Generic
Quinine Dihydrochloride
3 brands available in the market
At a glance
Quinine Dihydrochloride is a cinchona alkaloid and 4-methanolquinoline used for the treatment of malaria and nocturnal leg cramps. It rapidly acts on blood schizonticide by interfering with lysosomal function or nucleic acid synthesis in Plasmodia spp.
Description
Quinine is a cinchona alkaloid and 4-methanolquinoline that suppresses the asexual cycle of malaria parasites in erythrocytes by interfering with lysosomal function or nucleic acid synthesis. It has no activity against exoerythrocytic forms.
Indications
- Uncomplicated, severe, and complicated falciparum malaria
- Falciparum malaria resistant to other drugs
- Prevention of nocturnal muscle cramps
Therapeutic class
Anti-malarial drugs
Pharmacological class
Cinchona Alkaloid (4-Methanolquinoline)
Pharmacology
Quinine rapidly acts on blood schizonticide by interfering with lysosomal function or nucleic acid synthesis in Plasmodia spp. It suppresses the asexual cycle of malaria parasites and prevents parasite development in erythrocytes.
Mechanism of action
Interferes with lysosomal function or nucleic acid synthesis in malaria parasites.
Dosage
Adult Dose (IV):
- Loading dose: 20 mg/kg (max 1.4 g) over 4 hours IV infusion; maintenance started after 8 hours
- Maintenance infusion: 10 mg/kg (max 700 mg) over 4 hours every 8 hours
- Do not give loading dose if patient received quinine, quinidine, halofantrine, or mefloquine in previous 12 hours
- Severe hepatic/renal impairment: Maintenance dose 5-7 mg/kg every 8 hours
Pediatric Dose (IV): <5 mg/kg/hr by slow IV infusion
Administration
- Administered by healthcare professional as IV infusion only
- IV infusion preferred for seriously ill patients
- Switch to oral therapy when patient can swallow
Missed dose
If you miss a dose, consult your doctor.
Side effects
Side Effects (Cinchonism):
- Severe headache
- Nausea
- Vomiting
- Diarrhea
- Blurred vision
- Tinnitus
- Flushing of skin
- Fever
- Rash
- Pruritus
- Hypoglycemia
- Hemolysis in G6PD deficiency
- Thrombocytopenia
- Hepatitis
- Potentially fatal: Sinus arrest, AV block, ventricular fibrillation, sudden death (especially with IV use)
Precautions & warnings
- Caution in patients with cardiac conduction defects, heart block, or atrial fibrillation
- Monitor for cardiotoxicity, blood glucose, CBC, LFT, ECG
- Caution in prolonged QT interval, tinnitus, optic neuritis, myasthenia gravis
- Caution in pregnancy and lactation
Contraindications
- Hypersensitivity to quinine, mefloquine, or quinidine
- Nocturnal leg cramps
- Prolonged QT interval
- Tinnitus or optic neuritis
- Myasthenia gravis
- G6PD deficiency
- History of black water fever
Drug interactions
- Class IA/III antiarrhythmics (quinidine, procainamide, disopyramide, amiodarone, sotalol): Risk of QT prolongation and torsade de pointes
- Mefloquine: Risk of QT prolongation
- Rifampicin: Decreased plasma levels of quinine
- Ritonavir: Increased serum levels
- Warfarin: Increased anticoagulant effect
- Digoxin: Increased plasma levels
- Atorvastatin: Increased risk of myopathy and rhabdomyolysis
- Al/Mg-containing antacids: Delayed or decreased absorption
Food interactions
Take with food for better absorption; it is not known whether it is safe to consume alcohol.
Use in pregnancy
Use in Pregnancy: Safe in therapeutic doses during pregnancy; limited information on fetal risk.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Excreted in breast milk in insignificant amounts; safe to use.
Pediatric use
Pediatric dose based on weight; <5 mg/kg/hr slow IV infusion.
Geriatric use
Caution required in elderly patients; dose adjustment may be needed.
Renal / hepatic impairment
Renal Impairment: Severe renal impairment: Maintenance dose 5-7 mg/kg every 8 hours; consult your doctor.
Hepatic Impairment: Mild-moderate: No dose adjustment needed; Severe: Maintenance dose 5-7 mg/kg every 8 hours; consult your doctor.
Overdose effects
Overdose: Exacerbation of cinchonism (nausea, vomiting, tinnitus, visual disturbances), cardiac arrhythmias; treatment: symptomatic supportive care, gastric lavage, electrolyte monitoring.
Storage conditions
Store away from light and moisture; keep out of reach of children.
Chemical structure
Quinine Dihydrochloride