INFECTIONS: QUININE

Question 1

QUININE: INDICATIONS

Answer 1

• Quinine is commonly used for the treatment and prevention of night-time leg cramps
• Reserved for cases when cramps regularly disrupt sleep and when non-pharmacological methods, such as passive stretching exercises, have failed.
• Quinine is a first-line treatment option for Plasmodium falciparum malaria.

Question 2

QUININE: MOA

Answer 2

• Leg cramps are caused by sudden, painful involuntary contraction of skeletal muscle
• Quinine is thought to act by reducing the excitability of the motor end plate in response to acetylcholine stimulation
• This reduces the frequency of muscle contraction
• In malaria, the mechanism of action of quinine is not well understood, but its overall effect leads to rapid killing of P. falciparum parasites in the schizont stage in the blood.

Question 3

QUININE: ADVERSE EFFECTS

Answer 3

• Potentially v toxic and fatal in overdose
• Tinnitus, deafness and blindness (which may be permanent)
• GI upset
• HS Rxns
• Prolongs the QT interval and predispose to arrhythmias
• Hypoglycemia can occur

Question 4

QUININE: WARNINGS

Answer 4

• Hearing or vision loss
• teratogenic and therefore should not be prescribed in the first trimester of pregnancy
• Avoid in people with G6PD deficiency as can precipitate hemolysis

Question 5

QUININE: INTERACTIONS

Answer 5

• Do not prescribe in patient who take drugs that prolong the QT interval (eg. amiodarone, antipsychotics, quinolones, macroclides and SSRIs)

Question 6

QUININE: EXAMPLES

Answer 6

• Quinine Sulfate