Quinine Sulfate

The active ingredient is quinine sulfate, an alkaloid derived from the Cinchona tree. While its mechanism of action is not fully understood, it is thought to disrupt Plasmodium falciparum’s ability to make the protein and energy it needs to survive.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide, before using Quinine sulfate. However, the following is a synopsis of the general guidelines for the use of Quinine sulfate:

• Take all of the medication as directed.
• Take this medication with food to minimize stomach upset.
• For a missed dose, take it as soon as you remember, unless more than four hours have elapsed, in which case you should wait until your next dose, and not double it.
• Quinine may lower your blood sugar (hypoglycemia). If you are diabetic, you may need to monitor your sugars more closely while on this medication.

The most common side effects of Quinine sulfate include:

• Cinchonism, which presents in mild cases as headache, sweating, nausea, tinnitus (ringing in the ears), vertigo/ dizziness, and blurred vision.

Some individuals may experience serious side effects while using Quinine sulfate. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Symptoms of severe cinchonism: vomiting, diarrhea, abdominal pain, deafness, blindness, disturbances in heart rhythm or conduction.
• Severe blood/ lymphatic system disorders, which are life-threatening, and present as fatigue, weakness, dizziness, high heart rate, yellow skin/ eyes, or dark-coloured urine, blood in the stool/ urine, unexplained bleeding, or bleeding that continues for longer than usual.
• Heart rhythm or conduction problems, including QT prolongation (prolongation of the QT interval in the heart), which presents as shortness of breath, chest pain, or feeling lightheaded.
• Severe allergic reaction, which includes difficulty breathing, itchy hives, or swelling of the throat/ mouth/ lips.

These are not all of the possible adverse reactions of Quinine sulfate. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the U.S. Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Quinine sulfate, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including whether you have:

• Nocturnal leg cramps - this medication is not approved for the treatment of nighttime leg cramps, as the risks outweigh the benefits.
• Severe or complicated Plasmodium falciparum.

• Known or suspected hypersensitivity to quinine sulfate, including: hemolytic anemia (low red blood cell count), thrombocytopenia (low platelet count), thrombotic thrombocytopenic purpura (small blood clots throughout the body), Blackwater fever, hemolytic uremic syndrome, hemolysis (destruction of red blood cells).
• Known hypersensitivity to mefloquine or quinidine.
• QT-prolongation or atrial fibrillation.
• Glucose-6-phosphate dehydrogenase or G6PD deficiency.
• Myasthenia gravis (severe muscle weakness).
• Optic neuritis.

Quinine is usually taken for one week for the treatment of malaria.

When Quinine sulfate is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Drugs which inhibit (cyclosporine, antifungals, erythromycin) or induce (carbamazepine, phenobarbital, phenytoin) the action of hepatic enzymes which break down quinine, especially CYP3A4, may increase or decrease levels of quinine in your body. These drugs, especially inhibitors, should be avoided while taking quinine.
• Cimetidine, a drug used for acid reflux, should not be used with quinine as it can increase levels of quinine in your body.
• Antacids containing aluminum and/or magnesium can delay or reduce the absorption of quinine.
• Agents that increase the pH of the urine, such as sodium bicarbonate or acetazolamide, may reduce the excretion of quinine and increase the risk of toxicity.
• Quinine may increase blood levels of: atorvastatin (causing severe muscle pain), digoxin, warfarin (changing risk of bleeding), mefloquine (increasing risk of seizures and QT prolongation), and astemizole (increasing risk of severe QT prolongation).
• Quinine should not be used with other drugs that can cause QT prolongation, such as quinidine, procainamide, amiodarone, and sotalol.

Quinine sulfate is available as 200mg or 300mg capsules.

It should be stored at room temperature, away from the reach of children or pets.

Quinine sulfate is the generic version of Qualaquin and is manufactured by several drug companies.

Yes.

Barring any serious side effects as listed above, or under the advice of a physician, you should complete the entire course of quinine sulfate.

Malaria has a higher risk of causing harm or death in pregnant people compared to the general population, and a high risk of causing harm to a growing fetus. Quinine itself can cause developmental abnormalities in a growing fetus. It may also lower blood sugar, which should be monitored in all pregnant patients. However, if the benefit of treating malaria outweighs the risk of fetal harm, quinine can be used in pregnant individuals. Talk to your doctor if you are already pregnant or if you have any plans to become pregnant. They will know or recommend what is best for you.

While quinine is found in breast milk, it is generally considered compatible with breastfeeding. Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you.