Background

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.

Safety Safety definitions

When taken by mouth: Cinchona is LIKELY SAFE when used as a flavoring in tonic water and alcoholic beverages. But it is POSSIBLY UNSAFE when taken 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 over-the-counter use because it causes serious side effects. In large amounts, cinchona is UNSAFE and can be deadly.

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 when pregnant or 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.

Effectiveness

Dosing & administration

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.

Interactions with pharmaceuticals

Antacids

Interaction Rating=Moderate Be cautious with this combination.

Antacids are used to decrease stomach acid. Cinchona may increase stomach acid. By increasing stomach acid, cinchona might decrease the effectiveness of antacids. Also, cinchona contains quinidine and some antacids might slow down removal of quinidine from the body, increasing the risk of side effects.

Some antacids include calcium carbonate (Tums, others), dihydroxyaluminum sodium carbonate (Rolaids, others), magaldrate (Riopan), magnesium sulfate (Bilagog), aluminum hydroxide (Amphojel), and others.

Carbamazepine (Tegretol)

Interaction Rating=Moderate Be cautious with this combination.

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).

Digoxin (Lanoxin)

Interaction Rating=Moderate Be cautious with this combination.

Cinchona contains quinine and quinidine which can slow the rate at which digoxin is removed from the body. Taking cinchona along with digoxin might increase the effects and side effects of digoxin.

Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver. Cinchona might decrease how quickly the liver breaks down some medications. Taking cinchona along with some medications that are change by the liver may increase the effects and side effects of your medication. Before taking cinchona talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), aripiprazole (Abilify), clozapine (Clozaril), codeine, desipramine (Norpramin), dextromethorphan, donepezil (Aricept), duloxetine (Cymbalta), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), haloperidol (Haldol), imipramine (Tofranil), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), paroxetine (Paxil), risperidone (Risperdal), tramadol (Ultram), trazodone (Desyrel), venlafaxine (Effexor), and others.

Medications that can cause an irregular heartbeat (QT interval-prolonging drugs)

Interaction Rating=Moderate Be cautious with this combination.

Cinchona contains quinine and quinidine which can cause an abnormal heartbeat in some people. Taking cinchona with medicines that cause an abnormal heartbeat might cause serious side effects including heart rhythm problems (arrhythmias).

Some medications that affect the heartbeat include amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn), ibutilide (Corvert), procainamide (Pronestyl), sotalol (Betapace), thioridazine (Mellaril), and many others.

Medications that decrease stomach acid (H2-blockers)

Interaction Rating=Minor Be watchful with this combination.

Cinchona might increase stomach acid. By increasing stomach acid, cinchona might decrease the effectiveness of some medications that decrease stomach acid, called H2-blockers.

Some medications that decrease stomach acid include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid).

Medications that decrease stomach acid (Proton pump inhibitors)

Interaction Rating=Minor Be watchful with this combination.

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.

Some medications that decrease stomach acid include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)

Interaction Rating=Moderate Be cautious with this combination.

Cinchona might slow blood clotting. Taking cinchona along with medications that also slow clotting might increase the chances of bruising and bleeding.

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.

Phenobarbital (Luminal)

Interaction Rating=Moderate Be cautious with this combination.

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.

Quinidine

Interaction Rating=Major Do not take this combination.

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

Quinine

Interaction Rating=Major Do not take this combination.

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

Interactions with herbs & supplements

Herbs and supplements that might cause an irregular heartbeat (QT interval-prolonging products): Cinchona might affect electrical currents in the heart. This can increase the risk of having an irregular heartbeat. Taking cinchona with other supplements with similar effects might increase the risk for a serious heart issue. Examples of supplements with this effect include bitter orange, ephedra, grapefruit, iboga, and Panax ginseng.
Herbs and supplements that might slow blood clotting: Cinchona might slow blood clotting. There is a concern that using it with other natural products that can also slow blood clotting might increase the risk of bruising and bleeding. Some of these products are alfalfa, angelica, clove, garlic, ginger, Panax ginseng, horse chestnut, red clover, and others.

Interactions with foods

There are no known interactions with foods.

Action

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).