Quinine
Quinine in beverages is regulated in the US to a maximum of 83 ppm. At medical doses it can cause cinchonism (tinnitus, headache, nausea), thrombocytopenia, and serious immune-mediated reactions; pregnant individuals are advised to avoid quinine-containing drinks at high intake.
What it is
Bitter alkaloid from cinchona bark; historically antimalarial, used in beverages as a flavor at low levels.
Bitter flavoring in tonic waters and bitter lemon drinks.
Why it's flagged
- Idiosyncratic thrombocytopenia / severe reactions
- Avoid in pregnancy at high intake
What regulators actually say
"Quinine may be safely used in carbonated beverages... in an amount not to exceed 83 parts per million in the finished beverage."
"Off-label use of quinine to treat leg cramps poses a risk of serious and life-threatening hematologic reactions, including thrombocytopenia."
Regulatory status
United States — FDA
Permitted up to 83 ppm in carbonated beverages — 21 CFR 172.575
European Union — EFSA
Permitted at limited levels under Regulation 1334/2008 Annex III (max ~85 mg/L)
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