Quinine Sulfate is indicated in:

• Uncomplicated, severe, and complicated falciparum malaria
• Falciparum malaria resistant to other antimalarial drugs
• Prevention of nocturnal muscle cramps
• Relief of muscle cramps in Thomsen’s disease

Quinine is believed to act by interfering with protein metabolism and inhibiting nucleic acid synthesis in malarial parasites. It is a highly active blood schizonticide and suppresses the asexual erythrocytic stage of malaria parasites. Quinine is effective both for suppression of malaria and for treatment during acute clinical attacks.

Adult:

• Oral: 600 mg (of quinine salt) every 8 hours for 7 days.
• Parenteral: If the patient is seriously ill quinine should be given by intravenous infusion. The adult dosage regimen for quinine by infusion is loading dose of 20 mg/kg (up to maximum 1.4 g) of quinine salt infused over 4 hours then after 8-12 hours maintenance dose of 10 mg/kg (up to maximum 700 mg) of quinine salt infused over 4 hours every 8-12 hours (until patient can swallow tablets to complete the 7 days course).

Children:

• Oral: Quinine is well tolerated by children. The dosage regimen for quinine by mouth for children is 10 mg/kg (of quinine salt) every 8 hours for 7 days.
• Parenteral: The dosage regimen for quinine by intravenous infusion for children is calculated on a mg/kg basis as for adult.

Pregnancy: The adult treatment doses of oral and intravenous quinine given above (including the loading dose) can safely be given to pregnant women.

Quinine Sulfate is contraindicated in: Hypersensitivity to quinine or any component of the formulation, Optic neuritis History of blackwater fever.

Cinchonism is the most common adverse effect, which includes tinnitus, headache, nausea, and visual disturbances. Hematological disorders and skin reactions may also occur.

Quinine is not absolutely contraindicated during pregnancy. It is considered safe when used in therapeutic doses. It is excreted in breast milk in insignificant amounts and can be used during lactation when necessary.

Caution is required in patients with severe heart disease, myasthenia gravis, and diabetes mellitus. Intravenous administration should be given slowly. Concomitant use of mefloquine with quinine sulfate may increase the risk of adverse effects.

Anti-malarial drugs

Store in a cool, dry place away from light and moisture. Keep out of reach of children.