Quinine

Quinine is a white, crystalline alkaloid that contains anti-pyretic, anti-malarial, analgesic, and anti-inflammatory properties. The only known natural source for quinine is the bark of a cinchona tree. Common brand names for quinine are Malarin and Rhea Quinine Sulfate. Quinine is classified as a Cinchona alkaloid, Anti-malarial, and Anti-myotonic.

Indication for Quinine

Quinine is used to prevent and treat nocturnal recumbent leg cramps. Used alone, or with pyrimethamine and sulfonamide for the treatment of chloroquine-resistant falciparum malaria.

Routes and Dosage of Quinine

Nocturnal Leg Cramps

PO: ADULTS, ELDERLY: 200-300 mg at bedtime as needed.

Treatment of Malaria

PO: ADULTS, ELDERLY: 260-650mg 3 times a day for 6-12 days. CHILDREN: 10 mg/kg every 8 hours for 5-7 days.

Action of Quinine

Quinine depresses oxygen uptake and carbohydrate metabolism, elevates pH in intracellular organelles of parasites. It then produces parasitic death. Quinine also relaxes skeletal muscle by increasing the refractory period, decreasing excitability of motor end plates, and affecting the distribution of calcium with muscle fiber.

Side Effects and Adverse Reactions of Quinine

Side Effects of Quinine

Nausea
Headache
Tinnitus
Slight visual disturbances
Rashes
Wheezing
Dyspnea
Angioedema
Cardiac conduction disturbances
Decreased hearing

Adverse Reactions of

Cardiovascular effects
Severe headache
Intestinal cramps with vomiting or diarrhea
Confusion
Seizures
Blindness
Respiratory depression
Hypoprothrombinemia
Thrombocytopenic purpura
Hemoglobinuria
Asthma
Agranulocytosis
Hypoglycemia
Deafness
Optic Atrophy

Nursing Considerations for Clients Taking Quinine

Question for possibility of pregnancy prior to initiating therapy.
Question for hypersensitivity to quinine, quinidine.
Evaluate initial ECG and CBC results.
Check for hypersensitivity: flushing, rash/urticaria, itching, dyspnea, and wheezing.
Assess level of hearing, visual acuity, presence of headache or tinnitus, and nausea.
Report adverse effects promptly
Monitor CBC results for blood dyscrasias
Be alert to infection, bleeding or bruising, and unusual tiredness or weakness.
Assess pulse and ECG for arrhythmias.
Check fasting blood sugar levels; watch out for hypoglycemia.

Patient Teachings for Clients Taking Quinine

Report ringing in the ears or hearing loss.
Report for any visual disturbances.
Period lab tests are part of the therapy.

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