Use of quinine for common cramps in nonathletes has been controversial. In 1994 the Food and Drug Administration (FDA) issued a statement banning over-the-counter sale of quinine for nocturnal leg cramps, citing lack of adequate data to establish efficacy and concern for potential toxicity.5 Between 1969 and 1990 the FDA received 26 adverse reaction reports in which quinine was concluded to be the causative agent. The 3 studies discussed above consistently mention only tinnitus as likely related to quinine use. However, the descriptions and inference testing of side effects were inadequate in each study.
Of note, quinine is a category X drug and should not be used during pregnancy.6
Recommendations from others
No specific recommendations exist regarding the use of quinine in athletes. The American Medical Society of Sports Medicine recommends rest, stretching, and oral hydration for simple heat cramps, and intravenous fluids for very severe cases.7 Several texts also recommend rehydration with an oral electrolyte solution, as well as rest, stretching, and massage.8-10
CLINICAL COMMENTARY
Hydration and salt intake best approach for cramping in athletes
Sourav Poddar, MD
Team Physician, University of Colorado Buffaloes, University of Colorado Health Sciences Center, Denver
The use of quinine for the treatment or prevention of leg cramps in young adult athletes is not well studied. Safety and efficacy issues make it an unappealing option in the treatment of cramps and consequently it is not recommended for use in athletes. Hydration before, during, and after activity remains the cornerstone to approaching cramping in athletes. Appropriate salt intake for those who lose high concentrations of salt in their sweat may also be useful in prophylaxis. Once cramps occur, rehydration, stretching, massage, and rest work best.