What is this medication?
“ALERT: US Boxed Warning
Nocturnal leg cramps:
Quinine use for the treatment or prevention of nocturnal leg cramps may result in serious and life-threatening hematologic reactions, including thrombocytopenia and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (TTP). Chronic renal impairment associated with the development of TTP has been reported. The risk associated with quinine use in the absence of evidence of its effectiveness in the treatment or prevention of nocturnal leg cramps outweighs any potential benefit.”
How does this medication work?
Quinine, Qualaquin integrates into DNA of parasite, disrupting replication and transcription. It also has cardiovascular effects similar to quinidine and depresses oxygen uptake and carbohydrate metabolism.
How should I take this medication?
Oral: CDC guidelines: 648 mg every 8 hours, in combination with doxycycline, tetracycline, or clindamycin (preferred in pregnancy). Note: Administer quinine for 3 days unless the infection was acquired in Southeast Asia, in which case quinine duration of therapy is 7 days. Duration of concomitant agent is 7 days, regardless of geographic region.
Canadian product: 600 mg every 8 hours for 3 to 7 days. Note: Use in combination with tetracycline, doxycycline, or clindamycin.
Note: Dosage expressed in terms of the salt; 1 capsule Qualaquin = 324 mg of quinine sulfate = 269 mg of base; Canadian products contain 200 mg of quinine sulfate = 167 mg of base or 300 mg of quinine sulfate = 250 mg of base.
How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature. Swallow dose whole to avoid bitter taste. May be administered with food but take with food to decrease incidence of gastric upset.
You Need to Avoid: Avoid use of aluminum- or magnesium-containing antacids because of drug absorption problems.
What should I watch for while using this medication?
Before starting Quinine, Qualaquin make sure your physician is aware of any allergies or medications you currently take, if you have had any previous hypersensitivity reaction associated with quinine use, have altered cardiac conduction, has myasthenia gravis, optic neuritis, hepatic impairment, renal impairment, are pregnant, or breastfeeding. Quinine, Qualaquin use has been associated with rare but serious adverse events such as hemolytic anemia (G6PD deficient patients), hypersensitivity reactions, hypoglycemia, and thrombocytopenia.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Appearance of U waves on ECG, atrial fibrillation, atrioventricular block, bradycardia, cardiac arrhythmia, chest pain, flushing, hypersensitivity angiitis, hypotension, nodal rhythm disorder (nodal escape beats), orthostatic hypotension, palpitations, prolonged QT interval on ECG, syncope, tachycardia, torsades de pointes, unifocal premature ventricular contractions, vasodilation, ventricular fibrillation, ventricular tachycardia, altered mental status, aphasia, ataxia, chills, coma, confusion, disorientation, dizziness, dystonic reaction, headache, restlessness, seizure, vertigo, allergic contact dermatitis, bullous dermatitis, diaphoresis, exfoliative dermatitis, erythema multiforme, pruritus, skin necrosis (acral), skin photosensitivity, skin rash (papular rash, scarlatiniform rash, urticaria), Stevens-Johnson syndrome, toxic epidermal necrolysis, hypoglycemia, a bdominal pain, anorexia, diarrhea, esophagitis, gastric irritation, nausea, vomiting, agranulocytosis, aplastic anemia, blood coagulation disorder, bruise, disseminated intravascular coagulation, hemolysis (blackwater fever), hemolytic anemia, hemolytic-uremic syndrome, hemorrhage, hypoprothrombinemia, immune thrombocytopenia (ITP), leukopenia, neutropenia, pancytopenia, petechia, thrombocytopenia, thrombotic thrombocytopenic purpura, abnormal hepatic function tests, granulomatous hepatitis, hepatitis, jaundice, hypersensitivity reaction, antibody development (lupus anticoagulant syndrome), lupus-like syndrome, myalgia, tremor, weakness, blindness, blurred vision (with or without scotomata), diplopia, mydriasis, nocturnal amblyopia, optic neuritis, photophobia, vision color changes, vision loss (sudden), visual field loss, auditory impairment, deafness, tinnitus, a cute interstitial nephritis, renal failure, renal insufficiency, asthma, dyspnea, pulmonary edema, fever
Note the frequency of side effects has not been determined in clinical trials.
Note- this is not a complete list of side effects, only common ones and are generally dosage dependent. When higher doses are required the physician has weighed the risks and found the benefits to be greater, however regular monitoring (blood sugar, cholesterol, blood pressure, etc.) is important to make sure this does not change.
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