quinine dihydrochloride * 300 mg/ml ; parenteral use ; solution for injection

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2013

Use and administration :
Patient safety :
Marketed drugs :
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ATC Reproductive health Sport Vigilance
P ANTIPARASITIC PRODUCTS, INSECTICIDES AND REPELLENTS
P01 ANTIPROTOZOALS
P01B ANTIMALARIALS
P01BC METHANOLQUINOLINES
P01BC01 QUININE
Be careful
Be careful

Use and administration

quinine dihydrochloride * 300 mg/ml ; parenteral use ; solution for injection

Indications

This generic drug is indicated in the following cases:

  • Malarial attack
  • Severe malaria or malaria associated with vomiting

Dosage

Please refer to the global dosage information for the following ingredients at the bottom of this document:

Treatment monitoring

  • Monitor blood glucose levels during treatment
  • Monitor blood pressure during treatment
  • Monitor heart rate during treatment

Patient safety

quinine dihydrochloride * 300 mg/ml ; parenteral use ; solution for injection
Risk scale: XCritical IIIHigh IIModerate ILow

Drug interactions

XCritical

Severity: Contraindication

CYP3A4 substrates + Boceprevir
Risks and Mechanisms Risk of increased toxicity due to reduced metabolism by boceprevir.
IIIHigh

Severity: Combination not recommended

Quinine (intravenous route) + Mefloquine
Risks and Mechanisms Increased risk of the onset of epileptic seizures by the addition of proconvulsant effects.
Course of Action Maintain a 12 hour period between the end of the IV administration of quinine and the start of the administration of mefloquine.
Quinine (systemic route) + Rifampicin
Risks and Mechanisms Risk of lower effectiveness of quinine due to its increased hepatic metabolism by the enzyme inducer.
Quinine (systemic route) + Strong CYP3A4 inhibitors
Risks and Mechanisms Risk of quinine-induced increased adverse effects, particularly ventricular rhythm disorders and neurosensory disorders (cinchonism).
Course of Action Not recommended with the protease inhibitors. Caution with azole antifungal agents and some macrolides. Clinical and ECG monitoring. Possible dose adjustment of quinine during the enzyme inhibitor treatment and after its discontinuation.
IIModerate

Severity: Precaution

Quinine (systemic route) + Digoxin (systemic route)
Risks and Mechanisms Moderate increased digoxinemia.
Course of Action Clinical monitoring and ECG, if necessary, with possible dose adjustment of digoxine.
Quinine (systemic route) + Enzyme inducing anticonvulsants
Risks and Mechanisms Risk of lower effectiveness of quinine due to its increased hepatic metabolism by the enzyme inducer.
Course of Action Clinical monitoring and dose adjustment of quinine during the inductor treatment and after its discontinuation.
ILow

Severity: Take into account

CYP3A4 substrates + Nefazodone
Risks and Mechanisms Risk of increased specific substrate-induced adverse effects with often severe consequences.
CYP3A4 substrates + Strong CYP3A4 inhibitors
Risks and Mechanisms Risk of increased specific substrate-induced adverse effects with often severe consequences.

Contraindications

XCritical

Severity: Absolute contraindication

  • Bundle branch block
  • History of black water fever
  • Hypersensitivity to one of the components
  • Hypersensitivity to quinine and its derivatives
IIIHigh

Severity: Relative contraindication

  • Glucose-6-phosphate dehydrogenase [G6PD] deficiency

Precautions

IIModerate

Severity: Precaution

  • Hemolysis

Adverse effects

System Medium to high frequency (≥1/1 000) Low frequency (<1/1 000) Unknown frequency
Cardiovascular system Anaphylactic shock
Electrocardiogram abnormality
Dermatology Pruritus
Skin rash
Urticaria
Hematology Acute hemolytic anemia
Thrombocytopenia
Thrombocytopenic purpura
Instrumentation Fibrosis at the site of injection
Necrosis at the site of injection
Post-extravasation inflammation
Laboratory tests abnormality Hypoglycemia
Musculo-skeletal system Algodystrophy
Nervous system Convulsions
Toxicology Cinchonism

Marketed drugs

quinine dihydrochloride * 300 mg/ml ; parenteral use ; solution for injection

quinine dihydrochloride

Substance details

Chemistry

IUPAC dichlorhydrate de (alfa R)-alfa-(6-méthoxy-4-quinolyl)-alfa-[(2S,4S,5R)-(5-vinylquinuclidin-2-yl)]méthanol
Synonyms quinine dihydrochloride

Dosage

Defined Daily Dose (WHO)
Oral : 1.5 g
Parenteral : 1.5 g