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Quinine
Pham P and Bartlett JG
03-27-2008
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Available formulation in Zambia: Injection: 300 mg quinine dihydrochloride/ml in 2 ml ampoule. Tablet: 300 mg (quinine sulfate) or 300 mg (quinine bisulfate).
- Uncomplicated P. falciparum malaria: quinine 10 mg/kg (max 600 mg) PO q8h x 7 days PLUS doxycycline OR clindamycin.
- Complicated P. falciparum malaria: quinine dihydrochloride salt 20mg/kg IV load (infuse over 4 hours), then 10 mg/kg IV infuse over 4-6hrs (maintenance dose 8 hrs after loading dose). May repeat 10mg/kg IV q8h until pt can take oral quinine.
- Infusion rate should not exceed 5mg/kg/hr.
- Reduce quinine dose to 5-7 mg/kg if infusion last for more than 48 hrs or if pt develops renal failure.
- Continue for at least 7-10 days, or until smears are negative.
- Monitor ECG and blood glucose
- PIs may increase quinine serum concentrations. Use with close monitoring (e.g EKG)
- NNRTIs may decrease quinine serum concentrations. Monitor for anti-malarial efficacy of quinine. Quinine dose may need to be increased.
Zambia Information Author: Paul A. Pham Pharm.D.
- Malaria (concurrently with tetracycline, doxycycline, clindamycin, or pyrimethamine plus sulfadiazine, or pyrimethamine plus sulfadoxine in the treatment of chloroquine-resistant malaria caused by Plasmodium falciparum)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Quinine | Quinine | Various generic manufacturers (Ivax, Watson, ...) | oral
capsule
200mg; 325mg | $0.55; $0.90 |
|
|
|
| oral
tablet
260mg | $0.79 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Malaria: quinine 650 mg q8h x 3-7 d plus doxycycline 100 mg bid x 7 d OR pyrimethamine/sulfadoxine 3 tabs on last day of quinine.
- Quinine dihydrochloride 600mg IV q8h (IV not commercially available in the U.S.).
- Babesiosis: quinine 650mg PO q8h x 7d plus clindamycin 600mg PO q8h x 7d.
Usual dose.
Usual dose.
Usual dose, but some recommend increasing dosing interval to q24h. Therapeutic drug monitoring recommended.
Usual dose, days of dialysis dose post dialysis. Therapeutic drug monitoring recommended.
650mg q24h. Therapeutic drug monitoring recommended.
CVVHD: limited data. Use standard dose with close monitoring (CID 2004;39:288-289). Therapeutic drug monitoring recommended.
- GI intolerance
- Cinchonism (tinnitus, headache, nausea, abdominal pain, visual disturbances)
- Hemolytic anemia (G6PD deficiency)
- Cardiac arrhythmia
- Hypoglycemia
- Hepatitis
- Thrombocytopenia
- Hypotension (with rapid IV infusion)
Quinine serum level may be decreased by CYP3a4 inducers (rifampin, phenytoin, phenobarbital...).
Active against Chloroquine-resistant P. falciparum; Babesia microti
IV quinine (not available in the U.S.) is the drug of choice for complicated Plasmodium falciparum malaria. Monitor blood levels in patients with renal or hepatic dysfunction. For parenteral therapy, IV quinidine may be substituted for quinine (see quinidine module). Oral quinine plus doxycycline or pyrimethamine/sulfadoxine is recommended for uncomplicated malaria.
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