![]() when other treatable causes of cramp have been ruled out.when cramps are very painful or frequent.Before use for nocturnal leg cramps, the risks should be carefully considered relative to the potential benefits. Quinine should not be considered a routine treatment for nocturnal leg cramps, and should only be considered when cramps cause regular disruption of sleep. Patient selection and clinical monitoring The quinine salt should always be stated when prescribing because 200 mg quinine sulphate is equivalent to around 300 mg quinine bisulphate. The licensed dose for the treatment and prevention of nocturnal leg cramps in adults is 200–300 mg at night for quinine sulphate (recommended starting dose 200 mg), and is 300 mg at night for the bisulphate. Hence patients had around 20% fewer cramps in this period-around 1 episode a week difference-when taking quinine compared with placebo. A meta-analysis of eight randomised placebo controlled trials reported that the mean number of cramps in a 4-week period while taking placebo was 17♰8 and the absolute reduction in cramps while taking quinine was 3♶ (95% CI 2♲–5♱). Although patient response may vary, overall efficacy is modest. Quinine has been used in the UK for the treatment of nocturnal leg cramps for many years. See Drug Safety Update volume 11, issue 4 November 2017: 2. Updated advice has been issued on the dose-dependent QT-interval-prolonging effects of quinine. ![]()
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