Quinine Dihydrochloride (Intravenous Quinine)

Dose in renal impairment

eGFR (mL/min/1.73m²)	IV dose
20-50	5-7mg/kg every 8 hours
10-20	5-7 mg/kg every 8-12 hours
less than 10	5-7mg/kg OD
HD/HDF/High Flux/PD	Dose as in eGFR less than 10ml/min/1.73m². Dialysed; give after dialysis

Use in hepatic impairment

Use with caution in patients with severe hepatic impairment.

Pregnancy

High doses of quinine can be teratogenic in the first trimester. Quinine should not be used during pregnancy unless the benefits outweigh the risks.
For treatment of falciparum malaria: Pregnancy in a patient with malaria is not generally regarded as a contraindication to the use of quinine and it should not be withheld from pregnant women with life threatening malaria if other agents are inappropriate.

Breastfeeding

Discuss with pharmacy.

Quinine dihydrochloride is the injectable formulation of quinine. It is available by special-order only. Please contact a pharmacist for further information.
During therapy monitor ECG for cardiotoxicity, FBC for thrombocytopenia and blood glucose for hypoglycaemia. See product literature for further monitoring advice.

Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions (November 2017)

Link here

Be aware of dose-dependent effects on the QT interval and use caution if prescribing quinine in patients:

with conditions that predispose to QT prolongation such as pre-existing cardiac disease or electrolyte disturbance
taking other medicines that could prolong the QT interval
with atrioventricular block

Monitor patients closely if administration of quinine with phenobarbital or carbamazepine is necessary; serum levels of these anticonvulsant medicines could become raised and cause anticonvulsant toxicity.

See summary of product characteristics for drug interactions and potential adverse effects.

Summary of Product Characteristics (SPC) for Quinine Dihydrochloride 6% Sterile Concentrate 600mg in 10ml. Accessed via www.medicines.org.uk 26/03/18. Last updated 06/08/15
The Renal Drug Database. Quinine. Accessed via renaldrugdatabase.com 26/03/18. Last updated 23/11/17
BNF online accessed via www.medicinescomplete.com 7/1/19; last updated 4/12/17
MHRA. Drug Safety update (November 2017) Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions. Accessed at https://www.gov.uk/drug-safety-update/quinine-reminder-of-dose-dependent-qt-prolonging-effects-updated-medicine-interactions

General Information

Renal and hepatic impairment

Pregnancy and breastfeeding

Additional information

MHRA drug safety update

References

Editorial Information