Quinine (Dosage)

In this article, we will discuss Quinine (Dosage). So, let’s get started.

Quinine dihydrochloride 20 mg/kg of salt given in a concentration of 1 mg/ml of normal saline or 5% dextrose infused over a period of 4 hours as a loading dose followed by 10 mg/kg 8 hourly as a 4-hour infusion for 7-10 days. Infusion rate should not exceed 5 mg salt/kg/hour. Quinine dihydrochloride 12 mg of salt is equivalent to 10 mg base. Shift to oral therapy as soon as possible. If the patient is critically ill for more than 48 hr or develops acute renal failure and requires continuation of IV quinine, the dose should be reduced by 1/2 to 1/3 to avoid quinine toxicity. Total duration of therapy is 7-10 days. Intramuscular route is as efficacious as IV and can be given in a loading dose of 20 mg/kg (diluted to 60 mg/ml divided and injected into both anterior and lateral aspects of thighs and buttocks) followed by 10 mg/kg q 8 hr. The patient is shifted to oral therapy as soon possible. A single course of primaquine 0.75 mg/kg is given on completion of quinine therapy to eradicate gametocytes and prevent transmisson.

Indication: Severe falciparum malaria.

C/I: Optic neuritis, myasthenia gravis, prolonged QT interval, G-6-PD deficiency, and tinnitus.

Caution: Lethal hypotension, if injected rapidly, cinchonism and hypoglycemia. The loading dose should be avoided, if there is reliable evidence that patient received quinine, halofantrine or metloquine in the past 24 hours.

Adverse effects: Cardiac arrhythmias with long QT syndrome including torsades de pointes, thrombocytopenia due to
hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, leukopenia, disseminated intravascular coagulation, kidney failure, skin rashes like urticaria, angioedema, Stevens-Johnson syndrome and toxic epidermal necrolysis. Cinchonism may occur which is characterized by headache, vasodilation and sweating, nausea, tinnitus, hearing impairment, vertigo, or dizziness, blurred vision and disturbances in color perception.

(Inj qinarsol-300, quininga, rez-Q, quinine dihydrochloride 2 ml ampoule 300 mg per ml).

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