QUININE injectable

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 -