Quinine and Rivaroxaban

[mastiff22]

I am pacemaker dependant having had an av node ablation. Having given up all alcohol, which I used to really enjoy I have very infrequent episodes of AF. I have replaced my Gin and Tonic with a non alcoholic spirit and sugar free tonic. However, I have just heard that I should not be having tonic because the quinine in it renders the anticoagulant less efficient. Just wondered if anyone here has heard of this. I’m really gutted that that I can’t enjoy my new found drink.

[rosyG]

Hi,Quinine makes warfarin more effective and is dangerous but I don't know about the effect with DOACS It's best to check with your pharmacist for interactions

[mastiff22 in reply to rosyG]

Thank you for that.

[CDreamer]

Sorry to tell you but it’s contraindicated for AF - period. I get very ill if I take Tonic Water, alcohol no problem.

There is some tonic water that doesn’t contain quinine but I don’t like it.

[Shrek1974 in reply to CDreamer]

Wow, that has me thinking! I’ve been searching for my triggers (as most here do/have) & not had much joy. I had no idea about quinine & have tonic once in a blue moon.... Normally get it in at Christmas just incase somebody wants it & throw it away when we discover some thats found its way to the back of the cupboard & long out of date. 😂

[cuore in reply to CDreamer]

That's an interesting statement about tonic water being contraindicated for AF. A couple of days before taking my "Alsat" exams ( I think that's what you called them in those days - entrance exams for doctoral studies), a friend brought over gin and tonic for me to imbibe. I remember hardly having a drink before I began vomiting profusely. I was still sick for the exams resulting in compromised exam results. Fast forward five years later, I had a similar attack in a different scenario. Thereupon, I concluded I could not drink "gin and tonic." Fast forward another five years at a banquet where I was mixing myself Compari and soda, but accidentally grabbed the tonic instead for a Compari and tonic drink. The reaction was so bad that other than the violent vomiting, I couldn't even drive home, and had to be put to bed by my friends. I should say that I did not finish the drink. I definitely concluded it was the tonic alone that affected me. I have not had a drink of tonic since.

Now I am beginning to wonder whether those episodes with tonic were a warning sign of my propensity for AF which came to fruition many years later. I would welcome any links regarding this contraindication.

[CDreamer in reply to cuore]

The last time I had gin and tonic was about 5 years ago. It used to be my favourite tipple, especially on a hot day. I found that I began an intolerance to wine so decided to have a gin and tonic. I had been diagnosed with Myasthenia but wasn’t aware that quinine was contraindicated if you have Myasthenia that but also any irregular heart rate. Within about 5 mins of finishing my quite well diluted gin because, like you, I was more concerned about the alcohol. I was aware of HR increase, nausea, feeling ‘floaty’ but not in a nice way, eyes closed, breathing became laboured and I knew I was in trouble. Luckily my husband got me home safely and I went straight to bed and had recovered in the morning.

The only link, apart from the one below which refers to meds, is this which I know is not a study. healthline.com/health/quini...

I know the amount of quinine in tonic has been reduced in recent years but I won’t chance it anymore.

[mastiff22 in reply to CDreamer]

Having read both the articles you kindly recommended, C Dreamer, I find that it is not so much the risk of triggering my AF that causes me concern ( tonic water has not been a trigger for me in the past) but if I have interpreted the articles properly, it is the effects on the platelets and how this combined with the anticoagulant could increase the risk of uncontrolled bleeding that concerns me more.

[CDreamer in reply to mastiff22]

That’s a difficult one to answer and I doubt you will get a definitive answer from anyone. There are lots of foods and supplements that are supposedly contraindicated with anticoagulants but taken in food or beverages the are unlikely to contain enough of the active agent to be significant.

If you are that concerned then maybe avoid, purely for peace of mind.

[CDreamer]

Ref medicines.org.uk/emc/produc...

[mastiff22 in reply to CDreamer]

Not sure I want to thank you for that article CDreamer. Looks like tonic water is out on all counts! Back to the drawing board for me. 😢😢. Seriously, thank you, that has really clarified things for me.

[Cally53 in reply to CDreamer]

Well, you learn something every day! Not that I drink tonic water more than about three or four times a year!

[Talika]

I drink tonic water and it has never been a problem with af for me - I don’t drink large amounts because of the sugar but nevertheless I have never had a problem

[Barlick43]

I am pacemaker dependant like you, after node ablation for permanent af. I am on asprin for stents and rivaroxaban for clots/strokes. I have been for 3 years and at 77 have not given up my daily gin and tonic. I put half tonic and half sparking water with my gin ( I buy expensive gin and can often drink it with just the sparkling water). If I have a second gin which I am want to do, in special events, and I know 3-5 laters Cos of the feeling I get from heart action in response to the detox of alcohol. I can live with this and do

[Auriculaire]

Quinine is poison . It's ancient use as a malaria prophylactic came with all sorts of very nasty side effects. Although it is only present in tiny amounts in tonic water why put something so nasty into your body?

[Windlepoons]

I gave up alcohol 18 months ago as it triggers my AF and enjoyed the odd tonic instead. However the af episode before last came on immediately after a glass of tonic. That's out the window too now. 🤨

[Dollcollector]

Fizzy drinks are bad for you too.

[Eastwick]

I have never been told to give up alcohol and I am pacemaker dependent as you are! I have a glass of wine with dinner every night. My cardiologist knows this and is fine with it.

[Treschere]

This is interesting, I like to drink Tonic water on it's own as the gin now causes short lasting AF, in the article referred to by CDreamer it says reaction could be determined by the reaction to tonic water. Oh well there goes another pleasure.

[CDreamer in reply to Treschere]

If you are sensitive to it you maybe ok. It’s very individual. I do react very badly to tonic water and it only really clicked when I drank it on it’s own and still got a reaction and realised it wasn’t the gin! I still take the occasional gin with no consequences. We all react very differently to every substance.

[Desanthony]

I don't think all tonics have quinine - check. I am taking eliquis and quinine sulphate tablets for bad cramp - thankfully the quinine sulphate tablets work for the cramp and are OK with Eliquis - the Doc is quite happy to keep prescribing them with my twice yearly full blood checks. Best to ask your pharmacist about this.