II. Indications

  1. Non-Severe Malaria Treatment in Chloroquine resistant regions
    1. Combined with Doxycycline, Tetracycline or Clindamycin
    2. Alternative when Artemisinin Combination Therapy (ACT) is unavailable

III. Contraindications

  1. G6PD Deficiency
  2. Myasthenia Gravis
  3. Severe hepatic Impairment (Child-Pugh C)
  4. Do NOT use for Nocturnal Leg Cramps
    1. Low efficacy and high risk

IV. Dosing

  1. Malaria
    1. Combined with 7 days of Doxycycline, Tetracycline or Clindamycin
    2. Adult: 648 mg salt (542 mg base) three times daily orally for 3 days (7 days in Southeast Asia)
      1. In severe Chronic Kidney Disease, after first dose, decrease to 324 mg orally every 12 hours
    3. Child: 10 mg/kg up to 648 mg salt (8.3 mg/kg up to 542 mg base) three times daily orally
  2. Severe Babesiosis
    1. Combined with Clindamycin 7 to 10 mg/kg up to 600 mg IV every 6 hours for 7 to 10 days
    2. Adult: 650 mg orally every 6 to 8 hours
    3. Child: 8 mg/kg (up to 650 mg) orally every 8 hours

V. Mechanism

  1. Quinidine alkaloid extracted from cinchona tree bark
  2. Used as an antimalarial since the 1600s
    1. As with other antimalarials, inhibits Hemoglobin metabolism in Malarial blood stages

VII. Safety

  1. Considered safe in pregnancy
  2. Considered safe in Lactation
    1. Avoid in infants with G6PD Deficiency

VIII. Pharmacokinetics

  1. Oral doses peak in 1-3 hours
  2. Highly Protein bound
  3. Hepatic metabolism

IX. Drug Interactions

  1. Agents to avoid with Quinine
    1. Clarithromycin
    2. Erythromycin
    3. Rifampin
    4. Ritonavir
  2. Digoxin
    1. May increase Digoxin levels
  3. Warfarin
    1. Increased INR
  4. Antacids
    1. Decreases Quinine absorption

XI. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

quinine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
QUININE SULFATE 324 MG CAPSULE Generic $0.90 each

Ontology: Quinine (C0034417)

Definition (NCI) A quinidine alkaloid isolated from the bark of the cinchona tree. Quinine has many mechanisms of action, including reduction of oxygen intake and carbohydrate metabolism; disruption of DNA replication and transcription via DNA intercalation; and reduction of the excitability of muscle fibers via alteration of calcium distribution. This agent also inhibits the drug efflux pump P-glycoprotein which is overexpressed in multi-drug resistant tumors and may improve the efficacy of some antineoplastic agents. (NCI04)
Definition (CSP) quinine ascorbate is listed by USP as a smoking deterrent.
Definition (MSH) An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood.
Definition (PDQ) A quinidine alkaloid isolated from the bark of the cinchona tree. Quinine has many mechanisms of action, including reduction of oxygen intake and carbohydrate metabolism; disruption of DNA replication and transcription via DNA intercalation; and reduction of the excitability of muscle fibers via alteration of calcium distribution. This agent also inhibits the drug efflux pump P-glycoprotein which is overexpressed in multi-drug resistant tumors and may improve the efficacy of some antineoplastic agents. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41253&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41253&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C794" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011803
SnomedCT 373497008, 47065008
LNC LP16273-2, MTHU007609
English Quinine, Cinchonan-9-ol, 6'-methoxy-, (8alpha,9R)-, QUIN, quinine (medication), Quinine [Chemical/Ingredient], quiNINE, QUININE, quinine, (-)-Quinine, Quinine (product), Quinine (substance)
Swedish Kinin
Czech chinin
Finnish Kiniini
Russian KHININ, ХИНИН
Japanese キニン(キナアルカロイド), キニーネ
Polish Chinina
Portuguese Quinino, Quinina
Spanish quinina (producto), quinina (sustancia), quinina, Quinina
French Quinine
German Chinin
Italian Chinina