Cinquin

Indications

Quinine Sulphate is used to treat malaria caused by Plasmodium falciparum, including strains resistant to Chloroquine, usually together with a second medicine such as Doxycycline or Clindamycin. It is not recommended for preventing malaria or for night-time leg cramps, because of the risk of serious side effects.

How It Works

Quinine kills the malaria parasite while it lives inside red blood cells. It is thought to stop the parasite from safely breaking down the haemoglobin it feeds on, so toxic waste builds up and the parasite dies.

Dosage and Administration

Take as prescribed. For adults, a common regimen is 600 mg every 8 hours for 7 days, combined with another antimalarial chosen by the doctor. Doses for children and people with low body weight are based on weight. Take with or after food and a full glass of water to reduce stomach upset. Complete the full course even if you feel better. Severe malaria needs hospital treatment, usually with injections.

Interactions

Quinine can raise levels of Digoxin and increase the effect of Warfarin. Medicines that affect heart rhythm, such as Mefloquine, Halofantrine, Amiodarone, some antibiotics and antipsychotics, increase the risk of dangerous heart rhythm problems. Rifampicin can lower quinine levels. Antacids containing aluminium or magnesium can reduce absorption. Quinine can lower blood sugar further in people on diabetes medicines.

Contraindications

Do not use if you are allergic to Quinine or Quinidine, or have had low platelets, blood problems or a serious reaction to it before. Avoid in people with optic nerve inflammation, tinnitus from previous use, myasthenia gravis, long QT or certain heart rhythm problems, or G6PD deficiency unless the doctor decides otherwise.

Side Effects

A group of effects called cinchonism is common: ringing in the ears, hearing loss, headache, nausea, dizziness, blurred vision and flushing. Low blood sugar can occur, especially in pregnant women and in severe malaria. Stomach upset, rash and itching may also occur.

Get urgent medical help for unusual bruising or bleeding, blood in the urine or dark urine, sudden sweating, shaking or confusion (low blood sugar), fast or irregular heartbeat, fainting, severe vision or hearing loss, or a severe skin rash with blisters.

Pregnancy and Lactation

Malaria is very dangerous in pregnancy, and quinine is one of the medicines used to treat it, especially in the first 3 months, when a doctor decides it is needed. Blood sugar must be watched closely. Quinine passes into breast milk in small amounts; it is usually considered acceptable, but ask your doctor, particularly if the baby may have G6PD deficiency.

Precautions and Warnings

Use with care in heart disease, kidney or liver disease, and in older people. Watch for signs of low blood sugar. Stop and see a doctor if you notice bleeding, bruising or problems with sight or hearing. Do not use it for leg cramps.

Overdose

Quinine overdose is very dangerous and can cause blindness, deafness, fits, serious heart rhythm problems and death. Seek emergency medical help immediately, even if the person feels well at first.

Therapeutic Class

Antimalarial, cinchona alkaloid.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.