Quinine contraindications

Chloroquine (Aralen) is also used in die treatment of extraintestinal amebiasis (see section on Amebicides). Doxycycline is also used to treat infections caused by Neisseria gonorrhoeae, Treponema pallidum, Listeria monocytogenes, Clostridium, and Bacillus anthracis when penicillin is contraindicated. Quinine also may be used for die prevention and treatment of nocturnal leg cramps. 

VLa.2,6. Other antimalarials. Doxycydine (see Section ILb) is a useful and effective short-term prophylactic agent for travellers to chloroquine-resistant areas and can be used as an alternative when mefloquine or proguanil is unavailable or mefloquine is contraindicated. In combination with quinine also tetracycline is used as an antimalarial. 

Contraindications Complete AV block, development of thrombocytopenic purpura during prior therapy with quinidine or quinine, intraventricular conduction defects (widening of QRS complex)... 

Contraindications Hypersensitivity to quinine (possible cross-sensitivity to quini-dine), G-6-PD deficiency, tinnitus, optic neuritis, history of thrombocytopenia during previous quinine therapy, blackwater fever... 

All the new synthetic antimalarials may apparently be administered safely to the pregnant woman, but it is a firmly entrenched clinical impression that quinine in full dosage is contraindicated in the mother and may cause serious visual and oral disturbances in the infant. Black-water fever, a little-understood hemolytic syndrome sometimes complicating P. falciparum cases, has been associated with quinine administration in a high proportion of instances. If quinine is injected... 

Quinine is a cinchona alkaloid that acts rapidly against all four species of Plasmodium. It is used to treat protozoal infections and leg cramps, and as a bitter and flavoring agent. However, the drug is not used prophylactically for malaria. Quinines are contraindicated in patients with a history of hypersensitivity to quinine or quinidine. They should not be used in the presence of hemolysis and should be used with caution in patients with atrial fibrillation, cardiac conduction defects, or heart block. Quinine administration in myasthenia gravis may aggravate the disease, hence it should be avoided. Quinine can be used in pregnancy.37 Intravenous infusion of quinine should be slow, and the patient should be monitored for cardiotoxicity.38 Cinchonism, which is characterized by tinnitus, GI disturbances, and impaired vision may occur with therapeutic doses of quinine.39... 

Quinine is contraindicated in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, optic neuritis, tinnitus, or a history of blackwater fever and thrombocytopenia purpura. The symptoms of overdosage are tinnitus, dizziness, skin rash, and GI disturbance (intestinal cramping). With higher doses, cardiovascular and CNS effects may occur, including headache, fever, vomiting, apprehension, confusion, and convulsions. 

Quinine causes a marked but transient increase in plasma astemizole levels, and to avoid the possible risk of cardiac arrhythmias the manufacturers contraindicate this combination. Three case reports confirm that this is a clinically important interaction. 

Information is very limited, but on the basis of the evidence cited above the manufacturers of astemizole contraindicate the concurrent use of quinine in order to avoid the risk of cardiac arrhythmias. The case report that is cited here confirms that this is a potentially clinically hazardous drug combination. ... 

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