Quinine is approved for treatment of malaria, but is also commonly prescribed to treat leg cramps and similar conditions.
Quinine is believed to interfere with protein metabolism and inhibits nucleic acid synthesis in malarial parasites. Quinine is a highly active blood schizonticide and suppresses the asexual cycle of development of malaria parasites in the erythrocytes. It is effective both as a suppressive drug and in the over clinical attack of malaria.
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. Babesiosis: Adult: As sulfate: 650 mg every 6-8 hr. To be taken w/ clindamycin for 7-10 days. Child: 8 mg/kg (up to 650 mg) every 8 hr. To be taken w/ 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.
Hypersensitivity to quinine or quinidine. Myasthaenia gravis; haemolytic anaemia; quinine-resistant falciparum; patients w/ tinnitus or optic neuritis; patients who have suffered an attack of blackwater fever. Prolonged QT interval. Pregnancy. Lactation. CV diseases; G6PD deficient individuals.
Cinchonism characterised by tinnitus, impaired hearing, headache, nausea, vomiting, disturbed vision, vertigo, abdominal pain & diarrhoea; urticaria, pruritus, fever, angioedema, asthma, dyspnoea, haemoglobinuria, thrombocytopenic purpura, hypoglycaemia, renal failure, hypoprothrombinaemia, agranulocytosis, lnj site irritation, pain & necrosis. Sinus arrest, AV block, ventricular fibrillation & sudden death esp w/ IV use.
Quinine should not be withheld during pregnancy, despite its alleged abortifacient properties at high dosage, since it safeguards the life of the mother. Attention should be given to the considerable risk of hypoglycaemia in pregnant women with severe malaria. Quinine sulfate is excreted in breast milk, but no problems in humans have been reported.
Use of Mefloquine with Quinine sulphate may increase the chance of side effects.
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