QUININE

consumer_quinine_qualaquin

Medical and Pharmacy Editor: John P. Cunha, DO, FACOEP

Reviewed on 8/27/2021

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Uses | Dosage | Side Effects | Drug Interactions |

Warnings and Precautions

Brand Name: Qualaquin

Generic Name: Quinine

Drug Class: Antimalarials

WHAT IS QUININE AND HOW DOES IT WORK?

Quinine is a prescription drug used as an antimalarial drug indicated only for the treatment of
uncomplicated Plasmodium falciparum malaria. Quinine sulfate has been shown to be
effective in geographical regions where resistance to chloroquine has been documented.

Quinine is available under the following different brand names: Qualaquin.

WHAT ARE DOSAGE OF QUININE?

Dosage of Quinine:

Adult and Pediatric Dosages

Capsule

324 mg
Dosage Considerations – Should be Given as Follows:

Malaria

Adults

Uncomplicated (P. falciparum)

648 mg orally every 8 hours for 7 days

Chloroquine-Resistant (P. falciparum)

648 mg orally every 8 hours for 3-7 days concomitant tetracycline, doxycycline, or
clindamycin

Chloroquine-Resistant (P. vivax)

648 mg orally every 8 hours for 3-7 days concomitant doxycycline (or tetracycline) and
oral primaquine

Pediatric Dosages

Uncomplicated (P. falciparum)

30 mg/kg/day orally divided three times daily for 3-7 days

Should not exceed the usual adult oral dosage

Chloroquine-Resistant (P. falciparum)

30 mg/kg/day orally divided three times daily for 3-7 days, with concomitant doxycycline,
tetracycline, or clindamycin

Should not exceed the usual adult oral dosage

Chloroquine-Resistant (P. vivax)

 30 mg/kg/day orally three times daily for 3-7 days, with concomitant doxycycline and oral
primaquine

Should not exceed the usual adult oral dosage

Babesiosis

Adult Dosage:

648 mg orally every 8 hours, with concomitant orally or intravenously clindamycin

Pediatric Dosage:

25 mg/kg/day orally divided three times daily for 7 days, with concomitant oral
clindamycin

Dosage Modifications

Severe, chronic renal impairment: 648 mg orally once, then 324 mg orally every 12 hours

Hepatic impairment

Mild or moderate (Child-Pugh A or B): No dosage adjustment required; monitor closely

Severe (Child-Pugh C): Do not administer


QUESTION

Bowel regularity means a bowel

movement every day.

See Answer
WHAT ARE SIDE EFFECTS ASSOCIATED WITH USING QUININE?

Side effects of quinine include:

flushing of the skin

chest pain

fever

rash

itching

low blood sugar

upper abdominal pain

rupture of red blood cells in G6PD deficiency

low blood platelet count

hepatitis

night blindness

double vision

optic nerve deterioration

impaired hearing

hypersensitivity reaction

severe headache

nausea

vomiting

diarrhea

blurred vision

decreased blood pressure

sweating
ringing in the ears (tinnitus)

spinning sensation (vertigo)

distorted color perception

abdominal pain

deafness

blindness

irregular heartbeats

weakness

Lupus-like syndrome

deficiency of granulocytes in the blood

impaired blood clotting

overactive blood clotting

destruction of red blood cells

abnormal destruction of red blood cells

blood disorder causing clotting in small vessels

excessive bruising and bleeding

small round spots on the skin

discoloration of the skin

bleeding

bleeding disorder

severe malaria (blackwater fever)

low white blood cell count

reduction of red and white blood cells and platelets in the blood

no generation of new blood cells

lupus anticoagulant

confusion

altered mental status

seizures
coma

disorientation

shakiness

restlessness

loss of full control of bodily movements

acute involuntary contractions of muscles in the face, neck, trunk, pelvis, and extremities

communication disorder

suicide

hives

fever, sore throat, and rash (Scarlet Fever)

blistering rash

red and peeling rash

localized eruption of the skin (erythema multiforme)

Stevens-Johnson syndrome (SJS)

toxic epidermal necrolysis (TEN)

oval red skin rash

sensitivity to light

allergic contact dermatitis

black discoloration of the skin

inflammation of blood vessels in the skin

asthma

shortness of breath

fluid on the lungs

low blood pressure

dizziness upon standing

fast heart rate

slow heart rate

strong irregular heartbeat

fainting

atrioventricular block

irregular, fast heart rate

extra abnormal heartbeats (unifocal premature ventricular contractions [PVCs])

delayed heartbeat

U waves (small deflection on ECG)

serious irregular heart rhythms (QT prolongation)

ventricular fibrillation

torsades de pointes

cardiac arrest

irritation of the stomach

irritation of the esophagus

granulomatous hepatitis

yellowing of eyes and skin (jaundice)

abnormal liver function tests

loss of appetite

muscle pain

muscle weakness

blood in the urine

kidney failure

kidney impairment

acute kidney inflammation

visual disturbances

sudden vision loss

light sensitivity

diminished visual fields

fixed dilated pupils

inflammation of the optic nerve

 hearing impairment

This document does not contain all possible side effects and others may occur. Check with
your physician for additional information about side effects.

WHAT OTHER DRUGS INTERACT WITH QUININE?

If your doctor has directed you to use this medication, your doctor or pharmacist may already
be aware of any possible drug interactions and may be monitoring you for them. Do not start,
stop, or change the dosage of any medicine before checking with your doctor, health care
provider, or pharmacist first.

Quinine has no known severe interactions with other drugs.

Serious interactions of quinine include:

cisapride

dronedarone

eliglustat

pimozide

thioridazine

Quinine has serious interactions with at least 48 different drugs.

Quinine has moderate interactions with at least 138 different drugs.

Quinine has minor interactions with at least 82 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore,
before using this product, tell your doctor or pharmacist of all the products you use. Keep a
list of all your medications with you, and share this information with your doctor and
pharmacist. Check with your health care professional or doctor for additional medical advice,
or if you have health questions, concerns, or for more information about this medicine.

WHAT ARE WARNINGS AND PRECAUTIONS FOR QUININE?

Warnings

Limited or no benefit for treatment/prevention of nocturnal leg cramps

May cause serious and life-threatening hematologic reactions, including

thrombocytopenia and hemolytic uremic syndrome/thrombotic thrombocytopenic
purpura (HUS/TTP)

Chronic renal impairment associated with the development of TTP has been reported

This medication contains quinine. Do not take Qualaquin if you are allergic to quinine or
any ingredients contained in this drug

Keep out of reach of children. In case of overdose, get medical help or contact a Poison
Control Center immediately

Contraindications

Hypersensitivity

G6PD deficiency

Optic neuritis, tinnitus, history of quinine-associated blackwater fever, and

thrombocytopenic purpura

Pregnancy

Effects of Drug Abuse

No information available

Short-Term Effects

See "What Are Side Effects Associated with Using Quinine?"

Long-Term Effects

See "What Are Side Effects Associated with Using Quinine?"

Cautions

Reduce parenteral dose by half if over 48-hour parenteral treatment required; monitor
EKG, blood pressure, and glucose with parenteral treatment

FDA warns against unapproved use for leg cramps because of unpredictable serious and
life-threatening hematologic reactions including thrombocytopenia and hemolytic-
uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP)

QT prolongation

Concentration-dependent prolongation of the PR and QRS interval observed

At particular risk are patients with underlying structural heart disease and preexisting
conduction system abnormalities, elderly patients with sick sinus syndrome, patients
with atrial fibrillation with the slow ventricular response, patients with myocardial
ischemia, or patients receiving drugs known to prolong the PR interval (verapamil) or
QRS interval (flecainide or quinidine)

Pregnancy and Lactation

Do not use quinine during the first trimester of pregnancy

The risks involved outweigh potential benefits

Safer alternatives exist

Quinine enters breast milk. Consult your physician if breastfeeding

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