Dear Nellie

You are quite right that the FDA has stopped the over-the-counter marketing of quinine for leg cramps. There are important side effects that can occur, especially thrombocytopenia. Patients with CLL who are put on quinine usually have regular blood tests to determine their platelet counts.

The reasons that the FDA gave were first, that leg cramps are not life threatening - but they can be very troublesome. The common cold is not life-threatening but that doesn't mean we wouldn't like a cure, please.

Second there hasn't been a controlled clinical trial to show that quinine works. But that is also true for a lot of old remedies. A lot of patients will testify that quinine does work for leg cramps, but because it is an inexpensive drug and a non-life-threatening illness no-one is ever going to invest the time and money in doing a clinical trial - unless it is the patients themselves.

Third because the health risks outweigh the possible benefits. That is a judgement call. Over a period of 23 years the FDA averaged one report a year of death following quinine. I guess most of them would be due to thrombocytopenia which should certainly be monitored when patients take quinine. The other side effects were temporary sight and hearing disturbances, dizziness, fever, nausea, vomiting, and diarrhea. Although, these can be troublesome they would not be a reason for stopping marketing quinine.

I do not think that I would be deterred from prescribing quinine for leg cramps in CLL because of the FDA warning, but I would definitely monitor the platelet count.