Quinine

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QuotationMarkLeft.png I have made knowne...in these partes, a barke of a tree that infallibly cureth all intermittent feauours. It cometh from Peru, and is the barke of a tree called by the Spaniardes Kinkina QuotationMarkRight.pngSir Kenelm Didby (Letters 1656)

Contents

Introduction

Quinine is a plant alkaloid whose taste is known to most from tonic water and which became known to Western medicine in the 17th century for its actions as an antimalarial. There is reason to believe the Peruvian natives used it for its muscle relaxing properties, which as well as still finding use in treating leg cramps, will prevent violent shivering, which in Peru was sometimes caused by malaria. It is still most economical to extract it from the Cinchona tree's bark.

Clinical Use

Indications

  • Falciparum malaria
  • Nocturnal leg cramps

Administration

Oral

IV

Clinical Issues

TOXICITY

Cinchonism or quinism

Mild

  • Flushing, sweating
  • Tinnitus, vertigo, dizziness, deafness (reversible high-frequency hearing loss)
  • Blurred vision
  • Confusion, malaise, unease(dysphoria)
  • Headache
  • Abdominal cramps, nausea and vomiting, diarrhoea
  • Rashes including lichenoid photosensitivity

Severe

  • Rashes
  • Deafness
  • Somnolence
  • Loss of vision
  • Anaphylactic shock, blackwater fever
  • Cardiotoxicity, arrythmias
  • Death

Contra-indications

  • Haemoglobinuria
  • Myasthenia gravis
  • Optic neuritis

Cautions and Interactions

  • Monitor glucose during iv infusion
  • Pregnancy except in treating malaria
    • Very high doses cause first trimester abortion or birth defects, especially deafness
  • Reduce dose in renal failure

Side effects

  • Hypogylcaemia
  • Hypotension

Special advice

  • In overdose get specialist advice.

Pharmacology

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