Home Drug Guide Quinine Sulfate

Drug Guide

Generic Name

Quinine Sulfate

Brand Names Qualaquin

Classification

Therapeutic: Antimalarial

Pharmacological: Quinine alkaloid

FDA Approved Indications

Treatment of uncomplicated malaria caused by Plasmodium falciparum

Mechanism of Action

Quinine interferes with the parasite's ability to detoxify heme, leading to accumulation of toxic heme within the parasite, ultimately causing its death.

Dosage and Administration

Adult: Loading dose of 648-972 mg (8-10 mg/kg) PO every 8-12 hours for 1-2 days, followed by maintenance doses. Exact dosing depends on patient weight and response.

Pediatric: Dosing based on weight; typically 16-25 mg/kg/day divided into 2-3 doses.

Geriatric: Careful dosing with monitoring due to potential cardiac and CNS side effects.

Renal Impairment: Adjust dose; close monitoring recommended.

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the placenta, enters breast milk.

Metabolism: Primarily hepatic.

Excretion: Mostly renal, some biliary.

Half Life: Approximately 11-12 hours.

Contraindications

History of hypersensitivity to quinine or quinidine.
Porphyria.
History of tinnitus or hearing loss.
Retinopathy or visual disturbances.

Precautions

Use cautiously in patients with cardiac conduction abnormalities, hypoglycemia, or electrolyte disturbances.
Monitor for cinchonism, especially with high doses.

Adverse Reactions - Common

Cinchonism (tinnitus, headache, nausea, dizziness) (Common)
Gastrointestinal disturbances (Common)

Adverse Reactions - Serious

Hemolytic anemia (especially in G6PD deficiency) (Rare)
Hypersensitivity reactions including anaphylaxis (Rare)
Cardiac arrhythmias and hypotension (Rare)
Visual disturbances including blurred vision (Rare)

Drug-Drug Interactions

Concurrent use with drugs that prolong QT interval (e.g., macrolides, fluoroquinolones) may increase risk of arrhythmias.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of cinchonism and cardiac arrhythmias. Assess baseline ECG, hearing, and visual function.

Diagnoses:

Risk for toxicity related to high serum levels
Impaired vision or hearing

Implementation: Administer with food to reduce gastrointestinal upset. Monitor clinical response and adverse effects.

Evaluation: Effective clearance of malaria symptoms and absence of adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report ringing in the ears, hearing loss, visual changes, or dizziness.
Complete the full course of therapy.
Avoid driving or operating heavy machinery if experiencing adverse effects.

Special Considerations

Black Box Warnings:

Potential for severe hypersensitivity reactions and cinchonism.

Genetic Factors: G6PD deficiency increases risk of hemolytic anemia.

Lab Test Interference: May interfere with certain glucose or urine tests.

Overdose Management

Signs/Symptoms: Tinnitus, visual disturbances, hypotension, vomiting, severe cinchonism, arrhythmias.

Treatment: Supportive care, activated charcoal if ingestion was recent, anticonvulsants for seizures, correction of hypoglycemia, and supportive cardiac monitoring.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable for up to 2 years if stored properly.