What is Quinine
Quinine is an alkaloid that occurs naturally in the bark of the cinchona tree. The benefits of cinchona bark were first recognized in 1630 in South America, where cinchona is indigenous to certain regions.
By 1640 it was introduced into Spain for the treatment of fever. The early use of quinine for all types of febrile illness was erroneous and stemmed from the observed reduction of fever in malarial patients; it does not have antipyretic qualities.
Quinine was isolated from cinchona bark in 1820 and is still obtained from the natural source. It is the levorotatory isomer of quinidine, a more potent, but more toxic, antimalarial.
Quinine is approved for use in treating chloroquine-resistant malaria due to strains of Plasmodium falciparum; it is not approved for the prevention of malaria. There are serious safety concerns associated with the use of quinine; since 1969, the FDA has received 665 reports of adverse events with serious outcomes associated with quinine use, including 93 deaths. Because malaria is a life-threatening illness, the risks associated with quinine use are justified for treatment.
However, quinine is used off-label (on both an OTC and prescription basis) for the relief of nocturnal muscle cramping and, because of the risks associated with its use, both the manufacturer of the approved prescription product and the FDA warn against such use (see Contraindications).
In December 1995, non-prescription forms of quinine were removed from the market; as of December 2006 unapproved formulations were still found to be available.
The product manufactured by Mutual Pharmaceutical Company, Inc., a prescription-only drug, is the only quinine product approved by the FDA.
Brand Name
Qualaquin
Indications
- Babesia microti
- babesiosis
- malaria
- Plasmodium falciparum
- Plasmodium malariae
- Plasmodium ovale
- Plasmodium vivax
Side Effects
- abdominal pain
- agranulocytosis
- anorexia
- aphasia
- aplastic anemia
- ataxia
- atrial fibrillation
- AV block
- bleeding
- blurred vision
- bradycardia
- bullous rash
- cardiac arrest
- chest pain (unspecified)
- coagulopathy
- coma
- confusion
- contact dermatitis
- diaphoresis
- diarrhea
- diplopia
- disseminated intravascular coagulation (DIC)
- dizziness
- dyspnea
- dystonic reaction
- ecchymosis
- erythema
- erythema multiforme
- esophagitis
- exfoliative dermatitis
- fever
- headache
- hearing loss
- hemolysis
- hemolytic anemia
- hemolytic-uremic syndrome
- hepatitis
- hypoglycemia
- hypoprothrombinemia
- hypotension
- infertility
- interstitial nephritis
- jaundice
- leukopenia
- lupus-like symptoms
- maculopapular rash
- myalgia
- nausea
- neutropenia
- night blindness
- optic atrophy
- optic neuritis
- orthostatic hypotension
- palpitations
- pancytopenia
- peripheral vasodilation
- petechiae
- photophobia
- photosensitivity
- premature ventricular contractions (PVCs)
- pruritus
- pulmonary edema
- QT prolongation
- renal failure (unspecified)
- restlessness
- scotomata
- seizures
- sinus tachycardia
- Stevens-Johnson syndrome
- suicidal ideation
- syncope
- thrombocytopenia
- thrombotic thrombocytopenic purpura (TTP)
- tinnitus
- torsade de pointes
- toxic epidermal necrolysis
- tremor
- urticaria
- vasculitis
- ventricular fibrillation
- ventricular tachycardia
- vertigo
- visual impairment
- vomiting
- weakness
Monitoring Parameters
- blood glucose
- CBC
- ECG
- ophthalmologic exam
Contraindications
- alcoholism
- blackwater fever
- bradycardia
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- coronary artery disease
- diabetes mellitus
- females
- G6PD deficiency
- heart failure
- hemolytic-uremic syndrome
- hepatic disease
- hypertension
- hypocalcemia
- hypoglycemia
- hypokalemia
- hypomagnesemia
- infertility
- intramuscular injections
- long QT syndrome
- malnutrition
- mefloquine hypersensitivity
- muscle cramps
- myasthenia gravis
- myocardial infarction
- optic neuritis
- pregnancy
- QT prolongation
- quinidine hypersensitivity
- quinine hypersensitivity
- reproductive risk
- thrombocytopenia
- thrombotic thrombocytopenic purpura (TTP)
- thyroid disease
- tinnitus
Interactions
- Abiraterone
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- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
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- Acetaminophen; Dextromethorphan; Doxylamine
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