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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Quinine?
        
(Message started by: Sartorious on Oct 24^th, 2007, 2:37pm)

Title: Quinine?
Post by Sartorious on Oct 24^th, 2007, 2:37pm

Hi,

As I'm back in a cycle I thought I would do some research at work, and came across a paper that describes a remedy for CH in the 18th century.

It involves the use of 'Peruvian bark' which has quinine as its active ingredient. Quinine belongs to the alkaloid family (same as LSD/LSA, found in RC seeds, and caffeine).

As anyone used quinine during a bout i.e. whilst on holiday (malaria tablets) or drinking tonic water.

Sart.

p.s. how do you attach documents?

Title: Re: Quinine?
Post by clavers on Oct 26^th, 2007, 11:06am

I was hoping that someone would have some good information on this topic. It is very interesting.

Title: Re: Quinine?
Post by DennisM1045 on Oct 27^th, 2007, 9:45am

Unfortunately you can't find Quinine any more. The manufacturer stopped making it last year. My MIL used to take it for RLS.

-Dennis-

Title: Re: Quinine?
Post by vietvet2tours on Oct 27^th, 2007, 12:11pm

Side effects
See: cinchonism

It is usual for quinine in therapeutic doses to cause cinchonism; in rare cases, it may even cause death (usually by pulmonary edema). The development of mild cinchonism is not a reason for stopping or interrupting quinine therapy and the patient should be reassured. Blood glucose levels and electrolyte concentrations must be monitored when quinine is given by injection; the patient should also ideally be in cardiac monitoring when the first quinine injection is given (these precautions are often unavailable in developing countries where malaria is most a problem).

Cinchonism is much less common when quinine is given by mouth, but oral quinine is not well tolerated (quinine is exceedingly bitter and many patients will vomit up quinine tablets): other drugs such as Fansidar® (sulfadoxine (sulfonamide antibiotic) with pyrimethamine) or Malarone® (proguanil with atovaquone) are often used when oral therapy is required. Blood glucose, electrolyte and cardiac monitoring are not necessary when quinine is given by mouth.

In 1994, the U.S. Food and Drug Administration (FDA), banned the use of over-the-counter (OTC) quinine as a treatment for nocturnal leg cramps. Pfizer Pharmaceuticals had been selling the brand name Legatrin® for this purpose. This soon followed disallowing even prescription quinine for leg cramps, and all OTC sales of the drug for malaria. From 1969 to 1992, the FDA received 157 reports of health problems related to quinine use, including 23 which had resulted in death.[1]

Quinine can cause paralysis if accidentally injected into a nerve. It is extremely toxic in overdose and the advice of a poisons specialist should be sought immediately.

[edit]
Quinine and pregnancy

In very large doses, quinine also acts as an abortifacient; in the United States quinine is classed as a Category X teratogen by the Food and Drug Administration, meaning that it can cause birth defects (especially deafness) if taken by a woman during pregnancy. In the UK, the recommendation is that pregnancy is not a contra-indication to quinine therapy for falciparum malaria (which directly contradicts the US recommendation), although it should be used with caution; the reason for this is that the risks to the pregnancy are small and theoretical, as opposed to the very real risk of death from falciparum malaria. Futher research, conducted in Sweden's Consug University hospital, has found a weak but significant correlation between dosage increase in pregnancy and Klebs-Loeffler bacillus infections in neonates.

[edit]
Quinine and interactions with other diseases

Quinine can cause hemolysis in G6PD deficiency, but again this risk is small and the physician should not hesitate to use quinine in patients with G6PD deficiency when there is no alternative. Quinine can also cause drug-induced immune thrombocytopenic purpura (ITP).

Quinine can cause abnormal heart rhythms and should be avoided if possible in patients with atrial fibrillation, conduction defects or heart block.

Quinine must not be used in patients with hemoglobinuria, myasthenia gravis or optic neuritis, because it worsens these conditions.
http://upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Tonic_water_uv.jpg/180px-Tonic_water_uv.jpg

Title: Re: Quinine?
Post by George_J on Oct 27^th, 2007, 7:11pm

Found the following, with an intriguing partial text. Getting the full text requires a subscription.

http://jnnp.bmj.com/cgi/content/extract/78/11/1248

Best,

George

Title: Re: Quinine?
Post by cluster on Oct 28^th, 2007, 3:48pm

Quote:

‘‘A healthy, robust man of middle age was, each day, at the
same hour troubled by pain above the orbit of the left eye,
where the nerve leaves through the bony frontal opening;
after a short time the left eye began to redden and tears to
flow; then he felt as if his eye was protruding from its orbit
with so much pain that he became mad. After a few hours all
this evil ceased and nothing in the eye appeared at all
changed.
I ordered blood to be let, gave antiphlogistic purgatives, I
frequently applied cupping to the neck, vesicant adhesives
etc but all in vain. But in order to understand this miraculous
illness, I went to him at the time when he knew the pain
would return, and I saw all the symptoms he remembered; in
the carpal pulse however I found nothing changed. The
patient reminded me, whilst I sat with him, that in the medial
canthus of the eye he felt a large pulsation: I applied the
apex of my little finger to the artery, which goes around the
medial canthus of the eye, then with the other hand explored
the carpal pulse; and thus I manifestly perceived how the
artery in the canthus of the eye was pulsing more rapidly,
and strongly than it naturally does.
I therefore believed that there was a fever, but a topical one;
and I gave Peruvian bark and with luck cured it; and from
this case I later learned to use similar remedies.’’

Van Swieten referred to the effects of Peruvian bark(1) on the
previous page:

‘‘The Peruvian bark which has so much use in strengthening
the nervous system and in realigning the disordered moving
spirits, overwhelms any species of intermittent fever without
making any evident evacuations…’’

1 The active ingredient of Peruvian bark was quinine.

Source: J M S Pearce: Gerardi van Swieten: descriptions of episodic cluster headache. J Neurol Neurosurg Psychiatry. 2007 Nov; 78(11): 1248-9. Pearce is quoting: Isler HR.: Episodic cluster headache from a textbook of 1745: van Swieten's classic description. Cephalalgia. (1993); 13(3): 172-4. PMID 8358775.

Hope we found the cure now? :o

pf wishes,
Friedrich

Edit to add:

Hansruedi Isler translated the text from Latin out of the book:
Gerardus van Swieten: Commentaria in Hermanni Boerhaave Aphorismos de cognoscendis et curandis morbis, Lugduni Batavorum (Leiden), apud Johannem et Hermannum Verbeek, 1745, 34: 533

http://ck-wissen.de/ckwiki/images/thumb/8/87/VanSwietenProfile.JPG/120px-VanSwietenProfile.JPG
Gerard van Swieten

Wikipedia® about Gerard van Swieten: http://en.wikipedia.org/wiki/Gerard_van_Swieten