From the Guidelines
Quinine sulfate is not recommended for the treatment of restless leg syndrome (RLS) due to its potential serious side effects and lack of FDA approval for this purpose. According to the American Academy of Sleep Medicine clinical practice guideline 1, the suggested treatments for RLS include ferrous sulfate, dipyridamole, extended-release oxycodone, and bilateral high-frequency peroneal nerve stimulation, among others. Quinine sulfate is not mentioned as a recommended treatment option in this guideline.
The guideline emphasizes the importance of addressing exacerbating factors, such as alcohol, caffeine, and certain medications, and considering the pregnancy-specific safety profile of each treatment being considered 1. It also recommends against the use of certain medications, such as levodopa, pramipexole, and ropinirole, due to the risk of augmentation and other adverse effects 1.
In terms of iron supplementation, the guideline suggests that it should be instituted with oral or IV iron if serum ferritin ≤ 75 ng/mL or transferrin saturation < 20%, and only with IV iron if serum ferritin is between 75 and 100 ng/mL 1. However, quinine sulfate is not a recommended treatment option for RLS, and its use should be approached with caution due to potential serious side effects, including cardiac arrhythmias, thrombocytopenia, and cinchonism 1.
Some key points to consider when treating RLS include:
- Addressing exacerbating factors, such as alcohol and caffeine
- Considering the pregnancy-specific safety profile of each treatment being considered
- Using iron supplementation if serum ferritin ≤ 75 ng/mL or transferrin saturation < 20%
- Avoiding the use of certain medications, such as levodopa and pramipexole, due to the risk of augmentation and other adverse effects
- Using bilateral high-frequency peroneal nerve stimulation as a non-invasive, non-pharmacological treatment option
Overall, while quinine sulfate may be used off-label for RLS in some cases, it is not a recommended treatment option due to its potential serious side effects and lack of FDA approval for this purpose. Instead, clinicians should consider the recommended treatment options outlined in the American Academy of Sleep Medicine clinical practice guideline.
From the FDA Drug Label
Quinine sulfate capsules are not approved for: Treatment of severe or complicated P. falciparum malaria. Prevention of malaria. Treatment or prevention of nocturnal leg cramps [ see Warnings and Precautions (5.1)].
Quinine sulfate is not indicated for sleep or restless leg syndrome. In fact, the label explicitly states that quinine sulfate capsules are not approved for the treatment or prevention of nocturnal leg cramps, due to the risk of serious and life-threatening hematologic reactions and other adverse events. 2
From the Research
Quinine Sulfate and Restless Leg Syndrome
- Quinine sulfate is not a first-line treatment for restless leg syndrome (RLS) 3, 4, 5
- Dopaminergic agents, such as levodopa, ropinirole, and pramipexole, are considered the primary treatment options for RLS 3, 4, 5
- Quinine has been used as a symptomatic treatment for RLS, but its effectiveness is not well-established 6
- A study on patterns of treatment for RLS in primary care in the United Kingdom found that quinine was used as a treatment, but its use was not associated with a reduction in clinical symptoms or healthcare resource utilization 6
Quinine Sulfate and Sleep
- There is no direct evidence to suggest that quinine sulfate is indicated for sleep or restless leg syndrome 3, 4, 5, 7, 6
- Quinine sulfate may be used to treat leg cramps, which can disrupt sleep, but its use for this purpose is not well-established in the context of RLS 6
Treatment Options for Restless Leg Syndrome
- Dopaminergic agents, such as levodopa, ropinirole, and pramipexole, are considered the primary treatment options for RLS 3, 4, 5
- Other treatment options, such as pregabalin, gabapentin enacarbil, and oxycodone/naloxone, may also be effective for RLS 5
- Non-pharmacological treatments, such as lifestyle modifications and alternative therapies, may also be beneficial for RLS 3