Quinine.txt

CLINICAL USE

Severe and complicated falciparum malariaNocturnal cramp

DOSE IN NORMAL RENAL FUNCTION

IV: Quinine dihydrochloride: Loading dose 20 mg/kg to maximum 1.4 g, then after 8 hours, maintenance 10 mg/kg (up to maximum 700 mg) 8 hourly, reduced to 5–7 mg/kg if parenteral treatment required for more than 48 hoursOral: Quinine sulphate 600 mg every 8 hours for 5–7 daysNocturnal cramp: Quinine sulphate 200– 300 mg at night

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :324.4 (397.3 as dihydrochloride); (782.9 as sulphate)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :70–90

%Excreted unchanged in urine &nbsp &nbsp : 5–20

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :2.5–7.1

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :11 (healthy), 18 (malaria)/26

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Malaria: 5–7 mg/kg every 8 hours Cramp: Dose as in normal renal function

10 to 20 &nbsp &nbsp : Malaria: 5–7 mg/kg every 8–12 hours Cramp: Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Malaria: 5–7 mg/kg every 24 hours Cramp: Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

HDF/high flux &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anti-arrhythmics: flecainide levels increased; increased risk of ventricular arrhythmias with amiodarone – avoid concomitant use

Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid concomitant use

Antimalarials: increased risk of convulsions with mefloquine; avoid concomitant use with artemether/lumefantrine

Antipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant useCardiac glycosides: levels of digoxin increased (halve maintenance dose)

Ciclosporin: decreased ciclosporin levels reportedCimetidine: may increase plasma levels of quinine

ADMINISTRATION

Reconstition

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Route

IV infusion

, oral

Rate of Administration

4 hours

Comments

Add to sodium chloride 0.9% or glucose 5% for infusionLoading dose of 20 mg/kg may be required in some cases (refer to specialist treatment). Not to be given if patient has had quinine or mefloquine in previous 12–24 hours

OTHER INFORMATION

Quinine dihydrochloride injection is available as a special orderMonitor for signs of cardiotoxicity Give doses after haemodialysis on dialysis daysMonitor quinine levels if patient exhibits any symptoms of toxicity.

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