Quinine
- Atc Codes:P01BC01
- CAS Codes:6119-70-6#804-63-7#130-95-0
- PHARMGKB ID:6119-70-6#804-63-7#130-95-0
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Inhibits
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Cyprus: Quinine; Denmark: Kinin; France: Quinine; Germany: Chininum, Limptar N, Quinine; Greece: Chinium, Kinin, Quinine; Hungary: Chinium; Ireland: Quinine; Malta: Quinine; Portugal: Quinina; Sweden: Kinin; UK: Quinine.
North America
Canada: Chinium, Quinine; USA: Qualaquin.
Latin America
Argentina: Circonyl; Brazil: Palukin.
Drug combinations
Quinine, Aspirin, and Caffeine
Quinine, Aspirin, and Lithium
Quinine, Biotin (Vitamin B~7~), Pantothenic Acid (Vitamin B~5~), and Pyridoxine (Vitamin B~6~)
Chemistry
Quinine Sulfate: (C~20~H~24~N~2~O~2~)~2~ H~2~SO~4~ 2H~2~O. Mw: 782.94. Cinchonan-9-ol, 6′-methoxy-, (8α,9R), sulfate (2:1), dihydrate. CAS-6119-70-6; CAS-804-63-7 (anhydrous); CAS-130-95-0 (quinine).
Pharmacologic Category
Antiprotozoals; Antimalarials. (ATC-Code: P01BC01).
Mechanism of action
Alkaloid obtained from bark of cinchona tree is levorotatory isomer of quinidine. Depresses oxygen uptake and carbohydrate metabolism. Intercalates into DNA, disrupting replication and transcription of parasite. Blood schizonticidal agent active against asexual erythrocytic forms of Plasmodium falciparum, P. malariae, P. ovale, and P. vivax. Inactive against sporozoites or preerythrocytic or exoerythrocytic forms of plasmodia. Gametocytocidal for P. malariae and P. vivax, but no direct activity against P. falciparum gametocytes. Affects calcium distribution within muscle fibers and decreases excitability of motor end-plate region, increasing refractory period of muscle by direct action on muscle fiber and so diminishing response to tetanic stimulation. Has curare-like effect. Has cardiovascular effects similar to those of quinidine.
Therapeutic use
Suppression or treatment of chloroquine-resistant P. falciparum malaria (inactive against sporozoites, pre-erythrocytic or exoerythrocytic forms of plasmodia) in conjunction with other antimalarial agents.
Pregnancy and lactiation implications
Teratogenic effects reported in some animal studies. Quinine crosses human placenta, should not be used during pregnancy. Enters breast milk (use caution).
Unlabeled use
Treatment of Babesia microti infection in conjunction with clindamycin.
Contraindications
Hypersensitivity to quinine or any component of the formulation. Hypersensitivity to mefloquine or quinidine (cross-sensitivity reported). Prolonged QT interval. Myasthenia gravis. Optic neuritis. G6PD deficiency. History of black water fever. Thrombotic thrombocytopenia purpura, hemolytic uremic syndrome, thrombocytopenia. Tinnitus. Women who are or may become pregnant.
Warnings and precautions
Severe hypersensitivity reactions (e.g. Stevens-Johnson syndrome, anaphylactic shock) occurred. Use may cause significant hypoglycemia. Use with caution in atrial fibrillation or flutter/clinical conditions which may prolong the QT interval or cause cardiac arrhythmias (contraindicated if QT prolongation). Use with caution in hepatic/renal impairment, and in patients taking strong CYP3A4 inhibitors, moderate or strong CYP3A4 inducers and major CYP3A4 substrates. Quinine no longer recommended for treatment of nocturnal leg cramps.