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Paul A. Pham, Pharm.D and John G. Bartlett, MD
07-19-2010
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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.
- Oral quinine is indicated for the treatment of uncomplicated 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)
- IV quinine is not available in the U.S.
- Babesia species
- Leg cramps. FDA advises against use of quinine for leg cramps due to reports of severe hematologic adverse events.
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Qualaquin | Quinine | AR Scientific Inc. | oral
capsule
324mg | $5.46 |
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*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.
- Uncomplicated malaria: quinine 650 mg q8h x 3-7 d plus doxycycline 100 mg twice daily x 7 d OR clindamycin 450 mg q8h x 7 d OR pyrimethamine/sulfadoxine 3 tabs on last day of quinine.
- Babesiosis: quinine 650mg PO q8h x 7d plus clindamycin 600mg PO q8h x 7d.
- Quinine dihydrochloride: typical parenteral dose for malaria, 600mg IV q8h (IV not commercially available in the U.S.). Patients should be closely monitored re: ECG changes, and blood glucose levels.
- Monitor quinine blood levels in patients with renal or hepatic dysfunction, also when drug interactions suspected.
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
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Thrombocytopenia
- Hypotension (with rapid IV infusion)
- Hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura
- Protease inhibitors may increase serum quinine levels.
- Quinine serum level may be decreased by CYP3a4 inducers (rifampin, phenytoin, phenobarbital, NNRTIs...).
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 quinine 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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