Quinine Side Effects
It is possible that some side effects of quinine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
For the Consumer
Applies to quinine: oral capsule, oral tablet, oral tablet extended release
As well as its needed effects, quinine may cause unwanted side effects that require medical attention.
If any of the following side effects occur while taking quinine, check with your doctor immediately:More common
- stomach cramps or pain
- behavior change, similar to drunkenness
- black, tarry stools
- blood in the urine or stools
- blurred vision or change in vision
- cold sweats
- convulsions (seizures) or coma
- cool pale skin
- cough or hoarseness
- difficulty concentrating
- excessive hunger
- fast heartbeat
- fever or chills
- lower back or side pain
- painful or difficult urination
- pinpoint red spots on the skin
- restless sleep
- slurred speech
- sore throat
- unusual bleeding or bruising
- unusual tiredness or weakness
- Difficulty breathing or swallowing
- disturbed color perception
- double vision
- increased sweating
- muscle aches
- night blindness
- reddening of the skin, especially around ears
- ringing or buzzing in the ears
- swelling of the eyes, face, or inside of the nose
If any of the following symptoms of overdose occur while taking quinine, get emergency help immediately:Symptoms of an overdose
- blurred vision or change in vision
- chest pain
- double vision
- rapid or irregular heartbeat
For Healthcare Professionals
Applies to quinine: compounding powder, oral capsule, oral tablet
Disseminated intravascular coagulation has been reported in a 79-year-old female within 12 hours following a second dose of quinine 300 mg.
Hematologic side effects have included thrombocytopenia, purpura, neutropenia, thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, disseminated intravascular coagulation, petechiae, and ecchymosis. At least 7 cases of immune thrombocytopenia have been reported.
Dermatologic side effects have included flushing, pruritus, and skin rashes. Fixed drug eruption (nummular skin lesion) and fatal cutaneous vasculitis have been reported.
Fixed drug eruption (nummular skin lesion) has been reported in a 23-year-old female following exposure to quinine in tonic water. An open oral challenge, approved by the patient, with 30 mg quinine sulfate triggered the appearance of pruritus, erythema, and edema at the usual sites within 40 minutes of ingestion of the dose.
Gastrointestinal side effects have included abdominal pain, nausea, vomiting, diarrhea, and gastrointestinal upset.
Renal side effects have included renal failure secondary to thrombotic thrombocytopenic purpura-hemolytic uremic syndrome.
Respiratory side effects have included asthma symptoms, hemoptysis, and a case report of transient bilateral pulmonary infiltrates.
Transient bilateral pulmonary infiltrates have been reported in a 45-year-old woman following a single dose of quinine sulfate 325 mg for nocturnal cramps. Approximately 45 minutes after she took the single dose of quinine the following symptoms were present: sudden onset of dyspnea, wheezing, cough, breathlessness, severe anxiety, dry nonproductive cough, orthopnea, mild fever, chills, and pleuritic chest discomfort.
Ocular side effects have included visual disturbances including blurred vision with scotomata, photophobia, diplopia, diminished visual fields, disturbed color vision, and blindness.
Cardiovascular side effects have included cardiac dysrhythmias, including prolongation of the QT-interval.
Hepatic side effects have included changes in the hepatic enzyme system that synthesizes vitamin K dependent factors. At least one case report of hepatotoxicity with elevated alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase has been reported.
Within 24 hours of taking the first dose of quinine 260 mg for leg cramps, a 57-year-old Native American female presented to the hospital with symptoms of nausea, vomiting, generalized myalgia, headache, fever, chills, and rigor. The following liver enzymes were dramatically elevated: alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase. Following discontinuation of quinine, the patient's symptoms resolved within 48 hours and the liver enzyme concentrations declined within 72 hours.
Nervous system side effects have included apprehension, restlessness, confusion, syncope, dizziness, vertigo, tinnitus, hearing loss, and nystagmus. Cinchonism has been reported with repeated doses or high serum levels in 25% to 100% of patients. Signs and symptoms of cinchonism have been commonly reported. The clinical presentation of cinchonism have included temporary deafness/slight deafness, tinnitus, headache, dizziness, rash, mental dullness, depression, confusion, and nausea. Fatalities have been reported from single oral doses of 2 to 8 grams.
Tinnitus and impaired hearing may occur at plasma concentrations over 10 mcg/mL.
Hypersensitivity side effects have been reported in a few patients who experienced severe side effects after a single dose of quinine.
Metabolic side effects have included hypoglycemia and electrolyte imbalance.
Other side effects have included mucosal bleeding (gingival, gastrointestinal, epistaxis).
More about quinine
- Other brands: Qualaquin
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