Quinine 💊

💊 Quinine remains a key treatment for falciparum malaria. ⚠️ Never give by rapid IV injection - can cause lethal hypotension. Treatment is usually followed by a partner drug such as doxycycline, clindamycin, or Fansidar.

📖 About

• Alkaloid extracted from the bark of the Cinchona tree (South America).
• One of the oldest and still effective drugs for falciparum malaria.
• Check the BNF here for up-to-date prescribing.

⚙️ Mechanism of Action

• Active against asexual blood stages of Plasmodium.
• Inactive against exoerythrocytic stages (e.g. P. vivax, P. ovale liver hypnozoites).
• Resistance is reported but still widely useful.

🎯 Indications

• Treatment of falciparum malaria (oral or IV).
• Nocturnal leg cramps (rarely used now due to side-effect risk).
• ❌ Not indicated for malaria prophylaxis.

💊 Dosing – Quinine (check BNF/local policy)

⛔ Contraindications

• Optic neuritis.
• Caution in patients with G6PD deficiency (risk of haemolysis).

⚠️ Cautions

• Hypoglycaemia - especially with IV use in falciparum malaria (due to quinine-induced insulin release).
• Arrhythmias - ECG monitoring essential with IV therapy.

❌ Side Effects (Cinchonism)

• 🎧 Tinnitus and impaired hearing.
• 🤢 Nausea and vomiting.
• 👀 Visual disturbances.
• 🩸 Hypoglycaemia (esp. with IV treatment).
• 💓 Cardiac arrhythmias - requires ECG monitoring.

💡 Clinical Pearls

• Always combine quinine with another agent (doxycycline, clindamycin, or Fansidar) to prevent recrudescence.
• In severe falciparum malaria: careful fluid balance and hypoglycaemia monitoring are as critical as the drug itself.
• Artemisinin-based combination therapy (ACT) is now preferred first-line in many regions, but quinine remains vital where ACT is unavailable or contraindicated.