Classification:
Antimalarial Agent
Original Date:
August 2005
Revised Date:
February 2017
Indications:
- 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
Compatibility:
- 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
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
NO |
| IV Intermittent Infusion |
YES - if weight less than or equal to 5 kg - 50 mL minibag - fluid restricted patients or if unable to tolerate large volumes - dilute in 5 mL/kg |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
LOADING DOSE:
- 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
MAINTENANCE DOSE:
- 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
DOSING ADJUSTMENT IN RENAL FAILURE:
- 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
Notes:
- 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