Quinine is believed to interfere with protein metabolism and inhibits nucleic acid synthesis in malarial parasites. Quinine is a highly active blood schizonticide and suppresses the asexual cycle of development of malaria parasites in the erythrocytes. It is effective both as a suppressive drug and in the over clinical attack of malaria.

Quinine Sulfate is indicated in-

• Uncomplicated, severe and complicated falciparum malaria
• Falciparum malaria resistant to other drugs
• Prevention of nocturnal muscle cramps
• Alleviation of muscle cramps in Thomsen's disease.

Adult:

• Oral: 600 mg (of quinine salt) every 8 hours for 7 days.
• Parenteral: lf the patient is seriously ill quinine should be given by intravenous infusion. The adult dosage regimen for quinine by infusion is loading dose of 20 mg/kg (up to maximum 1.4 g) of quinine salt infused over 4 hours then after 8-12 hours maintenance dose of 10 mg/kg (up to maximum 700 mg) of quinine salt infused over 4 hours every 8-12 hours (until patient can swallow tablets to complete the 7 days course).

Children:

• Oral: Quinine is well tolerated by children. The dosage regimen for quinine by mouth for children is 10 mg/kg (of quinine salt) every 8 hours for 7 days.
• Parenteral: The dosage regimen for quinine by intravenous infusion for children is calculated on a mg/kg basis as for adult.

Pregnancy: The adult treatment doses of oral and intravenous quinine given above (including the loading dose) can safely be given to pregnant women.

Hypersensitivity reaction, optic neuritis, in case of black water fever etc.

Cinchonism which includes tinnitus, headache, nausea and visual disturbances. Hematological disorders and skin reaction may occur.

Severe heart disease, myasthenia gravis, diabetes mellitus, IV injection should be given slowly. Use of Mefloquine with Quinine sulphate may increase the chance of side effects.

Pregnancy & Lactation

In pregnancy, the quinine is not necessarily contraindicated. It is considered to be safe when used in therapeutic dosage in pregnancy. It is excreted in breast milk in insignificant amount which does not discard the use in lactation.