QUININE

Family: Rubiaceae

Genus: Cinchona

Species: officinalis, ledgeriana, succirubra, calisaya

Synonyms:Quinaquina officinalis, Quinaquina lancifolia, Quinaquina coccinea

Common names: Quinine bark, quina, quinine, kinakina, China bark, cinchona bark, yellow cinchona, red cinchona, Peruvian bark, Jesuit’s bark, quina-quina, calisaya bark, fever tree

Price: £22.50 – 1lb / 454 gm Bag

Parts Used: Bark, wood

From The Healing Power of Rainforest Herbs:

The genus Cinchona contains about forty species of trees. They grow 15-20 meters in height and produce white, pink, or yellow flowers. All cinchonas are indigenous to the eastern slopes of the Amazonian area of the Andes, where they grow from 1,500-3,000 meters in elevation on either side of the equator (from Colombia to Bolivia). They can also be found in the northern part of the Andes (on the eastern slopes of the central and western ranges). They are now widely cultivated in many tropical countries for their commercial value, although they are not indigenous to those areas.

TRIBAL AND HERBAL MEDICINE USES

Cinchona, or quinine bark, is one of the rainforest’s most famous plants and most important discoveries. Legend has it that the name cinchona came from the countess of Chinchon, the wife of a Peruvian viceroy, who was cured of a malarial type of fever by using the bark of the cinchona tree in 1638. It was supposedly introduced to European medicine in 1640 by the countess of Chinchon, even before botanists had identified and named the species of tree. Quinine bark was first advertised for sale in England in 1658, and was made official in the British Pharmacopoeia in 1677. Physicians gave credit to the drug and, because of its effectiveness with malaria, it was recognized officially even while the identity of the tree species remained unknown. Several years after the “Countess’s powder” arrived in England, it arrived in Spain. There, quinine bark was used by the Jesuits very early in its history and due to the influence of the Company of Jesus, the newly named “Jesuit’s powder” became known all over Europe. When the plant was finally botanically classified almost one hundred years later in 1737, botanists still named it after the countess for her contribution. Throughout the mid-1600s to mid-1800s quinine bark was the primary treatment for malaria and it evidenced remarkable results. It was also used for fever, indigestion, mouth and throat diseases, and cancer.

Natural quinine bark is still employed in herbal medicine systems around the world today. In Brazilian herbal medicine quinine bark is considered a tonic, a digestive stimulant, and fever-reducer. It is used for anemia, indigestion, gastrointestinal disorders, general fatigue, fevers, malaria and as an appetite stimulant. Other folk remedies in South America cite quinine bark as a natural remedy for cancer (breast, glands, liver, mesentery, spleen), amebic infections, heart problems, colds, diarrhea, dysentery, dyspepsia, fevers, flu, hangover, lumbago, malaria, neuralgia, pneumonia, sciatica, typhoid, and varicose veins. In European herbal medicine the bark is considered antiprotozoal, antispasmodic, antimalarial, a bitter tonic, and a fever-reducer. There it is used as an appetite stimulant, for hair loss, alcoholism, liver, spleen, and gallbladder disorders; and to treat irregular heart beat, anemia, leg cramps, and fevers of all kinds. In the U.S., quinine bark is used as a tonic and digestive aid; to reduce heart palpitations and normalize heart functions; to stimulate digestion and appetite; for hemorrhoids, varicose veins, headaches, leg cramps, colds, flu, and indigestion; and for its astringent, bactericidal, and anesthetic actions in various other conditions.

PLANT CHEMICALS

In 1820 two scientists, Pelletier and Caventou, isolated an alkaloid chemical in the bark which provided the highest antimalarial effect and named it quinine. Once discovered, methods were developed to extract only the quinine alkaloid from the natural bark to sell as an antimalarial drug.

The South American rainforests benefited from the income generated by harvesting cinchona bark for the extraction of this alkaloid from the bark for the manufacture of quinine drugs. In the middle of the 19th century, though, seeds of Cinchona calisaya and Cinchona pubescens were smuggled out of South America by the British and the Dutch. The calisaya species was planted and cultivated in Java by the Dutch and the pubescens species was cultivated in India and Ceylon by the British. However, the quinine content of these species was too low for high-grade, cost effective, commercial production of quinine. The Dutch then smuggled seeds of Cinchona ledgeriana out of Bolivia, paying $20 for a pound of seeds, and soon established extensive plantations of quinine-rich cinchona trees in Java. They quickly dominated the world production of quinine and, by 1918, the majority of the world’s supply of quinine was under the total control of the Dutch “kina burea” in Amsterdam. Huge profits were reaped – but Bolivia and Peru, from whence the resource originated, saw none of it.

The upheavals of the Second World War led to changes in the market which still remain in effect today. When Java was occupied by the Japanese in 1942, the Allies’ supply of quinine was cut off. South American sources of cinchona trees and quinine bark were once again in demand, but new plantations were planted by the Allies in Africa as well. This dire shortage of quinine fueled research for developing and producing a synthetic version of the quinine alkaloid rather than relying on the natural bark. In 1944 scientists were able to synthesize the quinine alkaloid in the laboratory. This led to various synthesized and patented quinine drugs which were manufactured by several pharmaceutical companies and which were of course, highly profitable. Today, Indonesia and India still cultivate cinchona trees; however Africa, with their expansions of the old WWII plantations, has emerged as the leading supplier of quinine bark. Much lower on the list of producers are the South American countries of Peru, Bolivia, and Ecuador, still struggling to compete. Although all cinchona species are good sources of quinine, C. succirubra and C. ledgeriana are the species containing the highest amount of quinine alkaloids – which is why they are the species of choice for cultivation today.

The cardiac effects of cinchona bark were noted in academic medicine at the end of the 17th century. Quinine was used sporadically through the first half of the 18th century for cardiac problems and arrhythmia and it became a standard of cardiac therapy in the second half of the 19th century. Another alkaloid chemical called quinidine was discovered to be responsible for this beneficial cardiac effect. Quinidine, a compound produced from quinine, is still used in cardiology today, sold as a prescription drug for arrhythmia. The sales demand for this drug still generates the need for harvesting natural quinine bark today because scientists have been unsuccessful in synthesizing this chemical without utilizing the natural quinine found in cinchona bark.

The main plant chemicals found in quinine bark include: aricine, caffeic acid, cinchofulvic acid, cincholic acid, cinchonain, cinchonidine, cinchonine, cinchophyllamine, cinchotannic acid, cinchotine, conquinamine, cuscamidine, cuscamine, cusconidine, cusconine, epicatechin, javanine, paricine, proanthocyanidins, quinacimine, quinamine, quinic acid, quinicine, quinine, quininidine, quinovic acid, quinovin, and sucirubine.

BIOLOGICAL ACTIVITIES AND CLINICAL RESEARCH

Interestingly enough, natural quinine extracted from quinine bark and the use of natural bark tea and/or bark extracts are making a comeback in the management and treatment of malaria. Malaria strains have evolved which have developed a resistance to the synthesized quinine drugs. It was shown in early studies that an effective dose of natural quinine bark extract elicited the same antimalarial activity as an effective dose of the synthesized quinine drug. Scientists are now finding that these new strains of drug-resistant malaria can be treated effectively with natural quinine and/or quinine bark extracts. As evolving pathogens develop widespread resistance to our standard antibiotics, antivirals, and antimalarial drugs, it is of little wonder that the use of the natural medicine in quinine bark is being revisited, even by such giants as the World Health Organization.

A recent use for quinine drugs has been for the treatment of muscle spasms and leg cramps. A 1998 study documented the beneficial effects of quinine for leg cramps, with tinnitus being the only documented side effect. In 2002, a double-blind placebo study was undertaken in which 98 people with nocturnal leg cramps were given 400 mg of quinine daily for 2 weeks. The results stated that quinine administered at this dose effectively reduced the frequency, intensity, and pain of leg cramps without relevant side-effects. This use has fueled the natural product market and more people are looking for natural quinine bark as an alternative to the synthesized prescription drugs for this purpose.

CURRENT PRACTICAL USES

Quinine bark is harvested today much as it has been for hundreds of years. The tree trunks are beaten and the peeling bark is removed. The bark partially regenerates on the tree and, after a few years and several cycles of bark removal, the trees are uprooted and new ones are planted. The commercial quinine market today is difficult to calculate. It is thought that 300-500 metric tons of quinine alkaloids are extracted annually from 5,000-10,000 metric tons of harvested bark. Nearly half of the harvest is directed to the food industry for the production of quinine water, tonic water, and as an FDA-approved bitter food additive. The remainder is utilized in the manufacture of the quinidine prescription drug. Quinine is very bitter tasting and commercially sold tonic waters often use quinine as it’s bitter ingredient/component. Commercially-produced tonic water usually contains around 100 to 300 parts per million quinine and up to a maximum allowable concentration of 70 milligrams of quinine per liter.

The longstanding natural remedy for quinine bark usually calls for a cup of boiling water to be poured over approximately 1-2 g of ground or chopped natural bark and allowed to steep for ten minutes. A cupful of this infusion is drunk half an hour before meals to stimulate the appetite, or after meals to treat digestive disorders. The use of pure quinine at large dosages can be toxic. The reported therapeutic oral dose for quinine alkaloids in adults is between 167-333 mg three times per day. Reportedly, a single dose of 2-8 grams of pure quinine alkaloids taken orally may be fatal to an adult. Natural bark teas prepared in the traditional manner, however, have a long history of use without toxic effects. A cup of traditional quinine bark tea would provide approximately 100 mg of total alkaloids, including quinine (based upon an average of 5% total alkaloid content in the raw bark).

The history of the cinchona tree provides a perfect example of how a natural product can go from folklore and indigenous use into world trade-and then into the drug market. It’s also a perfect example of how indigenous peoples and countries with important natural resources are too often pirated and left out of the profit loop by industrialized nations and rich, multinational, profit-driven organizations. Despite the fact that quinine and quinidine drugs were patented and sold, Peru and Bolivia – from whence the discovery was made and the resources extracted – did not share in the patents or resulting profits. Their natural resources were smuggled out and profitable world markets were created from them. They were poor, developing nations without multinational backing or investment capital – and ended up at the bottom of the heap while competing in a global market for resources indigenous to their countries.

While governments are making inroads and new laws concerning biodiversity and intellectual property rights to correct this situation, business still has a long way to go to “do the right thing.” Ideally, if natural quinine bark makes a comeback in the growing natural products industry or new drugs are developed for these drug-resistant strains of malaria, these new laws will protect the natural resources of these developing nations.

Traditional Preparation: One-half cup bark decoction 1-3 times daily or 1-2 ml of a 4:1 tincture is taken twice daily. One to 2 grams daily of powdered bark in tablets or capsules can be substituted if desired. See Traditional Herbal Remedies Preparation Methods page if necessary for definitions.

Contraindications: Quinine bark contains naturally-occurring quinine alkaloids. These quinine alkaloids are sold as prescription drugs with numerous side effects and warnings documented in the literature. Do not exceed the quinine bark natural remedy amounts shown above unless you are under the care and advice of a qualified health care practitioner who is familiar with the warnings, side effects, and contraindications of higher therapeutic levels of quinine alkaloids.

Drug Interactions: May potentiate blood thinning medications such as Warfarin.®

 

The above text has been printed from The Healing Power of Rainforest Herbs by Leslie Taylor, copyrighted © 2005

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† The statements contained herein have not been evaluated by the Food and Drug Administration. The information contained in this plant database file is intended for education, entertainment and information purposes only. This information is not intended to be used to diagnose, prescribe or replace proper medical care. The plant described herein is not intended to treat, cure, diagnose, mitigate or prevent any disease. Please refer to our Conditions of Use for using this plant database file and web site.

Third-Party Published Research on Quinine

All available third-party research on quinine can be found at PubMed. A partial listing of the published research on quinine is shown below: Anti-Parasitic & Antimalarial Actions:

Kumura, N., et al. “Synthesis and biological activity of fatty acid derivatives of quinine.” Biosci. Biotechnol. Biochem. 2005; 69(11): 2250-3.

Bertani, S., et al. “Evaluation of French Guiana traditional antimalarial remedies.” J. Ethnopharmacol. 2005 Apr 8; 98(1-2): 45-54.

Kanda, E., et al. “A female patient with malarial nephropathy.” Clin. Exp. Nephrol. 2004 Dec; 8(4): 359-62.

Pukrittayakamee, S., et al. “Quinine pharmacokinetic-pharmacodynamic relationships in uncomplicated falciparum malaria.” Antimicrob. Agents Chemother. 2003; 47(11): 3458-63.

Warhurst, D. C., et al. “The relationship of physico-chemical properties and structure to the differential antiplasmodial activity of the cinchona alkaloids.” Malar. J. 2003 Sep 1; 2: 26.

Pussard, E., et al. “Quinine distribution in mice with Plasmodium berghei malaria.” Eur. J. Drug Metab. Pharmacokinet. 2003 Jan-Mar; 28(1): 11-20.

Vieira, J. L., et al. “Drug monitoring of quinine in men with nonsevere falciparum malaria: study in the Amazon region of Brazil.” Ther. Drug Monit. 2001 Dec; 23(6): 612-5.

Aviado, D. M., et al. “Antimalarial and antiarrhythmic activity of plant extracts.” Medicina Experimentalis—International Journal of Experimental Medicine 1969; 19(20), 79–94.

Bitter Digestive Actions:

Yeomans, M. R. “Olfactory influences on appetite and satiety in humans.” Physiol. Behav. 2006 Aug; 89(1): 10-4.

Kozlov, A. P., et al. “Taste differentiation in the context of suckling and independent, adultlike ingestive behavior.”

Dev. Psychobiol. 2006 Mar; 48(2): 133-45.

Dinehart, M. E., et al. “Bitter taste markers explain variability in vegetable sweetness, bitterness, and intake.”

Physiol. Behav. 2006; 87(2): 304-13.

Anti-cramping Actions:

Woodfield. R., et al. “N-of-1 trials of quinine efficacy in skeletal muscle cramps of the leg.” Br. J. Gen. Pract. 2005 Mar; 55(512): 181-5.

Diener, H. C., et al. “Effectiveness of quinine in treating muscle cramps: a double-blind, placebo-controlled, parallel-group, multicentre trial.” Int. J. Clin. Pract. 2002; 56(4): 243–46.

Man-Son-Hing, M., et al. “Quinine for nocturnal leg cramps: a meta-analysis including unpublished data.” J. Gen. Intern. Med. 1998; 13(9): 600–6.

Antimicrobial Actions:

Rojas, J. J., et al. “Screening for antimicrobial activity of ten medicinal plants used in Colombian folkloric medicine: A possible alternative in the treatment of non-nosocomial infections.” BMC Complement. Altern. Med. 2006 Feb 17; 6(1): 2.

Wolf, R., et al. “Quinine sulfate and HSV replication.” Dermatol. Online J. 2003 Aug; 9(3): 3.

Neuroprotective Actions:

Gigout, S., et al. “Effects of gap junction blockers on human neocortical synchronization.” Neurobiol. Dis. 2006 Jun; 22(3): 496-508.

Actions on Insulin Sensitivity:

Rustenbeck, I., et al. “Desensitization of insulin secretion by depolarizing insulin secretagogues.” Diabetes. 2004 Dec; 53 Suppl 3: S140-50.

Grosse-Lackmann, T., et al. “Specificity of nonadrenergic imidazoline binding sites in insulin-secreting cells and relation to the block of ATP-sensitive K(+) channels.” Ann. N. Y. Acad. Sci. 2003 Dec; 1009: 371-7.

Rustenbeck, I., et al. “Desensitization of insulin secretory response to imidazolines, tolbutamide, and quinine. II. Electrophysiological and fluorimetric studies.” Biochem. Pharmacol. 2001 Dec; 62(12): 1695-703.

Rustenbeck, I., et al. “Desensitization of insulin secretory response to imidazolines, tolbutamide, and quinine. I. Secretory and morphological studies.” Biochem. Pharmacol. 2001 Dec; 62(12): 1685-94.

Limburg, P.J., et al. “Quinine-induced hypoglycemia.” Ann. Intern. Med. 1993 Aug; 119(3): 218-9.

MAO Actions:

Itoh, K., et al. “Stereospecific oxidation of the (S)-enantiomer of RS-8359, a selective and reversible monoamine oxidase A (MAO-A) inhibitor, by aldehyde oxidase.” Xenobiotica. 2005; 35(6): 561-73.

Itoh, K., et al. “Species differences in enantioselective 2-oxidations of RS-8359, a selective and reversible MAO-A inhibitor, and cinchona alkaloids by aldehyde oxidase.” Biopharm. Drug Dispos. 2006 Jan 6;27(3):133-139

Quinine Toxicity:

Flanagan, K. L., et al. “Quinine levels revisited: the value of routine drug level monitoring for those on parenteral therapy.” Acta. Trop. 2006; 97(2): 233-7.

Osinubi, A. A., “Morphometric and stereological assessment of the effects of long-term administration of quinine on the morphology of rat testis.” West Afr. J. Med. 2005 Jul-Sep; 24(3): 200-5.

Adam, I., et al. “Quinine for chloroquine-resistant falciparum malaria in pregnant Sudanese women in the first trimester.” East Mediterr. Health J. 2004 Jul-Sep; 10(4-5): 560-5.

Adam, I., et al. “Low-dose quinine for treatment of chloroquine-resistant falciparum malaria in Sudanese pregnant women.” East Mediterr. Health J. 2004 Jul-Sep; 10(4-5): 554-9.

Gopal, K. V., et al. “Unique responses of auditory cortex networks in vitro to low concentrations of quinine.”

Hear. Res. 2004 Jun; 192(1-2): 10-22.

Morrison, L. D., et al. “Death by quinine.” Vet. Hum. Toxicol. 2003 Dec; 45(6): 303-6.

Langford, N. J., et al. “Quinine intoxications reported to the Scottish Poisons Information Bureau 1997-2002: a continuing problem.” Br. J. Clin. Pharmacol. 2003 Nov; 56(5): 576-8.

Ingredients: 100% pure quinine (Cinchona succirubra) bark. No binders, fillers or additives are used. It is a wild harvested product—grown naturally in the Brazilian Amazon without any pesticides or fertilizers.

Suggested Use: This plant is best prepared as a decoction. Use ½ teaspoon of powder for each cup of water. Bring to a boil and gently boil in a covered pot for 20 minutes. Allow to cool and settle for 10 minutes and strain warm liquid into a cup (leaving the settled powder in the bottom of the pan). It is traditionally taken in ½ cup dosages, 1-3 times daily. For more complete instructions on preparing herbal decoctions, see the Methods for Preparing Herbal Remedies Page.

Contraindications: Quinine bark contains naturally-occurring quinine alkaloids. These quinine alkaloids are sold as prescription drugs with numerous side effects and warnings documented in the literature. Do not exceed the suggested use shown above unless you are under the care and advice of a qualified health care practitioner who is familiar with the warnings, side effects, and contraindications of higher therapeutic levels of quinine alkaloids.

Drug Interactions: May potentiate blood thinning medications such as Warfarin®.