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Quinine Sulphate

Quinine Sulphate

What is quinine used for?

Treating malaria infections (falciparum malaria, or if the infective species is not known, or if the infection is mixed). You'll usually need to take a course of another antimalarial (doxycycline or clindamaycin) either alongside the course of quinine, or after you've finished the course of quinine. Quinine is not suitable for preventing malaria.

Treating and preventing night-time leg cramps in adults and elderly people. Quinine is only used if the cramps cause regular and frequent disruption of sleep, and other measures, such as stretching exercises and massage, have not worked.

How does quinine work?

Quinine is a type of medicine called an antimalarial. You may be given it as quinine sulfate or quinine bisulfate.

Malaria is a potentially fatal disease caused by various types of single-celled (protozoan) parasites known as Plasmodium. Plasmodium are carried by mosquitoes and injected into the bloodstream during a bite from an infected mosquito. Once in the blood, the parasites travel to the liver, where they multiply. The parasites are then released back into the bloodstream where they invade the red blood cells and multiply again. An actual attack of malaria develops when the red blood cells burst, releasing a mass of parasites into the bloodstream. The attacks do not begin until a sufficient number of blood cells have been infected with parasites.

Precautions

Before taking quinine, tell your doctor or pharmacist if you are allergic to it; or to quinidine or mefloquine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: sudden vision change, confusion, severe trouble hearing, fast/irregular heartbeat, fainting, slow/shallow breathing, seizures, inability to wake up (coma).

Who should not take quinine?

People who have problems with vision caused by inflammation of the optic nerve (optic neuritis).

  • People with a sensation of ringing or other noise in their ears (tinnitus).
  • People with the muscular condition myasthenia gravis.
  • People with blood in their urine (haemoglobinuria).       
  • People who are allergic to any ingredients of the medicine.

Special considerations

• Administer quinine after meals to minimize gastric distress; don’t crush tablets because drug irritates gastric mucosa.

• Quinine is no longer used for acute malarial attack by P. vivax or for suppression of malaria from resistant organisms.

• Serum levels of 10 mcg/ml or more may confirm toxicity as the cause of tinnitus or hearing loss.

• Discontinue drug if signs of idiosyncrasy or toxicity occur.

• Drug falsely elevates urinary catecholamines and may interfere with 17-hydroxycorticosteroid and 17-ketogenic steroid tests.

Breast-feeding patients

• Before giving drug to breast-feeding woman, evaluate infant for possible G6PD deficiency.

Geriatric patients

• Use cautiously in patients with conduction disturbances.

DOSING CONSIDERATIONS

Hepatic Impairment

Avoid use in patients with severe hepatic impairment (Child-Pugh C). Dosage adjustments are not required for mild to moderate hepatic impairment (Child-Pugh A and B); however, these patients should be closely monitored for quinine-associated adverse effects.

Renal Impairment

For patients with severe chronic renal impairment, FDA-labeling recommends 648 mg PO once, then 324 mg PO every 12 hours; creatinine clearance is not specified.

Alternately, in cases of severe malaria, do not reduce the dose or interval for renal impairment. In other cases:

CrCl more than 50 mL/minute: No dosage adjustment needed.

CrCl 10 to 50 mL/minute: Extend dosing interval to every 8 to 12 hours.

CrCl less than 10 mL/minute: Extend dosing interval to every 24 hours.

Chronic Intermittent Hemodialysis

In patients receiving dialysis, dose after dialysis. In cases of severe malaria, do not reduce the dose or interval.

Peritoneal Dialysis

648 mg PO every 24 hours. In cases of severe malaria, do not reduce the dose or interval.

Continuous Renal Replacement Therapy

648 mg PO every 8 to 12 hours. In cases of severe malaria, do not reduce the dose or interval.

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