Quinine

Quinine is an antimalarial prescription medication approved by the FDA. It contains quinine sulfate that helps alleviate the symptoms of malaria, such as fever & chills. It is available in various forms and strengths but is widely used in the form of tablets taken orally by mouth. To decrease your risk of unwanted side effects, you should take Quinine exactly as directed by your doctor. You should take doses at evenly spaced intervals to get the most benefit of your medication. Consult a licensed medical professional for personalized guidance and advice regarding proper usage, dosage, and storage. Talk to your pharmacist, physician, or healthcare provider if you have any queries or concerns regarding the medication use.

Quinine is an antimalarial prescription medication primarily used to treat malaria. It contains quinine sulfate, derived from the bark of the cinchona tree. Quinine works by interfering with the life cycle of Plasmodium parasites, preventing them from multiplying in red blood cells. This antimalarial action helps alleviate the symptoms of malaria, such as fever and chills.

Quinine is available in various forms and strengths, including tablets (200 mg, 300 mg, 324 mg), capsules (200 mg, 300 mg, 324 mg), intravenous injection (300 mg/ml, 600 mg/ml), and intramuscular injection (300 mg/ml). It is usually taken orally with food to reduce stomach upset. Adults & adolescents aged 16 years and older are usually prescribed 648 mg every eight hours for seven days. A doctor determines dosages for children under 16 years.

Common side effects of Quinine include tinnitus, headache, nausea, dizziness, and blurred vision. Severe side effects, though rare, may include thrombocytopenia, hemolytic anemia, and cardiac arrhythmias. Patients should follow all prescribed instructions, avoid crushing or chewing tablets, and take doses at evenly spaced intervals. Quinine should be stored in a tightly closed container at a controlled room temperature, away from moisture and heat. If a dose is missed, take it as soon as remembered unless it is almost time to take the next scheduled dose. In case of a medication overdose, seek immediate medical attention. Regular physician or healthcare provider visits are crucial to monitor progress and manage adverse effects.

It is used to:

• Treat malaria
• Sometimes treat babesiosis, a severe or life-threatening illness transmitted from animals to humans by ticks.

What Are the Forms & Strengths of Quinine?

It comes in different forms and strengths, such as:

Form: Tablets

Strength: 200 mg, 300 mg, and 324 mg as quinine sulfate 

Form: Intravenous injection 

Strength: 300 mg/ml, 600 mg/ml

Form: Intramuscular injection 

Strength: 300 g/ml

Form: Capsules 

Strength: 200 mg, 300 mg, and 324 mg as quinine sulfate

What Are the Recommended Dosage of Quinine?

For Malaria

Oral Form

• Adults & adolescents aged 16 years and older: 648 mg every eight hours for seven days.
• Children under 16 years of age: Your doctor will determine the usage and dosage.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

• Before starting to take the medication, carefully read and follow the directions for use given in the medication guide & the patient information leaflet that came along with it or was provided by your pharmacist.
• If you do not understand any part of the leaflet or if you have any questions or concerns about medication use, ask your pharmacist or healthcare provider.
• Take this medication orally by mouth, exactly as directed by your doctor. To reduce the possibility of having an upset stomach, take it with food, typically every eight hours for three to seven days.
• If you are taking Quinoine in tablet or capsule form, do not crush, break, open, or chew it, as it tastes bitter. Swallow it whole.
• Take Quinine two or three hours before or after taking magnesium or aluminum antacids. These drugs bind with Quinine, thus preventing your body from fully absorbing the medication.
• The dosage, frequency, and duration of Quinine treatment depend on your medical condition, the country where you were exposed to this infection, other medications you may be using to treat the condition, and your body’s response to treatment. For pediatric patients, the dosage is also based on weight.
• You should continue taking this medication even if you feel well. Do not change your medication; take it more or less than prescribed, longer than needed, or more frequently without consulting your doctor.
• Do not skip any doses of Quinine. Keep taking this medication for the prescribed duration. Skipping or stopping the medication may result in the return of infection or make the infection more difficult to treat.
• For the medication to function properly, a constant amount of drug needs to be present in your body at all times. Take Quinine at evenly spaced intervals. Maintain consistency in dosage and take it around the same time every day to help you remember it.
• Tell your doctor if you do not feel better within one or two days of taking this medication. If your fever returns after your prescription is complete, immediately tell your doctor. They will help you determine if malaria has returned.
• Do not share your medications with others, even if they have the same condition as you do.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

Quinine works primarily as an antimalarial agent by interfering with the life cycle of Plasmodium parasites, which cause malaria. It acts as a blood schizonticide, targeting the asexual erythrocytic stage of the parasite. Quinine accumulates in the acidic food vacuoles of the parasite and is believed to interfere with the parasite’s ability to detoxify heme, a byproduct of hemoglobin digestion. This leads to the buildup of toxic heme, which kills the parasite. Additionally, Quinine may inhibit nucleic acid and protein synthesis in the parasite. It also has weak gametocidal activity against P. vivax and P. malariae. Besides its antimalarial effects, Quinine has antipyretic, analgesic, and anti-inflammatory properties, contributing to symptom relief in malaria patients.

Like every medication, Quinine may also cause side effects in some people. It is essential to mention that not everyone using this medication will experience these side effects. However, if you are concerned about the side effects, you should consult your doctor or healthcare provider and discuss any concerns or queries you have regarding the potential risks of using this medication. In most cases, the side effects caused by this medication are not severe and go away within a few days as your body adjusts to the medication. However, if they persist or become bothersome, immediately consult your doctor.

Common Side Effects of Quinine:

• Tinnitus (ringing in the ears)
• Headache
• Nausea
• Dizziness
• Blurred vision
• Mild stomach upset

Mild Side Effects of Quinine:

• Temporary changes in color perception
• Mild skin rash or itching
• Sweating
• Flushing
• Mild confusion
• Weakness
• Insomnia

Though serious side effects caused by Quinine are relatively rare, they can be life-threatening. Remember that your doctor has prescribed you Quinine as they have determined that the benefits of Quinine outweigh the risks associated with this medication use. Many people using this medication will not experience any severe side effects. But immediately call your doctor if you experience any new or worsening symptoms. Serious side effects require immediate medical attention. The list given below is not the complete list of severe side effects caused by Quinine. Consult your doctor for more details.

Serious Side Effects of Quinine:

• Thrombocytopenia. Its symptoms may include easy bruising, prolonged bleeding from cuts, blood in urine or stools, and petechiae.
• Hemolytic anemia: Its symptoms may include tiredness, pale skin, weakness, shortness of breath, dizziness, rapid heartbeat
• Severe allergic reactions such as anaphylaxis. Its symptoms may include difficulty breathing, swelling of the face/throat, severe rash, rapid pulse, dizziness, and loss of consciousness.
• Hypoglycemia’s symptoms may include confusion, dizziness, shakiness, sweating, hunger, irritability, and rapid heartbeat.
• Cardiac arrhythmias. Its symptoms may include palpitations, chest pain, shortness of breath, dizziness, and fainting.
• Severe skin reactions such as the Stevens-Johnson syndrome. Its symptoms may include painful skin rash, blisters on skin and mucous membranes, fever, sore throat, and fatigue.
• Kidney damage. Its symptoms may include decreased urine output, swelling in legs/ankles/feet, shortness of breath, nausea, and confusion.
• Liver toxicity. Its symptoms may include jaundice (yellowing of skin/eyes), abdominal pain, nausea, vomiting, dark urine, and pale stools.
• Optic neuritis. Its symptoms may include pain with eye movement, temporary vision loss, color vision loss, and flashing lights.
• Cinchonism. Its symptoms may include severe tinnitus, hearing loss, vertigo, vision disturbances, headache, nausea, vomiting, and abdominal pain.

[Note: This list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

• This medication may make you feel dizzy or cause blurred vision. You should not drive, operate heavy machinery, or engage in activities that require alertness & clear vision unless you can do them safely. Alcohol or marijuana may increase these symptoms.
• If you plan to have surgery, including a dental procedure, tell your surgeon, dentist, or doctor about all the medications you are taking, including prescription and over-the-counter medications and herbal or vitamin supplements.
• This medication should only be used during pregnancy when it is clearly needed. Discuss the potential risks, benefits, or other treatment options with your healthcare provider. Untreated malaria is a severe condition that may cause harm to both the mother and the unborn child.
• Quinine passes into breast milk. However, it is unlikely that it will cause harm to nursing infants. You should consult your healthcare provider doctor before breastfeeding while using this medication.
• This medication may cause severe side effects on your kidneys, heart, or blood cells. Discontinue taking it and immediately call your doctor if you experience a headache with angina, rapid heart rate, severe dizziness, unusual bleeding or bruising, or signs of an infection.
• You should not take Quinine if you have QT prolongation.
• You should not use Quinine to treat leg cramps as it is not FDA-approved for this purpose. If used improperly or without medical supervision, this medication may cause severe side effects or even death.

What Are the FDA Boxed Warning for Quinine?

The FDA has issued a boxed advisory warning for Quinine due to its use for treating leg cramps.

• FDA advises patients to use Quinine only for the treatment of malaria under the supervision of a licensed healthcare professional.
• It has been determined by the FDA that the potential risks associated with Quinine outweigh any potential benefit for treating leg cramps or other unapproved conditions.
• The FDA has not approved Quinine for any other use, including treating leg cramps.
• Patients & healthcare providers should report adverse events associated with quinine use to the FDA’s MedWatch progra

• Before starting to take this medication, share your complete family and medical history with your healthcare provider, especially if you have certain conditions that could worsen with using this medication, such as personal/family history of enzyme problems, blood problems, optic neuritis, myasthenia gravis, atrial fibrillation, kidney or liver-related conditions.
• Before taking Quinine, tell your doctor if you have an allergy to this medication or any of its ingredients or if you have any other allergies. Quinine may contain certain inactive ingredients that can cause allergic reactions or other problems. Consult your doctor for the full list of ingredients.
• Visit your doctor regularly, even after you or your child has completed the prescription, to check the progress and ensure that malaria has cleared up completely. Your doctor may suggest you take blood and urine tests to check for unwanted side effects.
• Call your doctor immediately if you experience heart rhythm changes. You may also feel dizzy or faint or have irregular, pounding, or fast heartbeats. Tell your doctor if you or anyone in your family has or has ever had heart rhythm problems, including QT prolongation.
• Contact your doctor immediately if you experience nosebleeds, weakness, black, tarry stools, unusual bleeding or bruising, blood in urine or stools, headache, dizziness, pain, swelling or joint discomfort, unusual vaginal bleeding, or pinpoint red spots on your skin. These symptoms may be a sign of a bleeding problem.
• Stay extra cautious to prevent injuries. Avoid sports or other situations where you could be cut, bruised, or injured. Brush and floss your teeth gently. Be extra careful while using sharp objects, including fingernail clippers and razors.
• Quinine may cause a certain blood disorder known as hemolytic anemia. Call your doctor if you have bleeding gums, difficulty breathing, back, stomach, leg cramps, chills, fever, swelling, headache, nausea, vomiting, loss of appetite, pale skin, yellowing of the eyes or skin, or nosebleeds.
• This medication may cause anaphylaxis and other severe allergic reactions, which may be life-threatening and require prompt medical assistance. Call your doctor or 911 immediately if you experience lightheadedness, rashes, itching, hoarseness, drowsiness, difficulty breathing, fainting, trouble swallowing, or swelling of your face, mouth, or hands after taking this medication.
• This medication may cause severe skin reactions. Symptoms may include blistering, peeling, loosening of the skin, severe acne, skin rash, red skin lesions, fever or chills, sores, or ulcers on the skin. Call your doctor immediately if you experience any of these symptoms.
• Quinine may cause hyperglycemia. If you experience symptoms of extremely low blood sugar levels, such as weakness, drowsiness, confusion, anxiety, or extreme hunger, tell your doctor right away.
• Before having any medical tests, let your doctor or healthcare provider know that you have been using Quinine, as this medication may affect certain tests.
• You should not take any other medication without consulting your doctor. This includes all prescription, over-the-counter medications, and herbal or vitamin supplements.

Quinine is contraindicated for use in patients who have:

• Hypersensitivity
• G6PD deficiency
• Optic neuritis
• Prolonged QT interval
• History of Blackwater Fever
• History of quinine-induced thrombocytopenia, hemolytic uremic syndrome, or thrombotic thrombocytopenic purpura
• Tinnitus or hearing problems
• Thrombocytopenia

• If you have missed a dose of Quinine, you should take it as soon as you remember.
• However, if it has been more than four hours since you missed your dose, you may omit it and take your next dose as per your regular dosage schedule.
• You should not simultaneously take double or extra doses of the same medication to compensate for the missed dose.
• You can set a reminder on your phone to prevent missing your dose.

[Note: If you have missed a medication dose and are still determining when to take the next one, immediately consult your doctor or pharmacist.]

You should not take Quinine more than prescribed, more frequently, or in large doses, as it can cause severe side effects. Symptoms of Quinine overdose may include blurred vision, blindness, other changes in vision, chest pain, dizziness, fainting, lightheadedness, sleepiness, and rapid or irregular heartbeats. If you experience severe side effects such as seizures, passing out, or difficulty breathing, seek immediate medical attention. You can call your doctor, 911, or poison control helpline. You can also head to the nearest emergency room.

[Note: If you consumed more than the recommended dose, get medical help immediately or call the Poison Help line at 1-800-222-1222.]

• Keep Quinine in a tightly closed container at a controlled room temperature, away from direct light, excess heat, and moisture.
• Keep it in a dark and dry place.
• Do not keep it in the bathroom or near the sink.
• Do not allow the medication to freeze.
• Keep all medications, including Quinine, in a safe place away from the sight and reach of children and pets.
• Do not use medications that have passed their expiration date, which is the last day of the month mentioned on the prescription label or carton.
• Do not keep medications that are outdated or no longer needed. Discard them safely.
• Do not pour them down the drain, throw them into the household garbage bin, or flush them down the toilet.
• Dispose of unwanted medications in such a way that prevents children, animals, and others from consuming them.
• The best way to eliminate unwanted medications is to give them away in a medicine take-back program.
• For more information on properly disposing unwanted medication, consult your pharmacist, healthcare provider, or local waste disposal company.

[Note: Discuss with your healthcare professional the proper disposal of unused medicine and any questions you may have regarding its storage.]

Certain medications can interact with Quinine and affect how it may work. It is important to note that this is not the complete list of interactions. Consult your doctor for more information. To prevent and manage potential drug interactions, tell your doctor beforehand about all the medications you are using or using or plan to take while using this medication. This includes all prescription, non-prescription, over-the-counter medications, and herbal or vitamin supplements. Possible drug interactions of Quinine are given below:

• Astemizole
• Atorvastatin
• Aurothioglucose
• Bepridil
• Cisapride
• Dronedarone
• Eliglustat
• Fluconazole
• Fosphenytoin
• Ketoconazole
• Levoketoconazole
• Mesoridazine
• Nelfinavir
• Phenytoin
• Pimozide
• Piperaquine
• Posaconazole
• Rifapentine
• Saquinavir
• Sparfloxacin
• Terfenadine
• Tetracycline
• Thioridazine
• Ziprasidone

What Are the Other Quinine Interactions?

Certain medications should not be used at or around the same time as consuming certain supplements, herbs, foods, and beverages, as interactions may occur. Consuming alcohol, tobacco, or marijuana (cannabis) with some medications may also cause interactions to occur. Anyone taking Quinine should consult with their healthcare provider or pharmacist about potential interactions with their specific diet, supplements, and lifestyle factors. Potential interactions of Quinine are as follows:

• St. John’s Wort
• Vitamin E
• Garlic supplements
• Grapefruit or grapefruit juice
• Calcium or vitamin K-rich foods
• High-fat meals
• Alcohol
• Caffeinated beverages
• Antacids
• Iron supplements

[Note: This isn’t a complete list, and there could be other drugs that interact with Quinine. Tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

People look for alternative medications to Quinine if it does not suit them or they do not get the desired results from it. There are many efficient Quinine alternatives present in the market, some of them are given below. However, you should consult your doctor before using them. They will help you determine which medication will work best for you.

• Malarone (atovaquone/proguanil)
• Lariam (mefloquine)
• Aralen (chloroquine)
• Plaquenil (hydroxychloroquine)
• Primaquine (primaquine phosphate)
• Coartem (artemether/lumefantrine)
• Doxycycline (doxycycline hyclate)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

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