Quinine injectable

Therapeutic action

Antimalarial.

Indications

Alternative to injectable artesunate, when it is not available, in the treatment of severe malaria.

Forms and strengths, route of administration

600 mg of quinine dihydrochloride in 2 ml ampoule (300 mg/ml), to be diluted in 5% glucose, for slow infusion.

The dosage is expressed in terms of salt.

Dosage

Child and adult:

• Loading dose: 20 mg/kg administered over 4 hours, then keep the vein open with an infusion of 5% glucose over 4 hours.
• Maintenance dose: 8 hours after the start of the loading dose, 10 mg/kg every 8 hours, alternating quinine over 4 hours and 5% glucose over 4 hours.
• For adults, administer each dose of quinine in 250 ml.
• For children under 20 kg, administer each dose of quinine in a volume of 10 ml/kg.
• Do not administer a loading dose to patients who have received oral quinine or mefloquine within the previous 24 hours: start with maintenance dose.

Duration

• Treat parenterally for at least 24 hours, then, if the patient can tolerate the oral route, change to a complete 3-day course of an artemisinin-based combination or, if not available, oral quinine to complete 7 days of quinine treatment.
• If not, continue parenteral treatment until the patient can change to oral route, without exceeding 7 days of parenteral treatment.

Contra-indications, adverse effects, precautions

• May cause hypoglycaemia, auditory and visual disturbances, cardiac disorders especially in the event of overdose, hypersensitivity reactions, and cardiac depression if injected undiluted by IV route.
• In patients with acute renal failure, reduce the dose by one-third if the parenteral treatment lasts more than 48 hours.
• Monitor blood glucose.
• Do not administer simultaneously with mefloquine. Administer mefloquine 12 hours after the last dose of quinine.
• Pregnancy: no contra-indication. The risk of quinine-related hypoglycaemia is very high in pregnant women.
• Breast-feeding: no contra-indication.