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| Interactions: | Astemizole
Adverse Effect: increased astemizole serum concentrations and potential cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: Concurrent administration of astemizole and quinine is contraindicated. Severe cardiotoxicity, including electrocardiographic abnormalities, torsades de pointes, ventricular arrhythmias, and cardiac arrest, have occurred in cases of high serum concentrations of astemizole.
Cimetidine
Adverse Effect: Quinine toxicity (headache, deafness, blindness, tachycardia) Clinical Management: Monitor for signs of quinine-induced CNS, cardiovascular, and ocular toxicity. If concurrent use cannot be avoided, select another H2-antagonist (eg, ranitidine or famotidine) that has less potential to alter drug metabolism.
Digoxin
Adverse Effect: Digoxin toxicity (nausea, vomiting, cardiac arrhythmias) Clinical Management: In patients taking digoxin who require quinine for greater than five to seven days, monitor digoxin levels and adjust dose accordingly.
Mefloquine
Adverse Effect: an increased risk of convulsions, electrocardiographic abnormalities, cardiac arrest, and decreased mefloquine efficacy Clinical Management: If mefloquine and quinine are both used during the initial treatment of severe malaria, mefloquine should be administered at least 12 hours after the last dose of quinine.
Metformin
Adverse Effect: An increased risk of lactic acidosis Clinical Management: In patients receiving metformin and Quinine , closely monitor serum glucose levels and metformin plasma concentrations. Metformin doses may need to be reduced.
Pancuronium
Adverse Effect: pancuronium toxicity (respiratory depression, apnea) Clinical Management: Quinine should be avoided if possible in the immediate postoperative period when the effects of neuromuscular blockers may be present. If quinine is used, the need for respiratory support should be anticipated.
Warfarin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with quinine, and should be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation. |
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