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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Chininum Sulphuricum
Generic Name
Chininum Sulphuricum
Active Ingredient
QuinineCategory
Inactivated Poliovirus Vaccine [EPC]
Salt Form
Sulfate
Variants
10
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 200 [hp_C]/1 | PELLET | ORAL | 37662-0254 |
| 30 [hp_C]/1 | PELLET | ORAL | 37662-0252 |
| 500 [hp_C]/1 | PELLET | ORAL | 37662-0255 |
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Chininum Sulphuricum, you must consult a qualified healthcare professional.
| 10 [hp_M]/1 | PELLET | ORAL | 37662-0257 |
| 1 [hp_Q]/1 | PELLET | ORAL | 37662-0258 |
| 6 [hp_C]/1 | PELLET | ORAL | 37662-0250 |
| 12 [hp_C]/1 | PELLET | ORAL | 37662-0251 |
| 100 [hp_C]/1 | PELLET | ORAL | 37662-0253 |
| 1 [hp_M]/1 | PELLET | ORAL | 37662-0256 |
| 6 [hp_C]/6[hp_C] | PELLET | ORAL | 66096-817 |
Detailed information about Chininum Sulphuricum
Quinine is an alkaloid antimalarial agent derived from cinchona bark, primarily used for the treatment of uncomplicated malaria caused by Plasmodium falciparum. It is known for its narrow therapeutic index and significant potential for systemic toxicity.
For the treatment of uncomplicated Plasmodium falciparum malaria in adults, the standard dosage is typically 648 mg (two 324 mg capsules) taken every 8 hours. This treatment course usually lasts for 3 to 7 days, depending on the geographic region of the infection and the degree of parasite resistance.
In many clinical protocols, Quinine is not used alone. Your healthcare provider will likely prescribe a second medication to be taken alongside or immediately following the Quinine course. Common companion drugs include:
Quinine dosage for children is strictly calculated based on body weight. The typical pediatric dose is 10 mg/kg (of quinine sulfate) every 8 hours for 3 to 7 days.
Because Quinine capsules (324 mg) are not easily divided, treating small children requires extreme caution. Healthcare providers may need to use alternative formulations or specialized compounding to ensure accurate dosing. Pediatric patients must be monitored closely for signs of toxicity, as they may be more susceptible to the drug's effects on blood sugar and heart rhythm.
In patients with significant kidney disease or renal failure, the clearance of Quinine is reduced. For those with a creatinine clearance (CrCl) below 30 mL/min, the dosing interval is often extended. A common adjustment is to administer the standard dose every 12 hours instead of every 8 hours after an initial loading dose. In patients undergoing hemodialysis, Quinine is not significantly removed, so no additional doses are required after a dialysis session.
Since Quinine is primarily metabolized by the liver, patients with mild to moderate hepatic impairment (Child-Pugh Class A or B) should be monitored closely for signs of toxicity. In cases of severe hepatic impairment (Child-Pugh Class C), Quinine should be used with extreme caution, and dosage reductions are typically necessary as the drug can accumulate to dangerous levels.
Clinical studies have not identified specific differences in response between elderly and younger patients. However, because older adults are more likely to have decreased renal or hepatic function and may be taking other medications that interact with Quinine, healthcare providers usually start at the lower end of the dosing range and monitor cardiovascular health closely.
To ensure the best results and minimize side effects, follow these guidelines:
If you miss a dose, take it as soon as you remember. However, if it is within 4 hours of your next scheduled dose, skip the missed dose and return to your regular schedule. Do not double the dose to catch up, as this significantly increases the risk of toxicity (cinchonism).
Quinine overdose is a medical emergency. Symptoms of overdose may include severe ringing in the ears (tinnitus), blindness, deafness, confusion, seizures, and life-threatening heart rhythm disturbances. If an overdose is suspected, contact emergency services or a poison control center immediately. Treatment usually involves supportive care, as there is no specific antidote for Quinine toxicity.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop the medication without medical guidance, as malaria can quickly become life-threatening if not treated completely.
The most characteristic side effect profile of Quinine is a cluster of symptoms known as Cinchonism. Almost every patient taking therapeutic doses of Quinine will experience some degree of these symptoms:
Quinine is a potent medication with a narrow therapeutic index. Patients must be aware that while it is effective against malaria, it carries risks of systemic toxicity. It should never be shared with others or used for any condition other than the one for which it was specifically prescribed. Patients with a history of heart rhythm problems, kidney disease, or certain genetic enzyme deficiencies must disclose these to their doctor before starting therapy.
Full FDA Text Summary: Quinine Sulfate use for the treatment or prevention of nocturnal leg cramps is strictly prohibited. Clinical data has demonstrated that Quinine can cause serious and life-threatening hematologic (blood) reactions, including immune-mediated thrombocytopenia (critically low platelets). These reactions can occur at any time during treatment, even after a single dose, and may lead to permanent organ damage or death. The FDA has determined that the risks of Quinine for leg cramps are not justified by its efficacy for that condition.
Certain medications should never be used with Quinine due to the risk of fatal interactions:
Quinine must NEVER be used in patients with the following conditions:
Quinine is classified as FDA Pregnancy Category C. In the context of malaria, the infection itself poses a significant risk of maternal death, miscarriage, and stillbirth. Therefore, the World Health Organization (WHO) and the CDC often recommend Quinine (usually in combination with clindamycin) as a first-line treatment for malaria in the first trimester of pregnancy when other options are limited. However, Quinine is known to cross the placenta and has been associated with congenital malformations (such as deafness) when used in very high doses. The most significant risk in pregnant women is severe hypoglycemia, as pregnancy and Quinine both stimulate insulin production. Frequent blood glucose monitoring is mandatory for pregnant patients receiving Quinine.
Quinine is excreted into breast milk in small amounts. While the levels are generally considered too low to be harmful to a healthy infant, there is a theoretical risk for infants with G6PD deficiency, who could develop hemolytic anemia through the milk. Breastfeeding mothers should consult their healthcare provider; in many cases, the benefits of treating the mother's malaria outweigh the risks to the infant, but the baby should be monitored for jaundice or dark urine.
Quinine acts as a blood schizonticide, meaning it targets the asexual reproductive stage of the malaria parasite within human erythrocytes (red blood cells). Its primary molecular mechanism involves the inhibition of heme polymerase. As the parasite digests host hemoglobin, it releases toxic heme. Quinine enters the parasite's acidic food vacuole via an 'acid trap' mechanism, where it becomes protonated and trapped. Once inside, it binds to ferriprotoporphyrin IX (heme), preventing its detoxification into hemozoin crystals. The resulting free heme-quinine complex is highly toxic, causing membrane lysis and enzymatic inhibition within the parasite.
Quinine has a rapid onset of action against blood-stage parasites, typically leading to a reduction in fever within 24–48 hours and clearance of parasites from the blood within 72–96 hours. It also possesses mild analgesic and antipyretic (fever-reducing) properties. A notable pharmacodynamic effect is its 'quinidine-like' action on the heart, where it acts as a Class IA antiarrhythmic by blocking sodium channels and prolonging the action potential duration.
Common questions about Chininum Sulphuricum
Quinine is primarily used for the treatment of uncomplicated malaria caused by the parasite Plasmodium falciparum, especially in areas where the parasite has developed resistance to other drugs like chloroquine. It works by killing the parasites while they are inside the red blood cells by interfering with their ability to detoxify waste products from hemoglobin digestion. It is not used to prevent malaria, only to treat an active infection. Additionally, the FDA has strictly prohibited its use for treating leg cramps due to the risk of severe and potentially fatal blood disorders. Always consult a healthcare provider for a proper diagnosis of malaria before starting this medication.
The most common side effects of Quinine are collectively known as 'cinchonism,' which occurs in almost everyone taking a full therapeutic dose. Symptoms of cinchonism include ringing in the ears (tinnitus), headache, nausea, slight blurring of vision, and dizziness. These effects are usually temporary and go away once the treatment is finished. However, if these symptoms become severe or if you experience hearing loss, you should contact your doctor immediately. Some people may also experience stomach pain or flushing of the skin. Taking the medication with food can often help reduce the severity of the nausea.
It is strongly recommended that you avoid alcohol while taking Quinine. Alcohol can worsen the common side effects of the drug, such as dizziness, confusion, and stomach upset. More importantly, both alcohol and Quinine can affect your blood sugar levels, increasing the risk of developing dangerously low blood sugar (hypoglycemia). Alcohol can also put additional strain on your liver, which is responsible for processing the Quinine. To ensure the medication works effectively and safely, it is best to abstain from alcohol until you have completed your full course of treatment.
Quinine is used during pregnancy only when the benefits of treating a life-threatening malaria infection outweigh the potential risks to the fetus. It is often considered a first-line treatment for malaria in the first trimester when other options are not available, but it must be used under strict medical supervision. One of the biggest risks for pregnant women taking Quinine is severe hypoglycemia, which can be dangerous for both the mother and the baby. There have also been rare reports of birth defects, such as deafness, when very high doses were used. If you are pregnant or planning to become pregnant, your doctor will carefully monitor your health and blood sugar levels during treatment.
Quinine begins working against the malaria parasites shortly after the first dose is absorbed into the bloodstream. Most patients will see a reduction in fever and an improvement in symptoms within 24 to 48 hours of starting treatment. However, it takes several days for the medication to completely clear the parasites from your blood. Even if you feel significantly better within a day or two, it is vital to finish the entire 3- to 7-day course as prescribed. Stopping the medication early can lead to the infection returning and may contribute to the development of drug-resistant malaria.
You should not stop taking Quinine suddenly unless you are experiencing a severe allergic reaction or a dangerous side effect, and even then, you should contact your doctor immediately. If you stop taking the medication before the full course is finished, the malaria parasites may not be completely eliminated from your body. This can cause the infection to come back, often more severely than before. Completing the full course of treatment is the only way to ensure the malaria is cured. If you are bothered by side effects like ringing in the ears, talk to your doctor about ways to manage them rather than stopping the drug.
If you miss a dose of Quinine, take it as soon as you remember. However, if it is almost time for your next scheduled dose (specifically within 4 hours), skip the missed dose and continue with your regular schedule. Do not take two doses at once to make up for a missed one, as this can lead to toxic levels of the drug in your body and increase the risk of serious heart or ear problems. Consistency is key to treating malaria effectively, so try to use a timer or pill box to help you remember your doses every 8 hours.
Weight gain is not a known or typical side effect of Quinine. Because Quinine is usually taken for a very short period (3 to 7 days) to treat an acute malaria infection, it does not have the long-term metabolic effects associated with drugs that cause weight gain. In fact, many patients with malaria experience a loss of appetite and nausea, which may lead to temporary weight loss during the illness. If you notice unusual swelling or rapid weight gain while taking Quinine, it could be a sign of a serious problem like kidney or heart issues, and you should seek medical attention immediately.
Quinine has many significant drug interactions, so it must be used cautiously with other medications. It can interact with heart medications like digoxin, blood thinners like warfarin, and certain antibiotics or antifungals. Some combinations can cause dangerous heart rhythm problems or increase the risk of bleeding. It is also often prescribed alongside other antibiotics like doxycycline to help cure malaria more effectively. Because of these complex interactions, you must provide your healthcare provider with a complete list of all prescription drugs, over-the-counter medicines, and herbal supplements you are currently taking.
Yes, Quinine Sulfate is available as a generic medication in the form of 324 mg capsules. Generic versions are required by the FDA to have the same quality, strength, and purity as the brand-name versions (such as Qualaquin). Using the generic version can be a more cost-effective way to treat malaria. Regardless of whether you take the brand-name or generic version, the safety warnings—especially the warning against using it for leg cramps—remain exactly the same. Always ensure you are receiving your medication from a reputable pharmacy to avoid counterfeit products.
Other drugs with the same active ingredient (Quinine)
These symptoms are typically mild to moderate and usually resolve once the medication is discontinued.
> Warning: Stop taking Quinine and call your doctor immediately if you experience any of the following serious reactions:
Because Quinine is typically used for short-term malaria treatment (3-7 days), long-term side effects are rare. However, repeated exposures can sensitize the immune system, making the patient more likely to develop severe thrombocytopenia or hemolytic reactions upon subsequent use. Chronic high-dose use (historically seen in some neurological conditions) has been associated with permanent hearing loss and optic nerve atrophy.
Quinine Sulfate is NOT approved for the treatment or prevention of nocturnal leg cramps. The use of Quinine for leg cramps has resulted in serious medical conditions, including:
Research indicates that the risks associated with using Quinine for leg cramps far outweigh any potential benefits. Healthcare providers are instructed to use Quinine only for its approved antimalarial indication.
Report any unusual symptoms, especially bleeding or vision changes, to your healthcare provider immediately.
To ensure safety during Quinine therapy, healthcare providers may require the following tests:
Quinine frequently causes dizziness, blurred vision, and tinnitus (cinchonism). These effects can significantly impair your ability to drive or operate heavy machinery safely. You should avoid these activities until you know how Quinine affects you.
Alcohol should be avoided while taking Quinine. Alcohol can increase the risk of gastrointestinal irritation and may worsen the dizziness and confusion associated with cinchonism. Furthermore, alcohol can interfere with blood sugar regulation, compounding the risk of Quinine-induced hypoglycemia.
There is no known withdrawal syndrome associated with Quinine. However, it is vital not to stop the medication prematurely. If you stop taking Quinine before the parasite is fully cleared from your blood, the malaria may return, potentially in a more severe or drug-resistant form.
> Important: Discuss all your medical conditions, especially heart, kidney, or blood disorders, with your healthcare provider before starting Quinine.
Quinine can interfere with certain laboratory tests, leading to false results:
For each major interaction, the mechanism usually involves competition for the CYP3A4 metabolic pathway or an additive pharmacodynamic effect on the heart's QT interval. Management typically involves dose adjustment, increased monitoring, or selecting an alternative medication.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking before starting Quinine.
Conditions requiring a careful risk-benefit analysis by a healthcare provider include:
There is a known cross-sensitivity between Quinine and Quinidine (a medication used for heart rhythm disorders). Patients who have had an adverse reaction to one should generally not be given the other. Additionally, patients who are sensitive to cinchona alkaloids found in some tonic waters or herbal supplements should exercise extreme caution.
> Important: Your healthcare provider will evaluate your complete medical history, including genetic factors and past drug reactions, before prescribing Quinine.
Quinine is approved for use in children for the treatment of P. falciparum malaria. However, safety and efficacy in children under the age of 16 for other uses have not been established. Pediatric patients are particularly sensitive to the bitter taste of the drug and the risk of hypoglycemia. Dosing must be precisely calculated by weight (10 mg/kg). In some cases, the use of Quinine in children has been associated with a higher incidence of cinchonism symptoms compared to adults.
Clinical trials of Quinine did not include sufficient numbers of subjects aged 65 and over to determine if they respond differently than younger subjects. However, geriatric patients are more likely to have age-related declines in kidney and liver function, which can lead to drug accumulation. There is also a higher prevalence of cardiovascular disease and polypharmacy (taking multiple medications) in the elderly, which increases the risk of dangerous drug interactions and QT prolongation.
For patients with a GFR (Glomerular Filtration Rate) less than 30 mL/min, the clearance of Quinine is significantly reduced. The standard recommendation is to maintain the initial loading dose (if used) but to reduce the maintenance doses or increase the dosing interval (e.g., from every 8 hours to every 12 hours). Monitoring for systemic toxicity is essential in this population.
In patients with mild to moderate hepatic impairment, Quinine levels may be slightly elevated, but the standard dose is often used with close monitoring. In severe hepatic impairment (Child-Pugh Class C), the half-life of Quinine is significantly prolonged. Dosage must be reduced, and the patient should be monitored for signs of cinchonism and cardiac arrhythmias.
> Important: Special populations require individualized medical assessment and often more frequent laboratory monitoring during treatment.
| Parameter | Value |
|---|---|
| Bioavailability | 76% to 88% |
| Protein Binding | 70% to 95% (Alpha-1-acid glycoprotein) |
| Half-life | 8 to 12 hours (Healthy) / up to 18 hours (Malaria) |
| Tmax | 1 to 3 hours |
| Metabolism | Hepatic (Primary: CYP3A4) |
| Excretion | Renal (20% unchanged), Biliary/Fecal (Remainder) |
Quinine is classified as a Cinchona Alkaloid and an Antimalarial. It belongs to the same broad therapeutic area as chloroquine and mefloquine but has a distinct chemical structure and mechanism that often allows it to remain effective against chloroquine-resistant strains of P. falciparum.