Consumer Drug Information

quinine

Generic Name: quinine (KWYE nine)
Brand names: Qualaquin, QM-260

What is quinine?

The U.S. Food and Drug Administration has banned the sale of all non-approved brands of quinine because of the risk of serious side effects or death. As of December 2006, Qualaquin is the only brand of quinine that is approved by the FDA.

Quinine is used to treat malaria, a disease caused by parasites. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Quinine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about quinine?

Quinine can cause serious or life-threatening side effects, and is approved for use only in treating malaria. Some people have used quinine to treat leg cramps, but this is not an FDA-approved use. Do not use quinine to treat any medical condition if your doctor did not prescribe quinine for that condition. Do not purchase quinine on the Internet or from vendors outside of the United States. Using this medication improperly or without the advice of a doctor can result in serious side effects or death.

Do not use this medication if you have ever had an allergic reaction to quinine or similar medicines such as mefloquine (Lariam) or quinidine (Cardioquin, Quinidex, Quinaglute).

You should not take quinine if you have a history of "Long QT syndrome", or if you have glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, myasthenia gravis, or optic neuritis (inflammation of the nerves in your eyes).

Call your doctor at once if you have a weak pulse, if you faint or collapse, if you have fever, confusion, pale or yellowed skin, dark colored urine, hearing or vision loss, purple spots under your skin, a blistering or peeling skin rash, or if you urinate less than usual or not at all.

No medication is 100% effective in treating malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

What should I discuss with my healthcare provider before taking quinine?

Quinine can cause serious or life-threatening side effects, and is approved for use only in treating malaria. Some people have used quinine to treat leg cramps, but this is not an FDA-approved use. Quinine will not treat severe forms of malaria, and it should not be taken to prevent malaria. Quinine also should not be taken to treat or prevent night-time leg cramps. Do not use this medication if you have ever had an allergic reaction to quinine or similar medicines such as mefloquine (Lariam) or quinidine (Cardioquin, Quinidex, Quinaglute), or if you have:

a history of "Long QT syndrome";
glucose-6-phosphate dehydrogenase (G-6-PD) deficiency;
myasthenia gravis; or
optic neuritis (inflammation of the optic nerve).

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before taking quinine, tell your doctor if you have:

heart disease or a heart rhythm disorder;
low potassium levels in your blood (hypokalemia); or
kidney or liver disease.

FDA pregnancy category C. It is not known whether quinine is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Hypoglycemia (low blood sugar) may be more likely to occur in pregnant women who are taking quinine. Signs of low blood sugar include hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, and fast heartbeat. Talk to your doctor about your specific risk for low blood sugar if you take quinine while you are pregnant. Quinine may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to a child younger than 16 years old.

How should I take quinine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take quinine with food to lessen stomach upset.

Call your doctor if your malaria symptoms do not improve after 2 days of taking quinine, or if your symptoms return after you have finished the medication.

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before your condition is completely treated. If you stop using the medication early for any reason, talk to your doctor about other forms of malaria prevention.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using quinine. You may need to stop using the medicine for a short time.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using quinine.

No medication is 100% effective in treating malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

Store quinine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If you are more than 4 hours late for your dose, skip it and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include headache, confusion, dizziness, ringing in your ears, vision or hearing loss, severe nausea or vomiting, sweating, uneven heart rate, feeling light-headed, and fainting or collapse.

What should I avoid while taking quinine?

Do not use quinine to treat any medical condition if your doctor did not prescribe quinine for that condition. Do not purchase quinine on the Internet or from vendors outside of the United States. Using this medication improperly or without the advice of a doctor can result in serious side effects or death. Quinine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using antacids without your doctor's advice. Use only the specific type of antacid your doctor recommends. Antacids contain different medicines and some types can make it harder for your body to absorb quinine.

Quinine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using quinine and call your doctor at once if you have any of these serious side effects:

uneven heart rhythm;
weak pulse, fainting or collapse;
fever, confusion, weakness;
pale or yellowed skin, dark colored urine;
unusual muscle weakness;
purple spots under the skin, urinating less than usual or not at all;
severe blistering, peeling, and red skin rash with a sore throat, fever, and headache;
severe nausea, vomiting, stomach pain, diarrhea; or
problems with hearing or vision.

Less serious side effects may include:

hunger, headache, confusion, irritability, sweating;
drowsiness, weakness, dizziness, tremors; or
warmth, redness, or tingly feeling under the skin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Quinine Dosing Information

Usual Adult Dose for Malaria:

Uncomplicated due to chloroquine-resistant, or unknown resistance, P falciparum infection:
542 mg base (650 mg sulfate salt) orally three times per day for 3 to 7 days. Treatment should be in conjunction with one of the following: doxycycline, tetracycline, or clindamycin.

Uncomplicated due to chloroquine-resistant P vivax infection:
542 mg base (650 mg sulfate salt) orally three times per day for 3 to 7 days. Treatment should be in conjunction with either doxycycline or tetracycline plus primaquine phosphate. In pregnant women quinine sulfate alone may be given for a duration of 7 days.

Usual Pediatric Dose for Malaria:

Less than 8 years old:
Uncomplicated due to chloroquine-resistant, or unknown resistance, P falciparum infection:
8.3 mg base (10 mg sulfate salt) orally three times per day for 7 days. Treatment may be combined with clindamycin.

Uncomplicated due to chloroquine-resistant P vivax infection:
8.3 mg base (10 mg sulfate salt) orally three times per day for 7 days.

Greater than or equal to 8 years old:
Uncomplicated due to chloroquine-resistant, or unknown resistance, P falciparum infection:
8.3 mg base (10 mg sulfate salt) orally three times per day for 3 to 7 days. Treatment should be in conjunction with one of the following: doxycycline, tetracycline, or clindamycin.

Uncomplicated due to chloroquine-resistant P vivax infection:
8.3 mg base (10 mg sulfate salt) orally three times per day for 3 to 7 days. Treatment should be in conjunction with either doxycycline or tetracycline plus primaquine phosphate.

What other drugs will affect quinine?

Before taking quinine, tell your doctor if you are using any of the following drugs:

arsenic trioxide (Trisenox);
astemizole (Hismanal);
cisapride (Propulsid);
cimetidine (Tagamet);
dextromethorphan (cough medicine);
digoxin (digitalis, Lanoxin);
droperidol (Inapsine);
metoprolol (Toprol);
paroxetine (Paxil);
rifampin (Rifadin, Rimactane, Rifater);
a blood thinner such as warfarin (Coumadin);
aminophylline (Truphylline), or theophylline (Elixophyllin, Respbid, Theobid, Theo-Dur, Uniphyl);
antibiotics such as clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S.), pentamidine (NebuPent, Pentam), sparfloxacin (Zagam), tetracycline (Brodspec, Tetracap), or troleandomycin (Tao);
heart rhythm medicine such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), ibutilide (Corvert), disopyramide (Norpace), procainamide (Procan, Pronestyl), quinidine (Cardioquin, Quinaglute), or sotalol (Betapace);
medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril);
narcotic medication such as levomethadyl (Orlaam) or methadone (Dolophine, Methadose);
seizure medication such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Luminal, Solfoton), or phenytoin (Dilantin); or
other anti-malarial drugs such as chloroquine (Arelan), halofantrine (Halfan), or mefloquine (Lariam).

This list is not complete and there may be other drugs not listed that can affect quinine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about quinine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.