Quinine (Patient information)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Contents

* 1 What is Qualaquin (quinine)?
* 2 What is the most important information I should know about Qualaquin (quinine)?
* 3 What should I discuss with my healthcare provider before taking Qualaquin (quinine)?
* 4 How should I take Qualaquin (quinine)?
* 5 What happens if I miss a dose?
* 6 What happens if I overdose?
* 7 What should I avoid while taking Qualaquin (quinine)?
* 8 Qualaquin (quinine) side effects
* 9 What other drugs will affect Qualaquin (quinine)?
* 10 Where can I get more information?
* 11 What does my medication look like?

## What is Qualaquin (quinine)?

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The U.S. Food and Drug Administration has banned the sale of all non-approved brands of quinine because of the risk of serious side effects or death. As of December 2006, Qualaquin is the only brand of quinine that is approved by the FDA.

Quinine is used to treat malaria, a disease caused by parasites. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Quinine may also be used for purposes other than those listed in this medication guide.

## What is the most important information I should know about Qualaquin (quinine)?

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The U.S. Food and Drug Administration has banned the sale of all non-approved brands of quinine because of the risk of serious side effects or death. As of December 2006, Qualaquin is the only brand of quinine that is approved by the FDA.

Quinine can cause serious or life-threatening side effects, and is approved for use only in treating malaria. Some people have used quinine to treat leg cramps, but this is not an FDA-approved use. Do not use quinine to treat any medical condition if your doctor did not prescribe quinine for that condition. Do not purchase quinine on the Internet or from vendors outside of the United States. Using this medication improperly or without the advice of a doctor can result in serious side effects or death.

Do not use this medication if you have ever had an allergic reaction to quinine or similar medicines such as mefloquine (Lariam) or quinidine (Cardioquin, Quinidex, Quinaglute).

You should not take quinine if you have a history of "Long QT syndrome", or if you have glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, myasthenia gravis, or optic neuritis (inflammation of the nerves in your eyes). Call your doctor at once if you have a weak pulse, if you faint or collapse, if you have fever, confusion, pale or yellowed skin, dark colored urine, hearing or vision loss, purple spots under your skin, a blistering or peeling skin rash, or if you urinate less than usual or not at all.

No medication is 100% effective in treating malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

## What should I discuss with my healthcare provider before taking Qualaquin (quinine)?

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Quinine can cause serious or life-threatening side effects, and is approved for use only in treating malaria. Some people have used quinine to treat leg cramps, but this is not an FDA-approved use. Quinine will not treat severe forms of malaria, and it should not be taken to prevent malaria. Quinine also should not be taken to treat or prevent night-time leg cramps. Do not use this medication if you have ever had an allergic reaction to quinine or similar medicines such as mefloquine (Lariam) or quinidine (Cardioquin, Quinidex, Quinaglute), or if you have:

* a history of "Long QT syndrome";
* glucose-6-phosphate dehydrogenase (G-6-PD) deficiency;
* myasthenia gravis; or
* optic neuritis (inflammation of the optic nerve).

Before taking quinine, tell your doctor if you are allergic to any drugs, or if you have:

* heart disease or a heart rhythm disorder;
* low potassium levels in your blood (hypokalemia); or
* kidney or liver disease.

If you have any of these conditions, you may not be able to use quinine, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. Quinine may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Hypoglycemia (low blood sugar) may be more likely to occur in pregnant women who are taking quinine. Signs of low blood sugar include hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, and fast heartbeat. Talk to your doctor about your specific risk for low blood sugar if you take quinine while you are pregnant. Quinine may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to a child younger than 16 years old.

## How should I take Qualaquin (quinine)?

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Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take quinine with food to lessen stomach upset.

Call your doctor if your malaria symptoms do not improve after 2 days of taking quinine, or if your symptoms return after you have finished the medication.

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before your condition is completely treated. If you stop using the medication early for any reason, talk to your doctor about other forms of malaria prevention.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using quinine. You may need to stop using the medicine for a short time.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using quinine.

No medication is 100% effective in treating malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

Store quinine at room temperature away from moisture and heat.

## What happens if I miss a dose?

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Take the missed dose as soon as you remember. If you are more than 4 hours late for your dose, skip it and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

## What happens if I overdose?

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Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a quinine overdose may include headache, confusion, dizziness, ringing in your ears, vision or hearing loss, severe nausea or vomiting, sweating, uneven heart rate, feeling light-headed, and fainting or collapse.

## What should I avoid while taking Qualaquin (quinine)?

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Do not use quinine to treat any medical condition if your doctor did not prescribe quinine for that condition. Do not purchase quinine on the Internet or from vendors outside of the United States. Using this medication improperly or without the advice of a doctor can result in serious side effects or death. Quinine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using antacids without your doctor's advice. Use only the specific type of antacid your doctor recommends. Antacids contain different medicines and some types can make it harder for your body to absorb quinine.

## Qualaquin (quinine) side effects

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Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using quinine and call your doctor at once if you have any of these serious side effects:

* uneven heart rhythm;
* weak pulse, fainting or collapse;
* fever, confusion, weakness;
* pale or yellowed skin, dark colored urine;
* unusual muscle weakness;
* purple spots under the skin, urinating less than usual or not at all;
* severe blistering, peeling, and red skin rash with a sore throat, fever, and headache;
* severe nausea, vomiting, stomach pain, diarrhea; or
* problems with hearing or vision.

Continue taking quinine and talk with your doctor if you have any of these less serious side effects:

* hunger, headache, confusion, irritability, sweating;
* drowsiness, weakness, dizziness, tremors; or
* warmth, redness, or tingly feeling under the skin.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

## What other drugs will affect Qualaquin (quinine)?

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Before taking quinine, tell your doctor if you are using any of the following drugs:

* arsenic trioxide (Trisenox);
* astemizole (Hismanal);
* cisapride (Propulsid);
* cimetidine (Tagamet);
* dextromethorphan (cough medicine);
* digoxin (digitalis, Lanoxin);
* droperidol (Inapsine);
* metoprolol (Toprol);
* paroxetine (Paxil);
* rifampin (Rifadin, Rimactane, Rifater);
* a blood thinner such as warfarin (Coumadin);
* aminophylline (Truphylline), or theophylline (Elixophyllin, Respbid, Theobid, Theo-Dur, Uniphyl);
* antibiotics such as clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S.), pentamidine (NebuPent, Pentam), sparfloxacin (Zagam), tetracycline (Brodspec, Tetracap), or troleandomycin (Tao);
* heart rhythm medicine such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), ibutilide (Corvert), disopyramide (Norpace), procainamide (Procan, Pronestyl), quinidine (Cardioquin, Quinaglute), or sotalol (Betapace);
* medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril);
* narcotic medication such as levomethadyl (Orlaam) or methadone (Dolophine, Methadose);
* seizure medication such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Luminal, Solfoton), or phenytoin (Dilantin); or
* other anti-malarial drugs such as chloroquine (Arelan), halofantrine (Halfan), or mefloquine (Mariam).

If you are using any of these drugs, you may not be able to use quinine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect quinine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

## Where can I get more information?

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* Your pharmacist has information about quinine written for health professionals that you may read.

## What does my medication look like?

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Quinine is available with a prescription under the brand name Qualaquin. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

* Qualaquin 324 mg--clear capsule

* Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
* Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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