Quinine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Malaria

Treatment of uncomplicated Plasmodium falciparum malaria: 648 mg orally every 8 hours for 7 days

Per Centers for Disease Control and Prevention (CDC) guidelines:
542 mg base (650 mg sulfate salt) orally 3 times a day for 3 to 7 days

Comments:
-Treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) infection should be in conjunction with one of the following: doxycycline, tetracycline, or clindamycin. In pregnant women, quinine sulfate plus clindamycin is recommended.
-Treatment of uncomplicated malaria due to chloroquine-resistant P vivax infection should be in conjunction with either doxycycline or tetracycline plus primaquine phosphate. In pregnant women, quinine sulfate alone for 7 days is recommended.

Usual Pediatric Dose for Malaria

Treatment of uncomplicated P falciparum malaria:
16 years or older: 648 mg orally every 8 hours for 7 days

Per CDC guidelines:
8.3 mg base/kg (10 mg sulfate salt/kg) orally 3 times a day for 3 to 7 days; pediatric dose should never exceed adult dose

Comments:
Less than 8 years:
-Treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) infection should be combined with clindamycin.
-Treatment of uncomplicated malaria due to chloroquine-resistant P vivax infection should be combined with primaquine phosphate.

8 years or older:
-Treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) infection should be in conjunction with one of the following: doxycycline, tetracycline, or clindamycin.
-Treatment of uncomplicated malaria due to chloroquine-resistant P vivax infection should be in conjunction with either doxycycline or tetracycline plus primaquine phosphate.

Renal Dose Adjustments

Mild and moderate renal dysfunction: Data not available

Severe chronic renal failure not on dialysis:
Loading dose: 648 mg orally once followed 12 hours later by maintenance dose
Maintenance dose: 324 mg orally every 12 hours

Liver Dose Adjustments

Mild or moderate liver dysfunction (Child-Pugh A or B): No adjustment recommended. Patients should be closely monitored for side effects of quinine.
Severe liver dysfunction (Child-Pugh C): Not recommended.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Quinine should be administered with food to minimize gastric upset.
-No more than the prescribed amount should be taken.
-If a dose is missed, the patient should not double the next dose. If the dose is missed by more than 4 hours, the patient should not take the missed dose, but resume the usual dosing schedule.

General (per CDC guidelines):
-The US manufactured quinine sulfate capsule is available in a 324 mg dosage; therefore, 2 capsules should be sufficient for adult dosing. Due to the unavailability of non-capsule forms of quinine, pediatric dosing may be difficult.
-Quinine treatment should be continued for 7 days if malaria infection was acquired in Southeast Asia, or for 3 days if acquired elsewhere.
-In pregnant women diagnosed with uncomplicated malaria due to chloroquine-resistant P falciparum or chloroquine-resistant P vivax infection, doxycycline or tetracycline may be given with quinine if other treatment options are not tolerated or are not available, and the benefit outweighs the risks.

Monitoring:
-General: Monitor for side effects (patients with liver dysfunction); monitor serum digoxin levels closely (if used concomitantly).
-Metabolic: Monitor for signs/symptoms of hypoglycemia.

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