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Quinine
💊 Quinine remains a key treatment for falciparum malaria. ⚠️ Never give by rapid IV injection - can cause lethal hypotension. Treatment is usually followed by a partner drug such as doxycycline, clindamycin, or Fansidar.
📖 About
- Alkaloid extracted from the bark of the Cinchona tree (South America).
- One of the oldest and still effective drugs for falciparum malaria.
- Check the BNF here for up-to-date prescribing.
⚙️ Mechanism of Action
- Active against asexual blood stages of Plasmodium.
- Inactive against exoerythrocytic stages (e.g. P. vivax, P. ovale liver hypnozoites).
- Resistance is reported but still widely useful.
🎯 Indications
- Treatment of falciparum malaria (oral or IV).
- Nocturnal leg cramps (rarely used now due to side-effect risk).
- ❌ Not indicated for malaria prophylaxis.
💊 Dosing – Quinine (check BNF/local policy)
| Indication | Dose & Notes |
|---|---|
| 🌍 Uncomplicated falciparum malaria (oral) |
• Quinine 600 mg PO every 8 h for 7 days
➕ Doxycycline 200 mg OD × 7 days ➕ Clindamycin 450 mg TDS if pregnant |
| 🚑 Severe falciparum malaria |
• Loading: Quinine 20 mg/kg slow IV infusion over 4 h (max 1.4 g)
• Maintenance (8 h later): 10 mg/kg (max 700 mg) IV or PO every 8 h, diluted in 500 mL NS/5% dextrose over 4 h • If IV unavailable → IM into anterior thigh (not buttock) |
| 💊 Alternatives (non-severe) |
• Atovaquone-proguanil (Malarone)
• Artemether-lumefantrine (Coartem/Riamet) |
⛔ Contraindications
- Optic neuritis.
- Caution in patients with G6PD deficiency (risk of haemolysis).
⚠️ Cautions
- Hypoglycaemia - especially with IV use in falciparum malaria (due to quinine-induced insulin release).
- Arrhythmias - ECG monitoring essential with IV therapy.
❌ Side Effects (Cinchonism)
- 🎧 Tinnitus and impaired hearing.
- 🤢 Nausea and vomiting.
- 👀 Visual disturbances.
- 🩸 Hypoglycaemia (esp. with IV treatment).
- 💓 Cardiac arrhythmias - requires ECG monitoring.
💡 Clinical Pearls
- Always combine quinine with another agent (doxycycline, clindamycin, or Fansidar) to prevent recrudescence.
- In severe falciparum malaria: careful fluid balance and hypoglycaemia monitoring are as critical as the drug itself.
- Artemisinin-based combination therapy (ACT) is now preferred first-line in many regions, but quinine remains vital where ACT is unavailable or contraindicated.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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