The short answer is that unfortunately there is no real alternative to quinine for treating cramp.
There have been both local and international reports of thrombocytopenia associated with quinine use. This is thought
to be an idiosyncratic hypersensitivity reaction which has a short time to onset and can be severe. Discontinuing quinine,
should symptoms of thrombocytopenia occur, may not necessarily prevent serious consequences. For these reasons quinine
is no longer indicated for the treatment of leg cramps.1
The first step for treating cramp is to exclude other possible causes. Some medicines that have been reported to cause
leg cramp include diuretics, calcium channel blockers (especially nifedipine), beta-agonists, steroids, and fibrates.2,
3, 4 Medical conditions associated with leg cramps include fluid and electrolyte disturbances, uraemia, diabetes,
and thyroid disease.2, 3, 4
There are limited options to prevent leg cramps however some suggestions include:2, 3, 4, 5
- General measures to improve sleep such as avoiding alcohol and caffeine-containing drinks before bed, and not going
to bed until tired.
- Stretching calf and foot muscles before going to bed and intermittently during the day.
- Drinking plenty of fluid during the day to avoid dehydration. But avoid drinking too much as this can dilute the
concentration of sodium in the blood which can also cause leg cramps. About six to eight glasses may be appropriate.
- Wearing good shoes may help as flat feet and other structural problems may make some people more susceptible to
- Avoiding tight or heavy bed covers may help as this can tighten calf and foot muscles. Loosening the covers or sleeping
on the stomach with feet hanging over the bed can keep muscles relaxed.
While there is limited evidence of the effectiveness of these measures they are generally safe and worth suggesting
to patients suffering from leg cramps.
Dietary supplements such as magnesium and vitamin E have been suggested as possible remedies for leg cramps however
the evidence of their effectiveness is lacking.6
Note: tonic water contains a very small amount of quinine. There have been isolated reports of adverse effects
such as thrombocytopenia and skin reactions in people drinking large quantities, however, this is rare. Consuming normal
quantities is unlikely to offer any benefit for treating leg cramps.
- Prescriber Update, Medsafe. Nov 2007. Available from;
- Riley J, Antony S. Leg cramps: Differential diagnosis and management. Am Fam Physician 1995; 52(6): 1794-1798.
- Butler JV, Mulkerrin EC, O'Keeffe ST. Nocturnal leg cramps in older people. Postgrad Med J 2002; 78: 596-598.
- Kanaan N, Sawaya R. Nocturnal leg cramps: Clinically mysterious and painful – but manageable. Geriatrics 2001; 56(6):
- Harvard Medical School Health. Five ways to prevent night time leg cramps. Harv Health Lett 2004; 30(2): 6.
- Clinical Evidence. BMJ Publishing Group Limited 2008. Available from