Formulary
Quinine: Indications, Dosing, Side Effects and Interactions
Quinine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Quinine: Indications, Dosing, Side Effects and Interactions
Quinine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Nocturnal leg cramps**
- **Adult** (By Mouth): 200-300 mg once daily, to be taken at bedtime.
**Non-falciparum malaria**
- **Adult** (By Intravenous Infusion): 10 mg/kg every 8 hours (max. per dose 700 mg), infused over 4 hours, given if patient is unable to take oral therapy. Change to oral chloroquine as soon as the patient's condition permits, reduce dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
**Falciparum malaria**
- **Child** (By Mouth): 10 mg/kg every 8 hours (max. per dose 600 mg) for 7 days, to be given together with or followed by either doxycycline (in children over 12 years), or clindamycin.
- **Adult** (By Mouth): 600 mg every 8 hours for 5-7 days, to be given together with or followed by either doxycycline or clindamycin.
- **Adult** (By Intravenous Infusion): Loading dose 20 mg/kg (max. per dose 1.4 g), infused over 4 hours, the loading dose of 20 mg/kg should not be used if the patient has received quinine or mefloquine during the previous 12 hours, then maintenance 10 mg/kg every 8 hours (max. per dose 700 mg) until patient can swallow tablets to complete the 7-day course, maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours, to be given together with or followed by either doxycycline or clindamycin, reduce maintenance dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
**Falciparum malaria (in intensive care unit)**
- **Adult** (By Intravenous Infusion): Loading dose 7 mg/kg, infused over 30 minutes, followed immediately by 10 mg/kg, infused over 4 hours, then maintenance 10 mg/kg every 8 hours (max. per dose 700 mg) until patient can swallow tablets to complete the 7-day course, maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours, to be given together with or followed by either doxycycline or clindamycin, reduce maintenance dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
**Non-falciparum malaria for quinine**
- **Child** (By intravenous infusion): 10 mg/kg every 8 hours (max. per dose 700 mg), infused over 4 hours, given if patient is unable to take oral therapy. Change to oral chloroquine as soon as the patient's condition permits, reduce dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
**Falciparum malaria for quinine**
- **Child** (By mouth): 10 mg/kg every 8 hours (max. per dose 600 mg) for 7 days, to be given together with or followed by either doxycycline (in children over 12 years), or clindamycin.
- **Neonate** (By intravenous infusion): Loading dose 20 mg/kg, infused over 4 hours, the loading dose of 20 mg/kg should not be used if the patient has received quinine or mefloquine during the previous 12 hours, then maintenance 10 mg/kg every 8 hours until patient can swallow oral medication to complete the 7-day course, maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours, to be given together with or followed by clindamycin, reduce maintenance dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
- **Child** (By intravenous infusion): Loading dose 20 mg/kg (max. per dose 1.4 g), infused over 4 hours, the loading dose of 20 mg/kg should not be used if the patient has received quinine or mefloquine during the previous 12 hours, then maintenance 10 mg/kg every 8 hours (max. per dose 700 mg) until patient can swallow tablets to complete the 7-day course, maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours, to be given together with or followed by either doxycycline (in children over 12 years), or clindamycin, reduce maintenance dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
**Falciparum malaria (in intensive care unit) for quinine**
- **Neonate** (By intravenous infusion): Loading dose 7 mg/kg, infused over 30 minutes, followed immediately by 10 mg/kg, infused over 4 hours, then maintenance 10 mg/kg every 8 hours until patient can swallow oral medication to complete the 7-day course, maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours, to be given together with or followed by clindamycin, reduce maintenance dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
- **Child** (By intravenous infusion): Loading dose 7 mg/kg, infused over 30 minutes, followed immediately by 10 mg/kg, infused over 4 hours, then maintenance 10 mg/kg every 8 hours (max. per dose 700 mg) until patient can swallow tablets to complete the 7-day course, maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours, to be given together with or followed by either doxycycline (in children over 12 years), or clindamycin, reduce maintenance dose to 5-7 mg/kg if parenteral treatment is required for more than 48 hours.
Cautions
Atrial fibrillation (monitor ECG during parenteral treatment); cardiac disease (monitor ECG during parenteral treatment); conduction defects (monitor ECG during parenteral treatment); elderly (monitor ECG during parenteral treatment) (in adults); electrolyte disturbance; G6PD deficiency; heart block (monitor ECG during parenteral treatment)
Contraindications
Haemoglobinuria; myasthenia gravis; optic neuritis; tinnitus
Side effects
Frequency not known Abdominal pain; agitation; agranulocytosis; angioedema; asthma; atrioventricular conduction changes; bronchospasm; cardiotoxicity; cerebral impairment; coagulation disorders; coma; confusion; death; diarrhoea; dyspnoea; fever; flushing; gastrointestinal disorder; haemoglobinuria; haemolysis; haemolytic uraemic syndrome; headache; hearing impairment; hypersensitivity; loss of consciousness; muscle weakness; myasthenia gravis aggravated; nausea; ocular toxicity; oedema; pancytopenia; photosensitivity reaction; QT interval prolongation; renal impairment; skin reactions; thrombocytopenia; tinnitus; vertigo; vision disorders; vomiting Overdose Quinine is very toxic in overdosage; life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable). For details on the management of poisoning, see Emergency treatment of poisoning .
Interactions
**Severe interactions:**
- Possible toxicity with phenytoin on stopping primidone); stiripentol, tiagabine, valproic acid, zonisamide.
**Other interactions (44):**
- Other Interactions As heparin has been shown to interact with intravenous nitroglycerine, high dose penicillin, quinine and tobacco smoking interaction cannot be ruled out for dalteparin.
- Pharmacodynamic-related interactions Medicinal products known to prolong the QT interval Caution is advised when prescribing OKEDI with medicinal products known to prolong the QT interval, such as...
- Examples include certain antiarrhythmics, such as those of Class 1A (such as quinidine, disopyramide and procainamide) and Class III (such as amiodarone, sotalol and dofetilide), certain...
- Combinations requiring caution Combinations which can increase the effects of digoxin when co-administered: amiodarone, canagliflozin, daclatasvir, flibanserin, flecainide, prazosin, propafenone,...
- Other drugs: antibiotics: aminoglycoside, lincosamide and polypeptide antibiotics, acylamino-penicillin antibiotics.
- Recurarisation has been reported after post-operative administration of: aminoglycoside, lincosamide, polypeptide and acylamino-penicillin antibiotics, quinidine, quinine and magnesium salts (see...
Pregnancy
High doses are teratogenic in first trimester , but in malaria benefit of treatment outweighs risk.
Breast feeding
Present in milk but not known to be harmful.
Hepatic impairment
With oral use: Manufacturer advises caution (risk of prolonged half-life). Dose adjustments With intravenous use: For treatment of malaria in severe impairment, reduce parenteral maintenance dose to 5-7 mg/kg of quinine salt. With oral use: Manufacturer advises dose reduction or increased dose interval.
Renal impairment
Dose adjustments With intravenous use: For treatment of malaria in severe impairment, reduce parenteral maintenance dose to 5-7 mg/kg of quinine salt.
Medicinal forms
Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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