Pharm

Quinine

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Quinine, Qualaquin

  • Indications
  1. Non-Severe Malaria Treatment in Chloroquine resistant regions
    1. Combined with Doxycycline, Tetracycline or Clindamycin
    2. Alternative when Artemisinin Combination Therapy (ACT) is unavailable
  • Contraindications
  1. G6PD Deficiency
  2. Myasthenia Gravis
  3. Severe hepatic Impairment (Child-Pugh C)
  4. Do NOT use for Nocturnal Leg Cramps
    1. Low efficacy and high risk
  • Dosing
  1. Malaria
    1. Combined with 7 days of Doxycycline, Tetracycline or Clindamycin
    2. Adult: 648 mg salt (542 mg base) three times daily orally for 3 days (7 days in Southeast Asia)
      1. In severe Chronic Kidney Disease, after first dose, decrease to 324 mg orally every 12 hours
    3. Child: 10 mg/kg up to 648 mg salt (8.3 mg/kg up to 542 mg base) three times daily orally
  2. Severe Babesiosis
    1. Combined with Clindamycin 7 to 10 mg/kg up to 600 mg IV every 6 hours for 7 to 10 days
    2. Adult: 650 mg orally every 6 to 8 hours
    3. Child: 8 mg/kg (up to 650 mg) orally every 8 hours
  • Mechanism
  1. Quinidine alkaloid extracted from cinchona tree bark
  • Adverse Effects
  1. Serious
    1. Hemolytic Uremic Syndrome
    2. Thrombotic Thrombocytopenic Purpura
    3. QTc Prolongation as well as PR and QRS Duration widening
  • Safety
  1. Considered safe in pregnancy
  2. Considered safe in Lactation
    1. Avoid in infants with G6PD Deficiency
  • Drug Interactions
  1. Agents to avoid with Quinine
    1. Clarithromycin
    2. Erythromycin
    3. Rifampin
    4. Ritonavir
  2. Digoxin
    1. May increase Digoxin levels
  3. Warfarin
    1. Increased INR
  4. Antacids
    1. Decreases Quinine absorption
  • Resources
  1. Quinine Sulfate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f567d5c7-ea5d-49a7-a035-b47208135f73
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia