Classifications: antimalarial; Therapeutic: antimalarial
Pregnancy Category: X
325 mg capsules
Inhibits protein synthesis and depresses many enzyme systems in malaria parasite. Has schizonticidal action and is gametocidal
with Plasmodium vivax and Plasmodium malariae but not Plasmodium falciparum. Resembles salicylates in analgesic and antipyretic properties and exerts curare-like skeletal muscle relaxant effect. Also
has oxytocic action and hypoprothrombinemic effect. Qualitatively similar to quinidine in cardiovascular effects. Generally
replaced by less toxic and more effective agents in treatment of malaria.
Effective against Plasmodium vivax and Plasmodium malariae but not Plasmodium falciparum. Generally replaced by less toxic and more effective agents in treatment of malaria.
Chloroquine-resistant falciparum malaria and in combination with other antimalarials for radical cure of relapsing vivax
malaria; also relief of nocturnal recumbency leg cramps.
Hypersensitivity to quinine; tinnitus, optic neuritis; myasthenia gravis; G6PD deficiency; pregnancy (category X).
Cardiac arrhythmias. Same precautions as for quinidine sulfate when used in patients with cardiovascular conditions.
Route & Dosage
Adult: PO 650 mg q8h for 3 d
Child: PO 25 mg/kg/d in three divided doses q8h for 3 d
Adult: PO 325 mg b.i.d. for 6 wk
Nocturnal Leg Cramps
Adult: PO 260300 mg h.s.
- Give with or after meals or a snack to minimize gastric irritation. Quinine has potent local irritant effect on gastric
mucosa. Do not crush capsule; drug is not only irritating but also extremely bitter.
- Store in tight, light-resistant containers.
Adverse Effects (≥1%)Body as a Whole:
Cinchonism (tinnitus, decreased auditory acuity, dizziness, vertigo, headache, visual impairment, nausea, vomiting, diarrhea,
fever); hypersensitivity (cutaneous
flushing, visual impairment, pruritus, skin rash, fever, gastric distress, dyspnea
tinnitus); hypothermia, coma. CNS:
Confusion, excitement, apprehension, syncope, delirium, convulsions, blackwater fever (extensive intravascular hemolysis
failure), death. CV:
Angina, hypotension, tachycardia, cardiovascular collapse. Hematologic: Leukopenia
hypoprothrombinemia, hemolytic anemia
Diagnostic Test Interference
Quinine may interfere with determinations of urinary catecholamines (Sobel and Henry modification procedure) and urinary steroids (17-hydroxycorticosteroids) (modification of Reddy, Jenkins, Thorn method).
May increase digoxin
levels; anticholinergic agents
add to vagolytic effects; cholinergic agents
may antagonize cardiac effects; anticonvulsants
increase the metabolism
of quinine, thus decreasing its efficacy
; carbonic anhydrase inhibitors
, sodium bicarbonate, chronic antacids
elimination of quinine, thus increasing its toxicity
may increase hypoprothrombinemic effects. Amantadine, carbamazepine, phenobarbital
levels may be increased. Food: Grapefruit juice
(>1 qt/d) may increase plasma
concentrations and adverse effects.
Well from GI tract. Peak:
13 h. Duration:
68 h. Distribution:
Widely distributed to most body tissues except the brain; crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
>95% in urine, <5% in feces. Half-Life:
Assessment & Drug Effects
- Be alert for S&S of rising plasma concentration of quinine marked by tinnitus and hearing impairment, which usually do not
occur until concentration is 10 mcg/mL or more.
- Follow the same precautions with quinine as are used with quinidine in patients with atrial fibrillation; quinine may produce
cardiotoxicity in these patients.
Patient & Family Education
- Learn possible adverse reactions and report onset of any unusual symptom promptly to physician.