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Quinine sulfate is a cinchona alkaloid best known for its use as an antimalarial. Although controversial, many clinicians believe that the drug is useful in the treatment of nocturnal leg cramps. The drug reportedly produces its effect on skeletal muscle via an increased refractory period, reduced excitability of the motor end plate to acetylcholine, and redistribution of calcium within the muscle fiber. After oral ingestion, the drug is well absorbed, metabolized by the liver, and excreted in the urine. 

Quinine is used alone or with other medications to treat malaria (a serious or life-threatening illness that is spread by mosquitos in certain parts of the world). Quinine should not be used to prevent malaria. Quinine is in a class of medications called antimalarials.

Quinine sulfate has a plasma half-life of 4 to 5 hours. Some individuals are hypersensitive to quinine sulfate and develop thrombocytopenia purpura, which may be life-threatening. Visual disturbances, nausea, vomiting, and skin rash have also been reported. The drug may increase plasma levels of digoxin and may potentiate the effects of neuromuscular blocking agents due to its curariform-like effects. Cinchonism does not usually occur at doses used to treat leg cramps. The drug is supplied as 260-mg tablets, and the recommended dose is 1 or 2 tablets nightly.

Quinine sulfate at a dose of 200–300 mg at night has been used for many years to treat nocturnal leg cramps. Usually idiopathic, these muscle cramps are common, particularly in older patients. Quinine may help by decreasing the excitability of the motor end-plate and increasing the muscle refractory period.

Quinine sulfate is a medication that is derived from the bark of the cinchona tree and is commonly used to treat or prevent malaria. It is a specific salt form of quinine, which is an alkaloid with antimalarial properties. Here are the primary applications of quinine sulfate:

1. Treatment of Malaria: Quinine sulfate has been used for centuries as a treatment for malaria, a mosquito-borne infectious disease caused by Plasmodium parasites. It works by interfering with the growth and reproduction of the parasites within the red blood cells. However, due to the development of resistance in some regions, quinine sulfate is now often used in combination with other antimalarial drugs.

2. Prevention of Malaria: Quinine sulfate can also be used as a prophylactic treatment to prevent malaria in individuals traveling to regions where the disease is prevalent. It helps to reduce the risk of infection by suppressing the activity of the malaria parasites in the bloodstream.

3. Off-Label Uses: Quinine sulfate has been used off-label for various medical conditions, such as treating leg cramps and muscle spasms. However, its use for these purposes is generally not recommended due to potential side effects and the availability of safer alternatives.

4. In the food sector : quinine is used as a flavouring mainly in beverages like bitter lemon and tonic water. When larger amounts of quinine are consumed, it can constitute a health problem for some consumer groups. Historically, tonic water contained very high levels of quinine and was extremely bitter, requiring sugar and, at times, gin to improve the flavor profile.
5. Quinine sulfate at a dose of 200–300 mg at night has been used for many years to treat nocturnal leg cramps. Usually idiopathic, these muscle cramps are common, particularly in older patients. Quinine may help by decreasing the excitability of the motor end-plate and increasing the muscle refractory period.

It’s important to note that quinine sulfate is associated with potential side effects and risks, especially when used for extended periods or at high doses. Common side effects include nausea, vomiting, headache, ringing in the ears (tinnitus), and changes in vision. In severe cases, quinine can cause more serious side effects, including cardiac arrhythmias and a potentially life-threatening condition known as quinine-induced thrombocytopenia.

Quinine sulfate should only be used under the guidance of a qualified healthcare professional, especially for the treatment of malaria. The choice of antimalarial medication and dosage depends on factors such as the specific type of malaria parasite, the region of travel, the patient’s medical history, and potential drug interactions.