Before Taking This Medicine
You should not use this medication if you have ever had an allergic reaction to quinine or similar medicines such as mefloquine or quinidine, or if...
How Should I Take quinine?
Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.Take with f...
What Happens If I Miss A Dose?
Take the missed dose as soon as you remember. If you are more than 4 hours late for your dose, skip the missed dose and take the medicine at your n...
What Should I Avoid While Taking quinine?
Avoid taking other anti-malaria medications without your doctor's advice. This includes chloroquine, halofantrine, and mefloquine.Avoid using antac...
What Other Drugs Will Affect quinine?
Many drugs can interact with quinine. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start...
What is Quinine used for?
Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria
How long does quinine treatment last?
Even with seven-day treatment durations, evaluations of different quinine dosage regimens have revealed interesting trends. Doses of 10 mg/kg/day given twice daily for 7 days were associated with day 28 treatment failure rates as high as 30%[37]. Increasing the quinine dosage to 15 mg/kg/day or 20 mg/kg/day improved treatment outcomes, with failure rates ranging from 8% to 14%[37], although potential increases in toxicity with higher dosages are a concern. The treatment regimen currently recommended in sub-Saharan Africa is 10 mg/kg of the base given 8 hourly for 7 days. This regimen was associated with a lower rate of recurrent infections on day 28 (6.3%) compared to the 10 mg/kg twice daily regimen (16.1%)[44].
How is quinine absorbed?
Quinine is rapidly absorbed both orally and parenterally, reaching peak concentrations within 1-3 hours[8] . It is distributed throughout the body fluids and is highly protein bound, mainly to alpha-1 acid glycoprotein. The binding capacity in plasma is concentration dependent, but also depends on the levels of alpha-1 acid glycoprotein, which therefore makes comparisons between different studies difficult[9]. Quinine readily crosses the placental barrier and is also found in cerebral spinal fluid. Excretion is rapid - 80% of the administered drug is eliminated by hepatic biotransformation and the remaining 20% is excreted unchanged by the kidney [10-12]. The half-life of quinine ranges between 11-18 hours [13,14]. Several pharmacokinetic characteristics of quinine differ according to the age of the subject and are also affected by malaria. The volume of distribution is less in young children than in adults, and the rate of elimination is slower in the elderly than in young adults. In patients with acute malaria the volume of distribution is reduced and systemic clearance is slower than in healthy subjects; these changes are proportional to the severity of the disease. As a result, plasma quinine levels are higher in patients with malaria. Protein binding of quinine is increased in patients with malaria as a result of an increased circulating concentration of alpha-1 acid glycoprotein [15].
What are the side effects of quinine?
The side effects commonly seen at therapeutic concentrations are referred to as cinchonism, with mild forms including tinnitus, slight impairment of hearing, headache and nausea. Impairment of hearing is usually concentration dependent and reversible [17]. More severe manifestations include vertigo, vomiting, abdominal pain, diarrhea, marked auditory loss, and visual symptoms, including loss of vision. Hypotension may occur if the drug is given too rapidly, and venous thrombosis may occur following intravenous injections [10]. Intramuscular administration is painful and may cause sterile abscesses. Hypoglycaemia is yet another common side effect of quinine therapy [15,18] and is a particular problem in pregnant women[19]. Hypoglycaemia has been reported to occur in up to 32% of patients receiving quinine therapy[18]. However in more recent studies, hypoglycaemia occurred in only 3% of adults and 2.8% of African children receiving quinine [20,21]. Less frequent but more serious side effects of quinine therapy include skin eruptions, asthma, thrombocytopaenia, hepatic injury and psychosis [22].
Which setting has no quinine resistance?
Equatorial Guinea, setting with no quinine resistance
Is Act a good treatment for malaria?
The advent of ACT has provided important new therapeutic options for the management of uncomplicated malaria in regions with high prevalence of multi-drug resistant malaria. A few available trials have shown superiority of ACT over quinine in the management of uncomplicated malaria [32,45,46]. In Brazil, patients treated with artemether-lumefantrine (AL) had significantly faster parasite clearance times when compared to those treated with quinine+doxycycline [46]. Considering the extensive available data, quinine should not be used to treat uncomplicated malaria when ACT is available [27,45]. ACT has the advantages of simplicity of dosing, which promotes adherence to therapy when compared with the seven-day treatment courses of quinine [32,45], better tolerance and decreased risks of serious toxicity.
Can you take quinine for 3 days?
3 day quinine regimens should not be used.
What is Quinine used for?
Quinine, drug obtained from cinchona bark that is used chiefly in the treatment of malaria, an infection caused by the protozoan parasite Plasmodium , which is transmitted to humans by the bite of various species of mosquitoes.
What was the only treatment for malaria?
During the 300 years between its introduction into Western medicine and World War I, quinine was the only effective remedy for malaria; as a specific treatment for this disease, quinine benefited a great many people.
What diseases were resistant to chloroquine?
During the 1960s several strains of the malarial parasite Plasmodium falciparum developed resistance to the synthetic drugs, particularly the highly valued chloroquine. The parasite remained sensitive, however, to quinine, which had to be reinstated in various parts of the world as the drug of choice despite the side effects that sometimes occur when the necessarily large doses of quinine are given. Prolonged administration of quinine may produce toxic symptoms such as deafness, disturbances in vision, rash, and gastrointestinal symptoms.
When was quinine first used?
Quinine was first synthesized in a laboratory in 1944; however, synthesis of the drug on a commercial scale is not economically feasible.
Which is more effective, chloroquine or quinine?
Some of them, such as chloroquine, are more effective than quinine in suppressing the growth of the blood forms of the malarial parasite; others, such as primaquine, act upon both the blood and tissue stages of the parasite, thus producing complete cures and preventing relapses.
Where did quinine come from?
Medicines, including quinine, were obtained from trees, as were dyes, tanning materials , and spices.…
Does quinine cause deafness?
Prolonged administration of quinine may produce toxic symptoms such as deafness, disturbances in vision, rash, and gastrointestinal symptoms. Get a Britannica Premium subscription and gain access to exclusive content. Subscribe Now.
What is Quinine used for?
Quinine is used to treat uncomplicated malaria, a disease caused by parasites. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.
What is the name of the disorder in which you have to take quinine?
a heart rhythm disorder called Long QT syndrome; an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G-6-PD); myasthenia gravis; optic neuritis (inflammation of the optic nerve); or. if you have taken quinine in the past and it caused a blood cell disorder, severe bleeding, or kidney problems.
What should I avoid while taking quinine?
Avoid taking other anti-malaria medications without your doctor's advice. This includes chloroquine, halofantrine, and mefloquine.
What other drugs will affect quinine?
Many drugs can interact with quinine. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with quinine, especially:
What happens if you take quinine?
if you have taken quinine in the past and it caused a blood cell disorder, severe bleeding, or kidney problems.
How long do you have to stop quinine?
If you need surgery or medical tests, tell your caregivers ahead of time that you are using quinine. You may need to stop using the medicine for a short time. Call your doctor if your symptoms do not improve after 2 days of treatment, or if your symptoms return after you have finished the medicine.
Can Quinine cause blurred vision?
Quinine may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.
What is Quinine used for?
Quinine, as a component of the bark of the cinchona (quina-quina) tree, was used to treat malaria from as early as the 1600s, when it was referred to as the "Jesuits' bark," " cardinal's bark," or "sacred bark.".
What is the best treatment for severe malaria?
The treatment of severe malaria requires prompt, safe, and effective intravenous anti-malarial drugs. Over the years, quinine has been the mainstay in the treatment of severe malaria and still remains the first line drug in most African countries [ 24 ].
What causes quinine to fail?
Treatment failures with quinine could also be explained by varying pharmacokinetic profiles of the drug. It is known that quinine pharmacokinetic properties and therapeutic responses vary with age, pregnancy, immunity and disease severity [ 99 ]. Also, as patients recover from malaria, there is usually an expansion of the volume of distribution and an increase in systemic clearance of quinine resulting in a decline in the average concentration of quinine in plasma [ 100 ]. These variations may lead to drug levels that may be inadequate to completely clear infection. The possibility that pharmacokinetic factors may explain quinine treatment failure was initially raised about 20 years ago when a Thai patient who had fatal severe malaria and apparent RIII resistance was found to have abnormally low levels of quinine despite adequate dosing [ 101 ]. Additional evidence for the impact of unusual quinine pharmacokinetics on treatment outcomes was provided by a more recent study describing early treatment failure in a patient with severe malaria with an abnormally high volume of distribution and increased quinine clearance, resulting in abnormally low quinine concentrations [ 102 ]. A few studies have proposed that an increase in the quinine dosage after the third day could compensate for declines in plasma drug levels during recovery, especially in areas with resistant P. falciparum [ 99 ]. However, this is not routinely practiced. Despite these anecdotal observations, there is little evidence for large variations in quinine pharmacokinetics [ 103] and the exact role that variations in drug levels play in quinine treatment responses is unclear.
How is quinine absorbed?
Quinine is rapidly absorbed both orally and parenterally, reaching peak concentrations within 1-3 hours [ 8 ]. It is distributed throughout the body fluids and is highly protein bound, mainly to alpha-1 acid glycoprotein. The binding capacity in plasma is concentration dependent, but also depends on the levels of alpha-1 acid glycoprotein, which therefore makes comparisons between different studies difficult [ 9 ]. Quinine readily crosses the placental barrier and is also found in cerebral spinal fluid. Excretion is rapid - 80% of the administered drug is eliminated by hepatic biotransformation and the remaining 20% is excreted unchanged by the kidney [ 10 – 12 ]. The half-life of quinine ranges between 11-18 hours [ 13, 14 ]. Several pharmacokinetic characteristics of quinine differ according to the age of the subject and are also affected by malaria. The volume of distribution is less in young children than in adults, and the rate of elimination is slower in the elderly than in young adults. In patients with acute malaria the volume of distribution is reduced and systemic clearance is slower than in healthy subjects; these changes are proportional to the severity of the disease. As a result, plasma quinine levels are higher in patients with malaria. Protein binding of quinine is increased in patients with malaria as a result of an increased circulating concentration of alpha-1 acid glycoprotein [ 15 ].
What is the greatest problem faced by malaria control programs worldwide?
Quinine resistance. Parasite drug resistance is probably the greatest problem faced by malaria control programs worldwide and is an important public health concern. Over the years, malaria parasites have developed resistance to a number of commonly used anti-malarial drugs.
What was the first successful use of quinine?
Background and historical perspective. The discovery of quinine is considered the most serendipitous medical discovery of the 17th century [ 1] and malaria treatment with quinine marked the first successful use of a chemical compound to treat an infectious disease [ 2 ].
Does quinine increase malaria?
As a result, plasma quinine levels are higher in patients with malaria. Protein binding of quinine is increased in patients with malaria as a result of an increased circulating concentration of alpha-1 acid glycoprotein [ 15 ]. Quinine has a low therapeutic index, and adverse effects with its use are substantial [ 16 ].
What is quinine used for?
Quinine is a medication and cutting agent used to cut illicit narcotics such as heroin; it has also been used to treat malaria and babesiosis. This includes the treatment of malaria due to Plasmodium falciparum that is resistant to chloroquine when artesunate is not available. While sometimes used for restless legs syndrome, quinine is not recommended for this purpose due to the risk of serious side effects. It can be taken by mouth or intravenously. Malaria resistance to quinine occurs in certain areas of the world. Quinine is also the ingredient in tonic water that gives it its bitter taste.
What happens if you take quinine?
Quinine can cause unpredictable serious and life-threatening blood and cardiovascular reactions including low platelet count and hemolytic-uremic syndrome / thrombotic thrombocytopenic purpura (HUS/TTP), long QT syndrome and other serious cardiac arrhythmias including torsades de pointes, blackwater fever, disseminated intravascular coagulation, leukopenia, and neutropenia. Some people who have developed TTP due to quinine have gone on to develop kidney failure. It can also cause serious hypersensitivity reactions include anaphylactic shock, urticaria, serious skin rashes, including Stevens–Johnson syndrome and toxic epidermal necrolysis, angioedema, facial edema, bronchospasm, granulomatous hepatitis, and itchiness.
What is the chiral moiety of quinine?
Quinine (and quinidine) are used as the chiral moiety for the ligands used in Sharpless asymmetric dihydroxylation as well as for numerous other chiral catalyst backbones. Because of its relatively constant and well-known fluorescence quantum yield, quinine is used in photochemistry as a common fluorescence standard.
When did quinine stop being sold?
From 1969, to 1992, the US Food and Drug Administration (FDA) received 157 reports of health problems related to quinine use, including 23 which had resulted in death. In 1994, the FDA banned the marketing of over-the-counter quinine as a treatment for nocturnal leg cramps.
Where did Quinine originate?
Quinine was first isolated in 1820 from the bark of a cinchona tree, which is native to Peru. Bark extracts had been used to treat malaria since at least 1632 and it was introduced to Spain as early as 1636 by Jesuit missionaries from the New World. It is on the World Health Organization's List of Essential Medicines.
Who invented the pill for malaria?
Conducting research in central Missouri, Dr. John S. Sappington independently developed an anti-malaria pill from quinine. Sappington began importing cinchona bark from Peru in 1820. In 1832, using quinine derived from the cinchona bark, Sappington developed a pill to treat a variety of fevers, such as scarlet fever, yellow fever, and influenza in addition to malaria. These illnesses were widespread in the Missouri and Mississippi valleys. He manufactured and sold "Dr. Sappington's Anti-Fever Pills" across Missouri. Demand became so great that within three years, Dr. Sappington founded a company known as Sappington and Sons to sell his pills nationwide.
Is quinine a first line treatment for malaria?
Medical. As of 2006, quinine is no longer recommended by the World Health Organization (WHO) as a first-line treatment for malaria, because there are other substances that are equally effective with fewer side effects. They recommend that it be used only when artemisinins are not available.
Why do people drink quinine?
People have consumed quinine in tonic water to help treat cases of malaria for centuries. In this article, learn about what quinine is and what its side effects and possible benefits are.
What are the side effects of quinine?
Some of the possible side effects of taking quinine as a medication include: abnormal heartbeat. kidney damage. severe allergic reaction. electrolyte imbalance. vision or eye issues.
Does quinine help with leg cramps?
People should not mistake tonic water for a healthful drink, as it may contain sugar and provides no additional nutritional value. Tonic water cannot help a person with leg cramps or restless legs syndrome. The quinine in tonic water is very diluted.
Does quinine cause nausea?
Side effects. Quinine is very diluted in tonic water. The likelihood of a person experiencing any side effects from drinking tonic water is slim. However, side effects of quinine can include: ringing in the ears. vomiting. stomach cramps. nervousness. nausea.
Can quinine be used for restless legs?
In fact, the FDA have warned doctors against prescribing quinine to treat leg cramps or restless legs syndrome. Tonic water is a carbonated soft drink that may contain sugar and has little nutritional value. The quinine present in tonic water provides a distinctive bitter flavor.
Does tonic water have nutritional benefits?
Tonic water does not have any known nutritional benefits.
Does tonic water cause thrombocytopenia?
thrombocytop enia (decreased blood platelets) lung toxicity. People who regularly drink tonic water may also want to consider the extra sugar and calories that they are consuming. Soft drinks, including tonic water, have little nutritional value but contribute to a person’s daily calorie intake.
What is Quinine used for?
Quinine’s primary benefit is for the treatment of malaria. It’s not used to prevent malaria, but rather to kill the organism responsible for the disease. When used to treat malaria, quinine is given in a pill form.
Where does Quinine come from?
Quinine is a bitter compound that comes from the bark of the cinchona tree. The tree is most commonly found in South America, Central America, the islands of the Caribbean, and parts of the western coast of Africa. Quinine was originally developed as a medicine to fight malaria.
What is tonic water?
While a gin and tonic and vodka and tonic are staples at any bar, tonic water is becoming a more versatile beverage. It’s now mixed with tequila, brandy, and just about any other alcoholic beverage. Citrus flavors are often added, so if you see the term “bitter lemon” or “bitter lime,” you know the drink includes tonic water with ...
What are the side effects of quinine?
ringing in the ears. confusion. nervousness. However, these are more common side effects for quinine taken as a medication. Among the most serious potential side effects associated with quinine are: bleeding problems. kidney damage.
Can you drink tonic water with quinine?
The U.S. Food and Drug Administration (FDA) allows tonic water to contain no more than 83 parts per million of quinine, because there can be side effects from quinine. Today, people sometimes drink tonic water to treat nighttime leg cramps associated with circulatory or nervous system problems. However, this treatment is not recommended.
Can you use tonic water for malaria?
The science isn’t there for tonic water or quinine to treat these conditions. See a doctor instead and explore other options. But if you’re traveling to a part of the world where malaria is still a threat, ask about the use of quinine to treat the disease if you’re unfortunate enough to contract it.
Does quinine cause low blood sugar?
have low blood sugar (because quinine can cause your blood sugar to drop)
Usual Adult Dose for Malaria
648 mg orally every 8 hours for 7 days Comments: -This drug has been effective in geographical regions with documented chloroquine resistance. Use: Only for treatment of uncomplicated Plasmodium falciparum malaria US CDC Recommendations: 542 mg base (650 mg sulfate salt) orally 3 times a day for 3 or 7 days Comments: -With doxycycline, tetracycline, or clindamycin, recommended as a preferred regimen for treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified); in pregnant women, this drug should be used with clindamycin. -With (primaquine or tafenoquine [Krintafel]) plus (doxycycline or tetracycline), recommended for treatment of uncomplicated malaria due to chloroquine-resistant P vivax; primaquine and tafenoquine must not be used during pregnancy. -In pregnant women with uncomplicated malaria due to chloroquine-resistant P falciparum or P vivax, doxycycline or tetracycline may be used with this drug if other treatment options are not tolerated/not available and the benefits are deemed to outweigh the risks. -If needed, as interim therapy for severe malaria until IV artesunate arrives -The US manufactured quinine sulfate capsule is available in a 324-mg dosage; therefore, 2 capsules should be sufficient for adult dosing. -Therapy should be continued for 7 days if infection was acquired in Southeast Asia, or for 3 days if acquired elsewhere. -Current guidelines should be consulted for additional information..
Usual Pediatric Dose for Malaria
16 years or older: 648 mg orally every 8 hours for 7 days Comments: -This drug has been effective in geographical regions with documented chloroquine resistance. Use: Only for treatment of uncomplicated P falciparum malaria US CDC Recommendations: 8.3 mg base/kg (10 mg sulfate salt/kg) orally 3 times a day for 3 or 7 days Maximum dose: 542 mg base (650 mg sulfate salt)/dose Comments: -With clindamycin in children younger than 8 years and with doxycycline, tetracycline, or clindamycin in children 8 years or older: Recommended as a preferred regimen for treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) -With primaquine in children younger than 8 years, with primaquine plus (doxycycline or tetracycline) in children 8 to 15 years, and with (primaquine or tafenoquine [Krintafel]) plus (doxycycline or tetracycline) in children 16 years or older: Recommended for treatment of uncomplicated malaria due to chloroquine-resistant P vivax -If needed, as interim therapy for severe malaria until IV artesunate arrives -Pediatric dose should never exceed adult dose. -The US manufactured quinine sulfate capsule is available in a 324-mg dosage; due to the unavailability of non-capsule forms of this drug, pediatric dosing may be difficult. -Therapy should be continued for 7 days if infection was acquired in Southeast Asia, or for 3 days if acquired elsewhere. -Current guidelines should be consulted for additional information..
Renal Dose Adjustments
Mild and moderate renal dysfunction: Data not available Severe chronic renal dysfunction: -Loading dose: 648 mg orally once followed 12 hours later by maintenance dose -Maintenance dose: 324 mg orally every 12 hours
Liver Dose Adjustments
Mild or moderate liver dysfunction (Child-Pugh A or B): No adjustment recommended. Severe liver dysfunction (Child-Pugh C): Not recommended. Comments: -Patients with mild or moderate liver dysfunction should be closely monitored for side effects of this drug. -Alternative therapy recommended for patients with severe liver dysfunction.
Precautions
US BOXED WARNING: -HEMATOLOGIC REACTIONS: Use of this drug for treatment/prevention of nocturnal leg cramps may lead to serious and life-threatening hematologic reactions (including thrombocytopenia and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura [HUS/TTP]); chronic renal dysfunction associated with TTP development reported.
Other Comments
Administration advice: -Do not use to treat severe/complicated P falciparum malaria, to prevent malaria, or to treat/prevent nocturnal leg cramps. -Administer with food to minimize gastric upset. -Do not exceed the prescribed amount. -Consult the manufacturer product information regarding missed doses. Storage requirements: -Store at 20C to 25C (68F to 77F). -Dispense in a tight container. General: -Unless otherwise specified, the dose is expressed as quinine sulfate (i.e., as the salt). -The Medication Guide should be dispensed to each patient. Monitoring: -General: For side effects in patients with liver dysfunction; serum digoxin levels (if used concomitantly) -Metabolic: For signs/symptoms of hypoglycemia Patient advice: -Read the US FDA-approved patient labeling (Medication Guide). -Do not take more than the prescribed amount..
Further information
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