Quinine information from DrugsUpdate
P - Contraindicated in pregnancy
L - Caution when used during lactation
LI - Lab *
Quinine is a natural white crystalline alkaloid having antipyretic (fever-reducing), antimalarial, analgesic (painkilling), and anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine.
The bark of the cinchona tree is used to make quinine.
Quinine is also used to treat lupus, nocturnal leg cramps and arthritis.
Pharmacodynamics
Pharmacokinetics
Quinine is a cinchona alkaloid and a 4-methanol quinoline. It rapidly acts on blood schizontocide by interfering with lysosomal function or nucleic acid synthesis in the Plasmodia spp. It has no activity against exoerythrocytic forms. In the skeletal muscle, quinine increases the refractory period and excitability of the myoneural junction.
Absorption
Rapid and almost complete from the GIT; peak plasma concentrations after 1-3 hr (oral).
Distribution
Widely distributed; crosses the placenta; enters breast milk. Protein-binding: 70%.
Metabolism
Extensively hepatic.
Excretion
Urine; 11 hr (elimination half-life).
Quinine Indications / Quinine Uses
Information Not Available
Quinine Adverse Reactions / Quinine Side Effects
Cinchonism characterised by tinnitus, impaired hearing, headache, nausea, vomiting, disturbed vision, vertigo, abdominal pain and diarrhoea; urticaria, pruritus, fever, angioedema, asthma, dyspnoea, haemoglobinuria, thrombocytopenic purpura, hypoglycaemia, renal failure, hypoprothrombinaemia, agranulocytosis, Inj site irritation, pain and necrosis.
Potentially Fatal: Sinus arrest, AV block, ventricular fibrillation and sudden death especially with IV use.
Precautions
Monitor
Monitor patients with hepatic impairment for adverse reactions.
Overdosage
Symptoms include GI effects, oculotoxicity, CNS disturbances and cardiotoxicity.
Special Precautions
Lactation. CV diseases; G6PD deficient individuals.
Other Drug Interactions
Rifampicin accelerates quinine clearance; cimetidine inhibits quinine metabolism; quinine may enhance hypoglycaemic effects of oral antidiabetics. Concurrent admin with aluminium and/or magnesium containing antacids may decrease the absorption of quinine.
Potentially Fatal: Increases digitalis toxicity; hypoprothrombinaemic effect of warfarin enhanced by quinine. Increased risk of convulsions with mefloquine. Increased risk of ventricular arrhythmias with halofantrine or other arrhythmogenic drugs e.g., amiodarone, astemizole, terfenadine, cisapride and pimozide.
Other Interactions
Information Not Available
Dosage
Oral
Malaria
Adult: As sulfate: 648 mg given every 8 hr for 7 days.
Child: 10 mg/kg given every 8 hr for 7 days.
Renal impairment: Severe chronic renal failure (as sulfate): 648 mg followed 12 hr later by maintenance doses of 324 mg every 12 hours.
Oral
Nocturnal leg cramps
Adult: 200-300 mg once at night.
Oral
Babesiosis
Adult: As sulfate: 650 mg every 6-8 hr. To be taken with clindamycin for 7-10 days.
Child: 8 mg/kg (up to 650 mg) every 8 hr. To be taken with clindamycin for 7-10 days.
Intravenous
Malaria
Adult: As dihydrochloride: Initially, 20 mg/kg (max: 1.4 g) given over 4 hr. Start maintenance doses 8 hr after the start of the initial infusion. Maintenance: 10 mg/kg (up to 700 mg) given over 4 hr every 8 hr. Loading dose should not be given if patient has received quinine, quinidine, mefloquine or halofantrine during the previous 24 hr. If parenteral treatment is required for >48 hr, maintenance dose should be reduced to 5-7 mg/kg.
Food(before/after)
Should be taken with food
List of Contraindications
Quinine and Pregnancy
Contraindicated in pregnancy.
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Quinine and Lactation
Caution when used during lactation
Quinine and Children
Safety and efficacy not established in children younger than 16 years of age.
Quinine and Geriatic
Studies did not include sufficient numbers of subjects older than 65 yr of age to determine if they respond differently from younger subjects.
Quinine and Other Contraindications
Hypersensitivity to quinine or quinidine. Myasthaenia gravis; haemolytic anaemia; quinine-resistant falciparum; patients with tinnitus or optic neuritis; patients who have suffered an attack of blackwater fever. Prolonged QT interval. Pregnancy.
Storage
Oral
Store at 25-30°C.
Lab interference
Oral
Store at 25-30°C.
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