Parenteral Manual


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Antimalarial Agent
Original Date: 
August 2005
Revised Date: 
February 2017
  • Treatment of severe Plasmodium falciparum infection or unable to tolerate oral medications

*See  "Pediatric Management Guidelines for Malaria Treatment "  on CHEOnet

Reconstitution and Stability: 
  • Available as 300 mg/mL injection
  • Protect from light
  • Must be diluted just prior to use
  • Stable for 24 hours at room temperature in D5W, 0.9% NaCl, and D5W-NS
  • Solutions Compatible: D5W, 0.9% NaCl, D5W-NS    ** D5W-NS is preferred as quinine dihydrochloride and malaria can cause hypoglycemia
  • Do not mix with other medications; run in dedicated line

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct


IV Intermittent Infusion

Usual dilution: in D5W/0.9% NaCl

- if weight less than or equal to 5 kg - 50 mL minibag
              greater than 5 kg to 10 kg - 100 mL minibag
            greater than 10 kg to 25 kg - 250 mL minibag
                         greater than 25 kg - 500 mL minibag

 - fluid restricted patients or if unable to tolerate large volumes - dilute in 5 mL/kg
Infusion time: over 4 hours

IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • quiNINE dihydrochloride [salt] 20 mg/kg by IV infusion over 4 hours
  • Maximum: 600 mg quiNINE dihydrochloride 
  • Omit loading dose if patient received quiNINE, quiniDINE, or mefloquine in previous 24 hours                     


  • quiNINE dihydrochloride  [salt] 10 mg/kg IV Q8H over 4 hours
  • Maximum: 600 mg quiNINE dihydrochloride 
  • Start 8 hours after loading dose
  • If IV therapy is required for greater than 48 hours, reduce maintenance dose by 1/3 to avoid accumulation
  • A minimum of 24 hours of parenteral therapy (3 maintenance doses) should be administered before switching to oral therapy



  • Decrease maintenance interval to Q 12 hours
Potential hazards of parenteral administration: 
  • Cinchonism: tinnitus, nausea, headache, blurred vision
  • Hypoglycemia
  • Occasional cardiac conduction disturbances
  • Hypersensitivity, hemolysis (rare)
  • Hepatotoxicity, skin rash
  • Restlessness, confusion, vertigo, apprehension
  • Monitor CBC, liver function tests, blood glucose
  • To be prescribed in combination with IV clindamycin
  • Switch to oral quinine as soon as possible
  • 300 mg quiNINE dihydrochloride = 245 mg quiNINE base
  • Contraindicated in G6PD deficiency
  • Use with caution in patients with myasthenia gravis, impaired liver function
  • Quinine can increase plasma concentrations of digoxin and oral anticoagulants
  • Amiodarone, verapamil and cimetidine increase serum quinine concentrations
  • Barbiturates, phenytoin and rifampin decrease serum quinine concentrations

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