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Overview: Cinchona is a plant called Cinchona calisaya. Supplements and teas that contain cinchona are used for various health purposes. However, its benefits are not well defined, and some of the chemicals in cinchona (quinine and quinidine) can cause serious side effects. Common side effects include headache, sweating, flushing, nausea, vomiting, ringing in the ears, diarrhea, dizziness, blurred vision, stomach pain, and heart rhythm changes. Serious side effects include severe skin reactions, immune system reactions, liver damage, and blood disorders. Before taking cinchona, make sure to tell your health care provider about any health conditions you have or medicines you are taking.

Uses

What is cinchona used for?

Cinchona (Cinchona calisaya) teas and supplements are used for various health purposes, but their benefits for any use are not well defined. Products that contain cinchona may also cause serious side effects.

Note: The FDA considers cinchona to be a natural flavoring substance for use in foods and drinks. Learn more about natural flavorings here. The FDA has not reviewed cinchona supplements for safety and effectiveness. Learn more about dietary supplements here.

How does cinchona work (mechanism of action)?

Cinchona (Cinchona calisaya), also known as yellow cinchona, is a plant native to South America. Its bark is sometimes used to make medicinal tea and dietary supplements. Very small amounts of the bark may also be used to flavor foods and drinks. Since cinchona bark contains large amounts of a chemical called quinine, it is sometimes called quinine cinchona or yellow quinine. 

Quinine and another chemical found in cinchona, quinidine, are available as prescription medicines that are used to treat malaria. This has led to interest in using cinchona to treat malaria. But the dose needed to treat malaria is very specific, and the amount of quinine or quinidine found in a specific cinchona product is not always clear. Quinine and quinidine can also cause serious side effects (see the Side Effects sectionfor more information).

If you are concerned that you may have been exposed to malaria, or if you have been diagnosed with malaria, seek medical help right away. Malaria is a serious infection that can be life-threatening if it is not treated correctly.

Herbal products, like cinchona, naturally contain many different chemicals, such as quinine and quinidine. The amounts of each chemical in a specific cinchona product may vary. Some, none, or all of these chemicals may have effects on the body. These effects may change depending on how much of each chemical is found in the product you are using.

How should I store cinchona?

You should store cinchona according to the product label. Most dietary supplements should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of cinchona?

The most common side effects of cinchona are listed below. These side effects may vary depending on the dose you are taking or the specific product you are using. Tell your health care provider if you have any of these side effects that bother you.

  • Headache
  • Sweating
  • Flushing
  • Nausea and vomiting
  • Ringing in the ears or hearing loss
  • Diarrhea
  • Dizziness
  • Blurred vision, changes in how you see color, or vision loss
  • Stomach pain
  • Heart rhythm changes (see below)

There may be other side effects of cinchona that are not listed here. Contact your health care provider if you think you are having a side effect of a supplement. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of cinchona?

While less common, the most serious side effects of cinchona are described below, along with what to do if they happen.

Severe Allergic Reactions. Cinchona may cause allergic reactions, which can be serious. Stop taking cinchona and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Severe Skin Reactions. Quinine and quinidine, which are chemicals found in cinchona, can cause severe skin reactions, called Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), that can lead to death if not treated. If you get a rash, stop taking cinchona and call your health care provider right away. Get emergency help if you have any of the following symptoms of SJS or TEN.

  • Painful red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms, including fever, chills, and muscle aches

Blood Disorders. Quinine and quinidine, which are chemicals found in cinchona, can cause blood disorders, such as agranulocytosis and hemolytic anemia. Get help right away if you have any of the following symptoms of blood disorders.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Frequent infection
  • Unusual weakness or tiredness
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Headache
  • Fast or abnormal heartbeat

Heart Rhythm Changes. Quinine and quinidine, which are chemicals found in cinchona, may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk for this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or take medicines that can prolong the QT interval. Tell your health care provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Low Blood Sugar (Hypoglycemia). Quinine, a chemical found in cinchona, can cause low blood sugar, which can be serious and may lead to death. Those who are pregnant may be at a higher risk. Stop taking cinchona and call your health care provider right away if you have any of the following symptoms of hypoglycemia.

  • Headache
  • Crankiness or anxiety
  • Hunger
  • Dizziness or confusion
  • Blurry vision
  • Slurred speech
  • Sweating
  • Feeling jittery or shakiness
  • Fast heartbeat
  • Seizures

Thrombotic Thrombocytopenic Purpura (TTP). Quinine, a chemical found in cinchona, can lead to a serious problem with blood clotting, called TTP. TTP is when blood clots form in some parts of your bloodstream, which causes a loss of platelets in the rest of the blood (thrombocytopenia). This can sometimes lead to kidney problems, including hemolytic uremic syndrome (HUS). TTP needs to be treated right away in the hospital or it can lead to death. Get emergency help if you have any of the following symptoms without another explanation.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
  • Changes in your vision
  • Unusual weakness or tiredness
  • Headache, confusion, or slurred speech
  • Fast heartbeat
  • Purplish spots (purpura) on the skin or in the mouth due to bleeding under the skin
  • Low amount of pee or pee that is pink or has blood in it

Immune System Reactions. Quinidine, a chemical found in cinchona, can cause inflammation of your liver, lungs, eyes, blood vessels, or lymph vessels and cause symptoms that look like a condition called lupus. Call your health care provider right away if you have any of the following symptoms.

  • Rash
  • Joint pain
  • Fever
  • Weakness or unusual tiredness
  • Cough
  • Blurred or double vision, eye pain or redness, sensitivity to light, or vision loss

Liver Damage. Liver damage (hepatotoxicity) can happen when taking quinidine, a chemical found in cinchona. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)

Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Warnings & Precautions

Who should not use cinchona?

Allergies to Ingredients. People who are allergic to any of the following should not take cinchona.

  • Cinchona
  • Cinchona calisaya
  • Quinidine
  • Quinine
  • Any of the ingredients in the specific product

Your pharmacist can tell you all of the ingredients in the specific cinchona products they stock.

Heart Block or Rhythm Problems. Cinchona should not be taken if you have a certain type of electrocardiogram (ECG) abnormality known as QT prolongation. You should also not take cinchona if you have certain types of heart blocks, also called atrioventricular (AV) blocks, unless you have a pacemaker.

Side Effects From Quinine or Quinidine. Cinchona contains quinine and quinidine, which are available as prescription medicines. If you have taken quinine or quinidine before and it caused severe side effects, such as low platelet levels, thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura, hemolytic uremic syndrome (HUS), or blackwater fever, you should not take cinchona.

Muscle Weakness. You should not take cinchona if you have a condition called myasthenia gravis.

What should I know about cinchona before using it?

Cinchona is used in small amounts as a flavoring in foods and drinks. It is also available as a tea and a dietary supplement. It cannot be marketed to treat or cure a disease.

Read and follow the directions on the specific product you are taking, or take it as recommended by your health care provider.

Keep cinchona out of the reach of children.

Herbal products, such as cinchona, naturally contain many different chemicals. The amount of each chemical in a specific cinchona product can change for many reasons, including the area where the plant was grown, the weather during growth, the time of year when it was harvested, and the way the plant was processed after being harvested. If you switch to a new bottle or a different brand, you may not have the same effects or side effects because of this variability. Talk to your health care provider if you have questions or concerns.

Cinchona is available in many different forms, including as a liquid extract, tea, or dried ground powder. Each of these forms may contain different amounts of the chemicals naturally found in the plant.

The FDA has not tested cinchona products to confirm that they contain the ingredients stated on their labels. Some dietary supplements have been tested by third-party organizations to confirm that they contain the ingredients listed on their labels and do not contain any harmful chemicals. Learn more about how to choose a safe dietary supplement product here.

What should I tell my health care provider before using cinchona?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. Also tell them if you have an upcoming surgery planned. Sharing this information will help your health care provider know if this or other supplements are right for you.

In particular, make sure that you discuss any of the following.

Malaria. If you are concerned that you may have been exposed to malaria, or if you have been diagnosed with malaria, seek medical help right away. Malaria is a serious infection that can be life-threatening if it is not treated correctly. You should not use cinchona to treat malaria at home.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Abnormal heart rate or rhythm, including heart block
  • Currently use a pacemaker
  • Heart disease, including a condition called long QT syndrome 
  • Liver or kidney problems
  • Blood disorders
  • Electrolyte imbalance, such as high or low levels of sodium or potassium
  • Persistent or severe vomiting or diarrhea
  • Myasthenia gravis
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Other Medicines and Supplements. Cinchona may interact with other medicines and supplements. Before taking cinchona, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. There is some concern that cinchona may increase the risk of a miscarriage. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. Some of the chemicals in cinchona, including quinine and quinidine, pass into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does cinchona interact with foods or drinks?

Do not drink grapefruit juice while taking cinchona. Cinchona contains a chemical called quinidine. Grapefruit juice can increase your blood levels of quinidine, which may lead to serious side effects.

It is unknown if drinking alcohol will affect cinchona.

Does cinchona interact with medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking cinchona.

  • A calcium channel blocker, such as diltiazem (Cardizem CD and others), nicardipine (Cardene), nifedipine (Adalat, Procardia XL), or verapamil (Verelan, Verelan PM), which is a medicine used for high blood pressure or other conditions
  • A medicine for seizures, such as carbamazepine, phenobarbital, or phenytoin
  • Acetazolamide or sodium bicarbonate, which may be used to lower the acid in your urine
  • Any medicine used to control your heart rate or rhythm (antiarrhythmic)
  • Aminophylline or theophylline, which are medicines for asthma or certain other breathing problems
  • Cimetidine (Tagamet HB), which is a medicine used for heartburn
  • Dextromethorphan, which is a cough suppressant
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Flecainide, which is a medicine used for irregular heart rhythm
  • Ketoconazole, which is a medicine used for fungal infections
  • Mefloquine, which is a medicine used to treat malaria
  • Metoprolol (Lopressor) or propranolol (Inderal LA, Innopran XL), which are medicines that may be used for certain heart conditions or to reduce blood pressure
  • Rifampin, which is a medicine commonly used to treat an infection called tuberculosis 
  • Ritonavir (Norvir), which is a medicine commonly used to treat HIV
  • Tetracycline, which is a medicine used to treat infections or other conditions
  • Warfarin, which is a blood thinner 
  • Haloperidol, which is a medicine for certain mental health conditions 
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure 
  • Medicines that can cause QT prolongation, which is a potentially dangerous heart rhythm problem

Many other medicines may alter the blood levels of cinchona, and vice versa. Tell your health care provider about all medicines that you take or have recently taken.

The interactions between cinchona and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with cinchona is incomplete. Always check with your health care provider before taking cinchona with any medicines.

Overdose/Missed Dose

What should I do if I accidentally use too much cinchona?

If you or someone else has used too much cinchona, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

Cinchona contains quinidine and quinine, which can cause serious side effects when taken incorrectly. Read the product label closely and speak to a health care provider about how to take cinchona safely. Do not take double or extra doses, even if you miss a dose.