Quinine

General

• Type: Antimalarial
• Dosage Forms: PO 324 (IM and IV formulations available outside US)
• Common Trade Names: Qualaquin

Adult Dosing

Indications by Disease

Disease	Dose	Context
Babesiosis	650mg TID	Severe parasitemia with Clindamycin use IV for severe
Malaria	648mg PO q8h x 7 days	Uncomplicated malaria, use with doxycycline or clindamycin

Pediatric Dosing

Indications by Disease

Disease	Dose	Context
Babesiosis	8mg/kg PO q8h x 7-10 days (Max: 648mg/dose)	Severe parasitemia with Clindamycin
Malaria	30mg/kg/day PO q8h x 3-7 days (Max: 648mg/dose)	Uncomplicated malaria, use with clindamycin

Special Populations

• Pregnancy Rating: C
• Lactation: Probably safe
• Renal Dosing
  • Adult
    • Severe chronic renal failure: 648mg PO x 1 then 324mg PO q12h
    • If on HD give after dialysis
  • Pediatric
    • Not defined
• Hepatic Dosing
  • Adult and Pediatric
    • No adjustment for Child-Pugh Class A or B
    • Avoid in Child-Pugh Class C

Contraindications

Black Box Warnings

• Hematologic Toxicity with use for nocturnal leg cramps
  • Thrombocytopenia
  • HUS/TTP

General

• Allergy to class/drug
• Allergy to mefloquine or quinidine
• Black water fever
• ITP/TTP/HUS
• Thrombocytopenia
• Glucose-6-Phosphate Deficiency (G6PD)
• Myasthenia gravis
• Optic neuritis
• QT prolongation/Congenital long QT syndrome
• Electrolyte abnormalities
• Bradycardia
• Ventricular arrhythmias
• CHF
• Recent MI

Caution

• Torsades de pointes
• Atrial fibrillation/Atrial flutter
• Pregnancy
• Hepatic impairment

Adverse Reactions

Serious

• Cinchonism
• QT prolongation
• Torsades de pointes
• Anaphylaxis
• Angioedema
• Bronchospasm
• Thrombocytopenia
• TTP/HUS
• Hemolytic anemia
• Black water fever
• Stevens-Johnson syndrome and toxic epidermal necrolysis
• Intestinal nephritis
• Renal impairment
• Hepatitis
• Leukopenia
• Neutropenia
• DIC
• Hypoglycemia
• Myasthenia gravis exacerbation
• Lupus
• Optic neuritis
• Blindness
• Deafness

Common

• Cinchonism
• Headache
• Vasodilation
• Diaphoresis
• Nausea/Vomiting
• Tinnitus
• Impaired hearing
• Vertigo
• Visual impairment
• Fever
• Flushing
• asthenia
• Rash
• Pruritus
• Urticaria
• Diarrhea
• Abdominal pain
• Photosensitivity

Pharmacology

• Half-life: 9-12 hours
• Metabolism: Liver 80%, CYP450
• Excretion: Urine
• Mechanism of Action: Unknown

Administration

• Give with food

Toxicity

• Mild
  • Nausea
  • Vomiting
  • Tinnitus
  • Vertigo
  • Deafness
• Severe
  • Ataxia
  • Convulsions
  • Coma
  • QRS/QT prolongation
  • Arrhythmia
• Retinal Toxicity
  • Blurry vision
  • Impaired visual fields
  • Blindness

See Also

• Malaria
• Babesiosis

References

• Epocrates