quinine bisulfate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
quinine bisulfate: clinical details
Prescribing considerations
- For nocturnal cramps, reserve use for painful or frequent episodes that regularly disrupt sleep after treatable causes and non-pharmacological measures have been addressed.
- Confirm the quinine salt explicitly because bisulfate and sulfate products are not directly interchangeable.
- Review previous reactions to quinine, including reactions after tonic water, and assess cardiac, renal, hepatic and G6PD-related risks.
Contraindications and cautions
- Hypersensitivity to quinine or an excipient
- Optic neuritis
- Tinnitus
- Myasthenia gravis
- Haemoglobinuria
Monitoring
- Monitor early for cinchonism, hypersensitivity, unexplained bruising or bleeding and clinical benefit.
- Reassess ongoing benefit when prescribed for nocturnal cramps.
- Remain alert to QT prolongation, hypoglycaemia, haemolysis, renal impairment and interacting medicines.
Clinical pharmacology
Quinine is a rapidly acting blood schizonticide and CYP3A4 substrate. Its precise antiparasitic mechanism is uncertain. It also blocks sodium channels, affects the skeletal-muscle motor end plate and has antiarrhythmic and proarrhythmic properties.
Formulation and product differences
- The selected product is a white, biconvex film-coated quinine bisulfate tablet.
- It contains lactose and is essentially sodium-free.
- The quinine salt must be specified because different salts contain different amounts of quinine base.
quinine bisulfate preparations and strengths
Tablet
Route: Oral
Strengths: 300 mg
quinine bisulfate interactions
Quinine has clinically important cardiac, bleeding and other interactions. Check all prescribed, over-the-counter and complementary products before use.
Medicines that prolong the QT interval
Combining them with quinine can increase the risk of dangerous ventricular arrhythmias; examples include amiodarone, moxifloxacin and some antipsychotics.
Digoxin and other cardiac glycosides
Quinine can increase blood concentrations and toxicity risk.
Warfarin and other anticoagulants
Quinine may strengthen anticoagulant effects and increase bleeding risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.