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Quinine

  • Medical and Pharmacy Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Brand Name: Qualaquin

Generic Name: Quinine

Drug Class: Antimalarials

What Is Quinine and How Does It Work?

Quinine is a prescription drug used as an antimalarial drug indicated only for treatment of uncomplicated Plasmodium falciparum malaria. Quinine sulfate has been shown to be effective in geographical regions where resistance to chloroquine has been documented.

Quinine is available under the following different brand names: Qualaquin.

Dosage of Quinine:

Adult and Pediatric Dosages

Capsule

Dosage Considerations – Should be Given as Follows:

Malaria

Adults

Uncomplicated (P. falciparum)

  • 648 mg orally every 8 hours for 7 days

Chloroquine-Resistant (P. falciparum)

Chloroquine-Resistant (P. vivax)

  • 648 mg orally every 8 hours for 3-7 days concomitant doxycycline (or tetracycline) and oral primaquine

Pediatric Dosages

Uncomplicated (P. falciparum)

  • 30 mg/kg/day orally divided three times daily for 3-7 days
  • Should not exceed the usual adult oral dosage

Chloroquine-Resistant (P. falciparum)

  • 30 mg/kg/day orally divided three times daily for 3-7 days, with concomitant doxycycline, tetracycline or clindamycin
  • Should not exceed the usual adult oral dosage

Chloroquine-Resistant (P. vivax)

  • 30 mg/kg/day orally three times daily for 3-7 days, with concomitant doxycycline and oral primaquine
  • Should not exceed the usual adult oral dosage

Babesiosis

Adult Dosage:

  • 648 mg orally every 8 hours, with concomitant orally or intravenously clindamycin

Pediatric Dosage:

  • 25 mg/kg/day orally divided three times daily for 7 days, with concomitant oral clindamycin

Dosage Modifications

  • Severe, chronic renal impairment: 648 mg orally once, then 324 mg orally every 12 hours

Hepatic impairment

  • Mild or moderate (Child-Pugh A or B): No dosage adjustment required; monitor closely
  • Severe (Child-Pugh C): Do not administer

What Are Side Effects Associated with Using Quinine?

Side effects of quinine include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Quinine?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Quinine has no known severe interactions with other drugs.

Serious interactions of quinine include:

Quinine has serious interactions with at least 48 different drugs.

Quinine has moderate interactions with at least 138 different drugs.

Quinine has minor interactions with at least 82 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Quinine?

Warnings

Contraindications

Effects of Drug Abuse

  • No information available

Short-Term Effects

  • See "What Are Side Effects Associated with Using Quinine?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Quinine?"

Cautions

  • Reduce parenteral dose by half if over 48 hour parenteral treatment required; monitor EKG, blood pressure, and glucose with parenteral treatment
  • FDA warns against unapproved use for leg cramps because of unpredictable serious and life-threatening hematologic reactions including thrombocytopenia and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP)
  • QT prolongation
  • Concentration-dependent prolongation of the PR and QRS interval observed
  • At particular risk are patients with underlying structural heart disease and preexisting conduction system abnormalities, elderly patients with sick sinus syndrome, patients with atrial fibrillation with slow ventricular response, patients with myocardial ischemia or patients receiving drugs known to prolong the PR interval (verapamil) or QRS interval (flecainide or quinidine)

Pregnancy and Lactation

  • Do not use quinine during the first trimester of pregnancy
  • The risks involved outweigh potential benefits
  • Safer alternatives exist
  • Quinine enters breast milk. Consult your physician if breastfeeding
Reviewed on 6/7/2017

Medscape. Quinine.
https://reference.medscape.com/drug/qualaquin-quinine-342696#0
RxList. Qualaquin Monograph.
https://www.rxlist.com/qualaquin-drug.htm

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