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Quinine Dosage

Medically reviewed on April 4, 2018.

Applies to the following strengths: 260 mg; 324 mg; 325 mg; 200 mg

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Malaria

648 mg orally every 8 hours for 7 days

Comments:
-This drug has been effective in geographical regions with documented chloroquine resistance.

Use: Only for treatment of uncomplicated Plasmodium falciparum malaria

US CDC Recommendations: 542 mg base (650 mg sulfate salt) orally 3 times a day for 3 or 7 days

Comments:
-With doxycycline, tetracycline, or clindamycin, recommended as a preferred regimen for treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified); in pregnant women, this drug should be used with clindamycin.
-With primaquine plus (doxycycline or tetracycline), recommended for treatment of uncomplicated malaria due to chloroquine-resistant P vivax; primaquine must not be used during pregnancy.
-In pregnant women with uncomplicated malaria due to chloroquine-resistant P falciparum or P vivax, doxycycline or tetracycline may be used with this drug if other treatment options are not tolerated/not available and the benefits are deemed to outweigh the risks.
-The US manufactured quinine sulfate capsule is available in a 324-mg dosage; therefore, 2 capsules should be sufficient for adult dosing.
-Therapy should be continued for 7 days if infection was acquired in Southeast Asia, or for 3 days if acquired elsewhere.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Malaria

16 years or older: 648 mg orally every 8 hours for 7 days

Comments:
-This drug has been effective in geographical regions with documented chloroquine resistance.

Use: Only for treatment of uncomplicated P falciparum malaria

US CDC Recommendations: 8.3 mg base/kg (10 mg sulfate salt/kg) orally 3 times a day for 3 or 7 days
Maximum dose: 542 mg base (650 mg sulfate salt)/dose

Comments:
-In children younger than 8 years (with clindamycin) and in children 8 years or older (with doxycycline, tetracycline, or clindamycin): Recommended as a preferred regimen for treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified)
-In children younger than 8 years (with primaquine) and in children 8 years or older (with primaquine plus [doxycycline or tetracycline]): Recommended for treatment of uncomplicated malaria due to chloroquine-resistant P vivax
-Pediatric dose should never exceed adult dose.
-The US manufactured quinine sulfate capsule is available in a 324-mg dosage; due to the unavailability of non-capsule forms of this drug, pediatric dosing may be difficult.
-Therapy should be continued for 7 days if infection was acquired in Southeast Asia, or for 3 days if acquired elsewhere.
-Current guidelines should be consulted for additional information.

Renal Dose Adjustments

Mild and moderate renal dysfunction: Data not available
Severe chronic renal dysfunction:
-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.
Severe liver dysfunction (Child-Pugh C): Not recommended.

Comments:
-Patients with mild or moderate liver dysfunction should be closely monitored for side effects of this drug.
-Alternative therapy recommended for patients with severe liver dysfunction.

Precautions

US BOXED WARNING:
-HEMATOLOGIC REACTIONS: Use of this drug for treatment/prevention of nocturnal leg cramps may lead to serious and life-threatening hematologic reactions (including thrombocytopenia and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura [HUS/TTP]); chronic renal dysfunction associated with TTP development reported. Risk associated with use of this drug (without proof of efficacy for nocturnal leg cramp treatment/prevention) outweighs any potential benefit.

Safety and efficacy have not been established in patients younger than 16 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Do not use to treat severe/complicated P falciparum malaria, to prevent malaria, or to treat/prevent nocturnal leg cramps.
-Administer with food to minimize gastric upset.
-Do not exceed the prescribed amount.
-Consult the manufacturer product information regarding missed doses.

General:
-Unless otherwise specified, the dose is expressed as quinine sulfate (i.e., as the salt).
-The Medication Guide should be dispensed to each patient.

Monitoring:
-General: For side effects in patients with liver dysfunction; serum digoxin levels (if used concomitantly)
-Metabolic: For signs/symptoms of hypoglycemia

Patient advice:
-Read the US FDA-approved patient labeling (Medication Guide).
-Do not take more than the prescribed amount.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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