Quinine Sulphate (Oral Quinine)

Dose in renal impairment

• No dose adjustment is required for treatment of malaria for oral quinine sulphate.
• Dialysed; give after dialysis.

Use in hepatic impairment

Reduce the dosage in hepatic disease.

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. It should not be withheld from pregnant women with life threatening malaria if other agents are inappropriate.

Breastfeeding

• Discuss with pharmacy.

• Quinine sulphate is only available as a tablet formulation. An injectable formulation of quinine is available as quinine dihydrochloride.
• 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.

1. Summary of Product Characteristics (SPC) for Quinine Sulfate Tablets BP 200mg. Accessed via www.medicines.org.uk 26/03/18. Last updated 01/03/18
2. The Renal Drug Database. Quinine. Accessed via renaldrugdatabase.com 26/03/18. Last updated 23/11/17
3. BNF online accessed via www.medicinescomplete.com 7/1/19; last updated 4/12/17

4. 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