| Customization: | Available |
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| Application: | Injection |
| Usage Mode: | Injection |
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QUININE DIHYDROCHLORIDE INJECTION
Indications
For the treatment of acute attacks of malaria, including attacks due to chloroquine-resistant or multi-drug-resistant strains of Plasmodium falciparum. Quinine is used Parenterally for cerebral, severe or complicated malaria, or when vomiting prevents retention of an orally administered drug. Quinine dihydrochloride is the salt usually employed for the preparation of injections.
Dosage and Administration
Usage:
1.By Slow Iv Infusion or deep IM Injection:The solution should be diluted before administration infused slowly over 4 hours. Hypotension and cardiac arrest may result from rapid intravenous injection. Intravenous quinine should be given only by infusion.If IV infusion is not possible, quinine dihydrochloride has been given IM route. The IM route should only be used as a last resort.
2.Adult Dosage: Usual adult and adolescent dose Malaria, Plasmodium falciparum, severe (treatment): Loading dose: 20 mg/kg up to a maximum of 1400 mg given slowly by infusion over 4 hours.
Precautions & Warning:
1.Quinine must be used with caution in patients with atrial fibrillation or other serious heart disease.
2.Quinine may aggravate symptoms of myasthenia gravis and should be used with care if at all in such patients.
3.Quinine may cause Hypoprothrombinaemia and enhance the effects of anticoagulants.
4Antimalarial agents and especially quinine, when given for prolonged periods, have been implicated in precipitating black water fever.
5.Precautions Check for hypersensitivity to quinine or quinidine before administration. It is important that when given intravenously it should be given by slow infusion and the patient observed closely for signs of cardiotoxicity.
6.Pulse and blood pressure should be closely monitored
7.Haemolysis
8.Atrial Fibrillation
Contraindications:
1.Hypersensitivity to quinine or quinidine
2.Hypoglycemia (quinine stimulates release of Pancreatic hormone from the pancreas; hypoglycemia may also be a complication of severe P. falciparum malaria, especially in children and during pregnancy)
3.Myasthenia gravis (quinine may exacerbate muscle weakness in myasthenia gravis due to its neuromuscular blocking effects) Purpura, thrombocytopenic, or history of (quinine may cause thrombocytopenic purpura, especially in highly sensitive patients or in patients with a previous history of this reaction to quinine)
Quinine Dihydrochloride Intravenous Infusion is contraindicated for use in premature infants because the formulation contains benzylalcohol.
Adverse Reactions:
1.Very common (≥10%) Gastrointestinal disturbances (abdominal or stomach cramps or pain; diarrhea; nausea; vomiting).
2.Common (1%-10%) cinchonism occurs. Cinchonism symptoms include tinnitus, impaired hearing, headache, nausea, disturbed vision, vomiting, abdominal pain, diarrhoea, and vertigo. Blood dyscrasias such as agranulocytosis, leukopenia, and/or thrombocytopenia hypoglycemia
3.Serious ADR (<1%) hypersensitivity reactions hypoprothrombinemia
Drug interactions:
1.Digitalis glycosides: Quinine markedly reduces the renal clearance of digoxin and digoxin levels may be doubled.
2.Flecainide: Quinine reduces the systemic clearance.
3.Warfarin: Quinine may potentiate warfarin by inhibiting its hepatic metabolism. 4.Cimetidine: Cimetidine inhibits the hepatic metabolism of quinine. Hypoglycaemic drugs: As quinine stimulates the release of Pancreatic hormone from islet cells, diabetic control may be compromised.
5.Mefloquine
Storage instructions:
Do not Store above 30 ºC. Protect from light. keep out of reach of children.
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