Ping Tiger Lily
Question:
Hi Kate Just to let you know that I followed your advice re: the cramps thread and saw the Dr for a blood test. The electrolytes are fine, so presumably the brain lapses are the start of senile dementia (g). Or having too much on my mind… Mind you, the cramps are worse and the Dr has upped the strength of the Quinine Sulphate.
Response:
Hi Kate Just to let you know that I followed your advice re: the cramps thread and saw the Dr for a blood test. The electrolytes are fine, so presumably the brain lapses are the start of senile dementia (g). Or having too much on my mind… Mind you, the cramps are worse and the Dr has upped the strength of the Quinine Sulphate.
Hi Nancy I also suffer from cramps, but I’ve stopped using Quinine Bi-sulphate. Maybe you should have another chat with your doc, armed with this: From the Australian Therapeutic Goods Administration Quinine indications – cramps deleted http://www.tga.gov.au/adr/aadrb/aadr0410.htm#5 As a consequence of the risk of thrombocytopenia (currently 228 ADRAC reports; 6 fatal),1 quinine is no longer approved in Australia for the treatment of nocturnal cramps. Reference (below) 1. ADRAC. Quinine and profound thrombocytopenia. Aust Adv Drug Reactions Bull 2002;21:10. http://www.tga.gov.au/adr/aadrb/aadr0208.htm#2 Quinine and profound thrombocytopenia ADRAC has published 2 previous Bulletin articles about quinine and thrombocytopenia but continues to receive reports of this serious problem.1,2 Since 1972, ADRAC has received 571 reports of suspected adverse reactions to quinine (sulfate or bisulfate), including 198 reports of thrombocytopenia, 4 of which had a fatal outcome. Twenty of these have been received since the beginning of the year 2000. The reactions generally occurred within 3 weeks of commencing quinine although two with intermittent use had a longer time to onset. In two cases the reaction occurred soon after the first dose. Seventeen of the 20 reports documented a platelet count which ranged between 0 and 14 x 109/L and most described hospitalisation and treatment with platelet transfusion, corticosteroids or immunoglobulin. Five reports described a positive quinine antibody test. A recent illustrative report involved a 25 year old woman who had been taking quinine intermittently for nocturnal cramps. She had been taking about two tablets a week for 2 months. She presented with a generalised purpuric rash, and was found to have a platelet count of 5×109/L. Quinine was ceased, and she was hospitalised and treated with prednisolone and immunoglobulin. Her platelet count recovered to normal within a week. Drug-induced anti-platelet antibodies were detected. Prescribers should consider the risks and likely benefits before prescribing quinine for nocturnal cramps, and should also consider other causes of cramp (for example, salt depletion particularly in summer, electrolyte disturbance, peripheral vascular disease, motor neurone disease). Meta-analyses have found that quinine prevents on average one or two cramps per week compared to placebo, without reducing the duration or severity of cramps.3 In 1995, the American FDA withdrew the indication of nocturnal cramps from all quinine products, because of a lack of evidence of efficacy, and the Australian Medicines Handbook recommends against its use for this indication.4 Daytime passive stretching of the calf muscles may be effective in preventing nocturnal cramps.5 As illustrated in the case report above, thrombocytopenia usually recovers within a week of stopping quinine, but treatment with platelets, steroids or immunoglobulin may be required. Since quinine-induced thrombocytopenia occurs via an immune-based mechanism, patients should in future avoid all quinine-containing products, including drinks such as tonic water and bitter lemon. References 1. ADRAC. Cinchona alkaloids – the bite’s as bad as the bark! Aust Adv Drug React Bull 1988; December. 2. ADRAC. Quinine, cramps and cricket. Aust Adv Drug React Bull 1991; 10: August. 3. Anonymous. Quinine and cramp. Prescr Internat 2000; 9: 154-7. 4. Australian Medicines Handbook, 3rd edition, Adelaide: AMH: 2002. p. 585 5. Daniell HW. Simple cure for nocturnal leg cramps. N Engl J Med 1979; 301: 216. Cheers, Alan, T2 d&e, Australia. Remove weight and carbs to email. — Everything in Moderation – Except Laughter.
Response:
dang Pattie…… sorry to hear this ‘potential cause’ has been eliminated for you…… it’s an easy fix if it IS the cause the next step…… how close to menopause are you i swear, i lose brain cells every freaking night in the middle of the night sweats and insomnia just started to talk to a neighbour of mine…. she has the same extreme symptoms that i have…. and they are NOT pleasant at all 
sigh sure hope this change in the quinine works for you!!! kate — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/
– Hide quoted text — Show quoted text – Hi Kate Just to let you know that I followed your advice re: the cramps thread and saw the Dr for a blood test. The electrolytes are fine, so presumably the brain lapses are the start of senile dementia (g). Or having too much on my mind… Mind you, the cramps are worse and the Dr has upped the strength of the Quinine Sulphate.
Response:
Hi Kate
– Hide quoted text — Show quoted text – dang Pattie…… sorry to hear this ‘potential cause’ has been eliminated for you…… it’s an easy fix if it IS the cause the next step…… how close to menopause are you i swear, i lose brain cells every freaking night in the middle of the night sweats and insomnia just started to talk to a neighbour of mine…. she has the same extreme symptoms that i have…. and they are NOT pleasant at all sigh sure hope this change in the quinine works for you!!! kate —
Fortunately (or unfortunately….) the menopause is long behind me! I finished periods 8 years ago at age 50 and the other symptoms tailed off after a couple of years. I remember it well and the night sweats and other symptoms are *grim*!!! I recall saying at the time to a friend a couple of years younger than me "well, this is something mother never told me about, so I’m just warning you in case you think you’re dying in a couple of years time". However, something I noticed was that I didn’t have the forgetful symptoms on holiday, (at least after the first couple of days when I got into relaxed mode), so I guess it’s just too much going on in my head – stressful job etc!
Response:
- Hide quoted text — Show quoted text – Hi Alan Sorry, nearly got caught out answering earlier when I was at work! Not that I care that much as I am the supervisor of the person but I don’t like them to see me doing something which isn’t work! Got to keep the reputation up (ggg). I’ve been on the quinine for over a month now, it would seem that the people affected were affected pretty quickly so could it be that they were particularly vulnerable? I must say all these medications I am on do worry me and they seem to multiply every month! Patti Penzance, Cornwall Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7
The Milo Alan here 
With an excellent A1c like yours, why worry about the meds? — Alan de gustibus non disputandum est
Response:
Hi Alan Sorry, nearly got caught out answering earlier when I was at work! Not that I care that much as I am the supervisor of the person but I don’t like them to see me doing something which isn’t work! Got to keep the reputation up (ggg). I’ve been on the quinine for over a month now, it would seem that the people affected were affected pretty quickly so could it be that they were particularly vulnerable? I must say all these medications I am on do worry me and they seem to multiply every month! Patti Penzance, Cornwall Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7
Response:
Hi Alan The Milo Alan here With an excellent A1c like yours, why worry about the meds? I’ve a strong feeling that the next A1c won’t be nearly as good Several colds, a cortizone injection and changing basal haven’t helped… though I suppose it’s been more level and not so many lows. Did you mean why bother taking the meds?
No, i meant why bother about changing the meds. They are obviously doing the job they are supposed to, so don’t bother with increasing, decreasing, or changing. IOW, with a praiseworthy A1c like yours, you have little to worry about. Keep the meds, keep the exercise, keep the diet, and then we can all get envious lol — Alan de gustibus non disputandum est – Hide quoted text — Show quoted text – Patti Penzance, Cornwall Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7
Response:
Hi Alan The Milo Alan here With an excellent A1c like yours, why worry about the meds?
I’ve a strong feeling that the next A1c won’t be nearly as good Several colds, a cortizone injection and changing basal haven’t helped… though I suppose it’s been more level and not so many lows. Did you mean why bother taking the meds? Patti Penzance, Cornwall Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7
Response:
– Hide quoted text — Show quoted text – Hi Alan Sorry, nearly got caught out answering earlier when I was at work! Not that I care that much as I am the supervisor of the person but I don’t like them to see me doing something which isn’t work! Got to keep the reputation up (ggg). I’ve been on the quinine for over a month now, it would seem that the people affected were affected pretty quickly so could it be that they were particularly vulnerable? I must say all these medications I am on do worry me and they seem to multiply every month! Patti Penzance, Cornwall Novorapid as required Perindopril, aspirin, Lipitor & 50mg Thyroxin. A1c 5.7
Hi Patti, I’ve been using prescribed Quinine Bisulphate for years; I was aware that they could be dangerous, but I only took them on an "as required" basis when the cramps were particularly severe. Mine can get to the point where I fear bone breakage – although that hasn’t happened yet. But I doubt that I’d have taken 20 tablets in a year. I’ve never had any side effects, although once is enough for a fatal one:-( The warning I quoted was enough for me to finally decide not to take the risk any more. You’ll have to chat with your doc for any further advice on it. I also suggest you discuss Alan’s (Milo) comments with the doctor. I am not a one to use meds unless they are definitely needed. Cheers, Alan, T2 d&e, Australia. Remove weight and carbs to email. — Everything in Moderation – Except Laughter.
Response:
Oh, my God, Alan! I will certainly be showing that to the doc!
– Hide quoted text — Show quoted text – Hi Kate Just to let you know that I followed your advice re: the cramps thread and saw the Dr for a blood test. The electrolytes are fine, so presumably the brain lapses are the start of senile dementia (g). Or having too much on my mind… Mind you, the cramps are worse and the Dr has upped the strength of the Quinine Sulphate. Hi Nancy I also suffer from cramps, but I’ve stopped using Quinine Bi-sulphate. Maybe you should have another chat with your doc, armed with this: From the Australian Therapeutic Goods Administration Quinine indications – cramps deleted http://www.tga.gov.au/adr/aadrb/aadr0410.htm#5 As a consequence of the risk of thrombocytopenia (currently 228 ADRAC reports; 6 fatal),1 quinine is no longer approved in Australia for the treatment of nocturnal cramps. Reference (below) 1. ADRAC. Quinine and profound thrombocytopenia. Aust Adv Drug Reactions Bull 2002;21:10. http://www.tga.gov.au/adr/aadrb/aadr0208.htm#2 Quinine and profound thrombocytopenia ADRAC has published 2 previous Bulletin articles about quinine and thrombocytopenia but continues to receive reports of this serious problem.1,2 Since 1972, ADRAC has received 571 reports of suspected adverse reactions to quinine (sulfate or bisulfate), including 198 reports of thrombocytopenia, 4 of which had a fatal outcome. Twenty of these have been received since the beginning of the year 2000. The reactions generally occurred within 3 weeks of commencing quinine although two with intermittent use had a longer time to onset. In two cases the reaction occurred soon after the first dose. Seventeen of the 20 reports documented a platelet count which ranged between 0 and 14 x 109/L and most described hospitalisation and treatment with platelet transfusion, corticosteroids or immunoglobulin. Five reports described a positive quinine antibody test. A recent illustrative report involved a 25 year old woman who had been taking quinine intermittently for nocturnal cramps. She had been taking about two tablets a week for 2 months. She presented with a generalised purpuric rash, and was found to have a platelet count of 5×109/L. Quinine was ceased, and she was hospitalised and treated with prednisolone and immunoglobulin. Her platelet count recovered to normal within a week. Drug-induced anti-platelet antibodies were detected. Prescribers should consider the risks and likely benefits before prescribing quinine for nocturnal cramps, and should also consider other causes of cramp (for example, salt depletion particularly in summer, electrolyte disturbance, peripheral vascular disease, motor neurone disease). Meta-analyses have found that quinine prevents on average one or two cramps per week compared to placebo, without reducing the duration or severity of cramps.3 In 1995, the American FDA withdrew the indication of nocturnal cramps from all quinine products, because of a lack of evidence of efficacy, and the Australian Medicines Handbook recommends against its use for this indication.4 Daytime passive stretching of the calf muscles may be effective in preventing nocturnal cramps.5 As illustrated in the case report above, thrombocytopenia usually recovers within a week of stopping quinine, but treatment with platelets, steroids or immunoglobulin may be required. Since quinine-induced thrombocytopenia occurs via an immune-based mechanism, patients should in future avoid all quinine-containing products, including drinks such as tonic water and bitter lemon. References 1. ADRAC. Cinchona alkaloids – the bite’s as bad as the bark! Aust Adv Drug React Bull 1988; December. 2. ADRAC. Quinine, cramps and cricket. Aust Adv Drug React Bull 1991; 10: August. 3. Anonymous. Quinine and cramp. Prescr Internat 2000; 9: 154-7. 4. Australian Medicines Handbook, 3rd edition, Adelaide: AMH: 2002. p. 585 5. Daniell HW. Simple cure for nocturnal leg cramps. N Engl J Med 1979; 301: 216. Cheers, Alan, T2 d&e, Australia. Remove weight and carbs to email. — Everything in Moderation – Except Laughter.
