Cochrane for Clinicians

Putting Evidence into Practice

Quinine for Leg Cramps


Am Fam Physician. 2016 Feb 1;93(3):177-178.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are quinine-based agents safe and effective in treating muscle cramps?

Evidence-Based Answer

Quinine is moderately effective in decreasing the frequency and intensity of muscle cramps, but it is also associated with an increase in minor adverse effects. In addition, there is a risk of rare but serious adverse effects. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Muscle cramps affect between 50% and 60% of adults.1 Little is known about their pathophysiology, so many remedies are used empirically. A crystalline alkaloid powder extracted from the bark of the South American cinchona tree, quinine is well known for its use in treating malaria and providing the bitter flavor for tonic water. Quinine has been used by the Quechua of South America for medicinal purposes for centuries, and has been researched since the 1930s and 1940s as a cure for muscle cramps.2 However, quinine is not without adverse effects, and the U.S. Food and Drug Administration withdrew the indication for treatment of muscle cramps because of reports of serious adverse effects such as hemolytic uremic syndrome, disseminated intravascular coagulation, and arrhythmias.3 Despite this, many patients still request quinine

Author disclosure: No relevant financial affiliations.


El-Tawil S, Al Musa T, Valli H, et al. Quinine for muscle cramps. Cochrane Database Syst Rev. 2015;(4):CD005044.


show all references

1. Allen RE, Kirby KA. Nocturnal leg cramps. Am Fam Physician. 2012;86(4):350–355....

2. Katzberg HD, Khan AH, So YT. Assessment: symptomatic treatment for muscle cramps (an evidence-based review): report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2010;74(8):691–696.

3. U.S. Food and Drug Administration. Questions and answers about FDA's enforcement action against unapproved quinine products. Accessed June 16, 2015.

4. Ohira A, Yamaguchi S, Miyagi T, et al. Fixed eruption due to quinine in tonic water: a case report with high-performance liquid chromatography and ultraviolet A analyses. J Dermatol. 2013;40(8):629–631.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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