QUININE injectable

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    Prescription under medical supervision

     

    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.
      NEVER ADMINISTER BY IV INJECTION.

    Dosage

    The dosage is expressed in terms of salt:

     

    • 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 (alternate 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, 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 (reagent strip test).
    • Do not administer simultaneously with mefloquine (risk of seizures, cardiac toxicity). 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

    Remarks

    • 10 mg quinine dihydrochloride = 8 mg quinine base.
    • Administration by IM deep injection (into the anterior thigh only) is possible when infusion cannot be performed (e.g. before transferring a patient). However this may cause numerous complications. Doses are the same as for the IV route. Quinine should be diluted (1/2 or 1/5). For the loading dose, administer half the dose into each thigh.

    Storage

     
    – Below 25 °C