CINCHONA

OTHER NAME(S):

Arbol de la Quina, Bois aux Fièvres, Calisaya Bark, Cascarilla, China Bark, Cinchona calisaya, Cinchona carabayensis, Cinchona ledgeriana, Cinchona officinalis, Cinchona pubescens, Cinchona succirubra, Chinarinde, Chinarindenbaum, Chinin baum, Cinchonine, Écorce du Pérou, Écorce de Quina, Écorce de Quinquina Rouge, Fever Tree, Fieberrinde, Fieberrindenbaum, Jesuit'’s Bark, Kina-Kina, Ledgerbark, Peruvian Bark, Poudre des Jésuites, Pulvis Cardinalis, Pulvis Partum, Quina, Quina-amarela, Quina-do-Amazonas, Quina-quina, Quineira, Quinine, Quino, Quinquina, Quinquina Gris, Qui quina Jaune, Quinquina Rouge, Red Bark, Red Cinchona Bark, Yellow Cinchona, Yellowbark.<br/><br/>

Overview

Overview Information

Cinchona is a tree. People use the bark to make medicine.

Cinchona is used for increasing appetite; promoting the release of digestive juices; and treating bloating, fullness, and other stomach problems. It is also used for blood vessel disorders including hemorrhoids, varicose veins, and leg cramps. Some people use cinchona for mild influenza, swine flu, the common cold, malaria, and fever. Other uses are for cancer, mouth and throat diseases, enlarged spleen, and muscle cramps.

Cinchona is used in eye lotions to numb pain, kill germs, and as an astringent. Cinchona extract is also applied to the skin for hemorrhoids, ulcers, stimulating hair growth, and managing varicose veins.

In foods, cinchona is used as a bitter flavoring in tonic water and alcoholic beverages.

How does it work?

Cinchona bark contains quinine, which is a medicine used to treat malaria. It also contains quinidine which is a medicine used to treat heart palpitations (arrhythmias).
Uses

Uses & Effectiveness?

Insufficient Evidence for

  • Malaria.
  • Hemorrhoids.
  • Varicose veins.
  • Colds.
  • Leg cramps.
  • Influenza.
  • Malaria.
  • Fever.
  • Cancer.
  • Mouth and throat diseases.
  • Enlarged spleen.
  • Muscle cramps.
  • Loss of appetite.
  • Stomach discomforts, such as bloating and fullness.
  • Other conditions.
More evidence is needed to rate the effectiveness of cinchona for these uses.

Side Effects

Side Effects & Safety

Cinchona is LIKELY SAFE when used as a flavoring in tonic water and alcoholic beverages.

Cinchona is POSSIBLY UNSAFE when taken by mouth as a medicine. Cinchona products sold as over-the-counter (OTC) medicines are required to carry the warning, “Caution - discontinue use if ringing in the ears, deafness, skin rash, or visual disturbances occur.“ Cinchona contains quinine, which was banned by the U.S. Food and Drug Administration (FDA) from sale over-the-counter for treatment of leg muscle cramps because it caused serious side effects.

In large amounts, cinchona is UNSAFE and can be deadly. Symptoms of overdose include ringing of the ears, headache, nausea, diarrhea, and vision disturbances. Cinchona can also cause bleeding and allergic reactions, including hives and fever.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Don’t use cinchona if you are pregnant or breast-feeding. There is some evidence that cinchona is UNSAFE to use during pregnancy and if you are breast-feeding.

Stomach or intestinal ulcers: Don’t use cinchona if you have ulcers. It might increase the risk of bleeding.

Heart conditions such as long QT interval syndrome: Cinchona contains quinine and quinidine that can cause an irregular heartbeat and might increase the risk of irregular heartbeat in people with long QT syndrome.

Myasthenia Gravis: Don’t use cinchona if you have myasthenia gravis. It contains quinine and quinidine that can cause muscle weakness and make your condition worse.

Surgery:Cinchona can slow blood clotting, so there is a concern that it might increase the risk of extra bleeding during and after surgery. There is also concern that quinidine in cinchona can increase the effects of muscle relaxants used during surgery. Stop using cinchona at least 2 weeks before a scheduled surgery.

Interactions

Interactions?

Major Interaction

Do not take this combination

!
  • Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with CINCHONA

    Cinchona might slow blood clotting. Taking cinchona along with medications that also slow clotting might increase the chances of bruising and bleeding.<br><nb>Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

  • Quinidine interacts with CINCHONA

    Cinchona contains quinidine. Taking quinidine along with cinchona can increase the effects and side effects of quinidine and cause heart problems. Do not take cinchona if you are taking quinidine.

  • Quinine interacts with CINCHONA

    Cinchona contains quinine. Taking quinidine along with cinchona can increase the effects and side effects of quinine and cause heart problems. Do not take cinchona if you are taking quinine.

Moderate Interaction

Be cautious with this combination

!
  • Carbamazepine (Tegretol) interacts with CINCHONA

    The body breaks down carbamazepine to get rid of it. Cinchona contains quinine. Quinine can cause the body to break down carbamazepine (Tegretol) too quickly. Taking cinchona along with carbamazepine (Tegretol) can decrease the effectiveness of carbamazepine (Tegretol).

  • Phenobarbital (Luminal) interacts with CINCHONA

    Cinchona contains quinine. Quinine might increase how much phenobarbital (Luminal) is in the body. Taking cinchona with phenobarbital might increase the effects and side effects of phenobarbital.

Minor Interaction

Be watchful with this combination

!
  • Antacids interacts with CINCHONA

    Antacids are used to decrease stomach acid. Cinchona may increase stomach acid. By increasing stomach acid, cinchona might decrease the effectiveness of antacids.<br><nb>Some antacids include calcium carbonate (Tums, others), dihydroxyaluminum sodium carbonate (Rolaids, others), magaldrate (Riopan), magnesium sulfate (Bilagog), aluminum hydroxide (Amphojel), and others.

  • Medications that decrease stomach acid (H2-Blockers) interacts with CINCHONA

    Cinchona might increase stomach acid. By increasing stomach acid, cinchona might decrease the effectiveness of some medications that decrease stomach acid, called H2-Blockers.<br><nb>Some medications that decrease stomach acid include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid).

  • Medications that decrease stomach acid (Proton pump inhibitors) interacts with CINCHONA

    Cinchona might increase stomach acid. By increasing stomach acid, cinchona might decrease the effectiveness of medications that are used to decrease stomach acid, called proton pump inhibitors.<br><nb>Some medications that decrease stomach acid include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).

Dosing

Dosing

The appropriate dose of cinchona depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for cinchona. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

View References

REFERENCES:

  • Amabeoku GJ, Chikuni O, Akino C, Mutetwa S. Pharmacokinetic interaction of single doses of quinine and carbamazepine, phenobarbitone and phenytoin in healthy volunteers. East Afr Med J 1993;70:90-3. View abstract.
  • Bramer SL, Suri A. Inhibition of CYP2D6 by quinidine and its effects on the metabolism of cilostazol. Clin Pharmacokinet. 1999;37 Suppl 2:41-51. View abstract.
  • Bruce-Chwatt LJ. Three hundred and fifty years of the Peruvian fever bark. Br Med J (Clin Res Ed). 1988;296(6635):1486-7. View abstract.
  • Cheng GG, Cai XH, Zhang BH, et al. Cinchona alkaloids from Cinchona succirubra and Cinchona ledgeriana. Planta Med 2014;80:223-30.
  • Code of Federal Regulations, Title 21, chapter 1, subchapter B, part 172, subpart F (172.510): Natural flavoring substances.
  • Code of Federal Regulations, Title 21, chapter 1, subchapter D, part 369, subpart B (21CFR369.20): Drugs: recommended warning and caution statements.
  • Dooms-Goossens A, Deveylder H, Duron C, et al. Airborne contact urticaria due to cinchona. Contact Dermatitis 1986;15(4):258. View abstract.
  • Druilhe P, Brandicourt O, Chongsuphajaisiddhi T, Berthe J. Activity of a combination of three cinchona bark alkaloids against Plasmodium falciparum in vitro. Antimicrob Agents Chemother 1988;32(2):250-4. View abstract.
  • FDA Drug Safety Communication: New risk management plan and patient medication guide for Qualaquin (quinine sulfate). 07-08-2010. https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm218202 (accessed 02/18/17).
  • Goss A. Building the world's supply of quinine: Dutch colonialism and the origins of a global pharmaceutical industry. Endeavour 2014;38(1):8-18. View abstract.
  • Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
  • Hardman JG, Limbird LL, Molinoff PB, eds. Goodman and Gillman's The Pharmacological Basis of Therapeutics, 9th ed. New York, NY: McGraw-Hill, 1996.
  • Holt GA. Food & Possible Interactions with Drugs: Revised and Expanded Ed. Chicago, IL: Precept Press, 1998.
  • Lee MR. Plants against malaria, part 1: cinchona or the Peruvian bark. J R Coll Physicians Edinb 2002;32(3):189-96. View abstract.
  • Roersch van der Hoogte A, Pieters T. Science in the service of colonial agro-industrialism: the case of cinchona cultivation in the Dutch and British East Indies, 1852-1900. Stud Hist Philos Biol Biomed Sci 2014;47 Pt A:12-22. View abstract.
  • Shah BH, Nawaz Z, Virani SS, Ali IQ, Saeed SA, Gilani AH.The inhibitory effect of cinchonine on human platelet aggregation due to blockade of calcium influx. Biochem Pharmacol 1998;56:955-60. View abstract.
  • US Food and Drug Administration notice: Drug products containing quinine - enforcement action dates. Docket # 2006N-0476. Federal Register 2006 (December 15);71 (241): 75557-60.

More Resources for CINCHONA

CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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