Drug Interaction:
Drug interactions -summary
Quinine sulphate +
Aluminium contng antacids-
delay or decrease absorption of concurrent quinine.
Anticoagulants oral -
quinine depress the hepatic enzyme system that synthesis
Vitamin K dependent clotting factors and enhance the action of
warfarin and other oral anticoagulants
Cimetidine
reduce quinine oral clearance and increase its elimination half-life.
Digoxin
serum concentrations increased by concurrent quinine.
Mefloquine
do not use concurrently with quinine.
if required to be used delay meloquine admin. by at least 12 hours
after last dose of quinine. Risk of convulsions increased by coadmin.
Neuromuscular blocking agents-
blockade of these agents is potentiated by quinine, and result
in respiratory difficulties
Urinary alkalinizers , acetazolamide , Sod bicarb
administered concurrently with quinine increase quinine blood levels.
Drug/Lab Test Interaction: Elevated values for 17 ketogenic steroids may occur with Zimmerman method.
Indication:
LIST OF DRUGS DURING 2006
Sr.No- 100
Name of the Drug- Combipack of 21 tablet of
Quinine sulphate 600mg each &
8 capsule of Doxycycline (as HCL) 100mg each Pharmacological Classification- For P.Falciparam malaria
Date of Approval- 10-08-2006
Approved by U.S.FDA on 30-12-2006 (Ref- FDA approved List)
Malaria
New drugs approved For Marketing by Drug Controller General of India(DCGI )
during the period January 1988 to November 2014
(Ref- IDMA Annual Publication 2015)
Name of Drug Indication Date of Approval
Combipack of 21 Tablet of Quinine 10-08-2006
sulphate 600mg each & 8 Capsule of
Doxycycline as Hcl 100mg each
For P.Falciparam malaria
FIXED DOSE COMBINATIONS APPROVED BY DCG(I)
FROM JANUARY 1961 TILL NOVEMBER 2014
Name of Drug Indication Date of Approval
Combipack of 21 tablet of Quinine sulphate 600mg each & 08-10-2006
8 capsule of Doxycycline hcl 100mg each
For P.Falciparum malaria
Adverse Reaction:
Cichonism may occur in therapeutic doses. Acute hemolysis, hemolytic anemia,
Thrombocytopenic purpura Agranulocytosis, hyperprothrombinemia.
Visual disturbances, including disturbed colour vision and perception,
Photophobia,blurred vision with scotomata Night blindness, amyblyopia,
Diplopia,diminished visual fields. Tinnitus, deafness, Vertigo, headache, fever,
Apprehension, reslessness, Confusion, syncope.
Cutaneous rashes, flushing, Sweating, facial oedema.
Contra-Indications:
Hypersensitivity to quinine,glucose -6-phosphate dehydrogenase(G6PD) deficiency, optic neuritis, history of back water fever and thrombocytopenic purpura (associated with previous quinine ingestion), pregnancy.
Special precautions:
Discontinue quinine if there is any evidence of hypersensitivity. Continuous flushing, pruritus, skin rashes, fever, gastric distress, dyspnea, ringing in the ears and visual impairment may occur, particularly only with small doses of quinine.
Extreme flushing of the skin followed by intense,generalised pruritus is most common.
Pregnancy- Quinine has an oxytocic action that appears to occur only with doses that are higher than those recommended It also crosses the placenta. Congenital malformation have occured primarily in large doses (upto 30g) for attempted abortion.
Lactation- Quinine is excreted in breast milk in small amounts. Although no adverse efects have been reported in the nursing infant, rule out patients at risk for G6PD deficiency before breast feeding.
Dosages/ Overdosage Etc:
For P.Falciparam malaria
Indication
Malaria
Dosage:
Adults- 650mg every 8 hours for 5 to 7 days
Children- 25mg/kg/day in divided doses every 8 hours for 5 to 7 days..
Other Information:
For Availability/supplies
Contact -
1.Indian Drug Manufacturers Association (IDMA)
Phone- 022- 24944624/ 24974308
Fax- 022- 24950723
Email- idma@vsnl.com
Website: www.idma-assn.org
2.Bulk Drug Manufacturers Association (India)(BDMA)
Phone - 040-23703910/ 23706718
Fax- 040-23704804
Email- info@bdmai.org
Website: www.info@bdmai.org
Vestibular Disorders
Drugs causing adverse reactions ( 388 )
1. Aminoglycosides
2. Quinine
3. Mustine
Patient Information:
1.To be taken with meals or after meals.
2. May cause diarrhea, nausea, stomach cramps, or pain and vomiting, ringing of ear. Notify physician
3. Stop the drug if there is an indication of allergy, viz flushing, itching, rash.
. AVOID CONCURRENT USE WITH ERYTHROMYCIN
4. Allergies- tell your doctor if you have ever had any unusual or allergic reaction
to quinidine or quinine. Also tell your doctor if you are allergic to any other
substances, such as foods, presevatives or dyes.
5.Pregnancy - studies on effects of pregnancy have not been done in either humans
or animals. However, a closely related medicine has been shown to shown
to cause birth defects of the nervous system. Quinine may also cause
contractions of the uterus.
6.Breast feeding- quinidine passes into the breast milk. However it has not been
reported cause problems in nursing babies
7. Children - no specific information available comparing use of this medicine in
children with use in other age groups.
8. Elderly- not expected to cause different side effects or problems in older
people than in younger adults.
9. Other medicines -
Anticoagulants - risk of bleeding may be increased
Other heart medicine - effects on the heart may be increased
Pimozide - risk of heart rhythm problems may be increased
Urinary alklalinisers - effects may be increased because levels of quinidine
in body may be increased
10. Other medical problems -
Tell your doctor if you have any other medical problems especially -
Asthma - possible allergic reaction
Blood disease
Infection
Kidney disease or
Liver disease - efects may be increased because of slower removal of
quinidine from the body.
Myasthenia gravis - muscle weakness may be increased
Overactive thyroid
Psoriasis
11. Missed dose -
If you miss a dose of this medicine, take it as soon as possible. however,
if it is almost time for the next dose, skip the missed dose. Do not double doses.
12. Storage -
Keep out of reach of children. Store away from heat or direct sunlight. Do not store
the capsule in bathroom, near the kitchen sink, or in other damp places.
13. Outdated medicines -
Do not keep outdated medicine or medicine no longer needed. Be sure that any
discarded medicine is out of reach of children.
Pharmacology/ Pharmacokinetics:
Ref- Drug Facts And comparisons (2010)
Pharmacology-
Quinine inhibits necleic acid synthesis, protein synthesis and glycolysis in P.falciparum
and can bind with hemazoin in parasite erythrocytes. However, the precise mechansim
of the animalarial activity of quinine is not completely understood.
Phamacokinetics-
Absorption- The oral bioavailability of quiinine is 76% to 88% in healthy adults. After a
single oral dose of quiuinine the mean time to reach maximum concentration Tmax was
longer and mean AUC area under curve were higher in subjects with uncomplicated
P.falcipatium malaria than in healthy adults.
Qunine Pharmacokinetic Parameters after a single dose of
Quinine capsules
Parameter Healthy subjects Uncomplicated P.falciparum
(n=23) malaria patients
mean +/- SD (n=15)
mean +/-SD
Dose mg/kg 8.7 10
Tmax (h) 2.8+/-0.8 5.9+/-4.7
Cmax( mcg/mL ) 3.2+/-0.7 8.4
AUC 0-12 (mcg/mL ) 28 73
Interaction with Food:
Not significant
Pregnancy and lactation:
Pregnancy-
Quinine has an oxytocic action that appears to occur only with doses that are higher than those recommended It also crosses the placenta. Congenital malformation have occured primarily in large doses (upto 30g) for attempted abortion.
Lactation
Quinine is excreted in breast milk in small amounts. Although no adverse efects have been reported in the nursing infant, rule out patients at risk for G6PD deficiency before breast feeding.
Manufacturer Details