Quinine and leg cramps

We would like to respond to Hogan’s commentary,1 which states that quinine is not a safe drug in the treatment of muscle cramps. Hogan points out that nonpharmacologic and other pharmacologic options should be tried before prescribing quinine sulphate.1 But, it is important to note that our previously published recommendations and guidelines2 maintain a clear role for quinine when prescribed by physicians, and when adequate counselling is given to patients and adequate monitoring is in place. Simply calling a drug unsafe may lead to bans similar to those enacted in the United States, which severely limit options for neuromuscular clinicians who care for patients with disabling and terminal conditions such as amyotrophic lateral sclerosis.