Quinine dihydrochloride for injections is a concentrated solution and must be diluted before use. This medicine is used for the treatment of severe malaria or when the patient is unable to take medication by mouth. It is also used in the treatment of Babesiosis, a rare disease caused by an infection carried by ticks.
When you must not be given it
You must not be given Quinine dihydrochloride for injectionsif you have an allergy to quinine or quinidine. Some of the symptoms of an allergic reaction may include: Shortness of breath Wheezing or difficulty breathing Swelling of the face, lips, tongue or other parts of the body Rash, intense itching, flushing or hives on the skin Ringing in the ears Changes in vision Fever Stomach pain or upset.
How to have Quinine dihydrochloride for injections
Quinine dihydrochloride for injections must only be given by a doctor or nurse. Quinine dihydrochloride for injections is a concentrated solution and must be diluted before use. It will be infused slowly into a vein only after dilution into an intravenous (IV) solution. If Quinine dihydrochloride for injections cannot be infused into a vein, it may be injected into a muscle. Your doctor will decide what dose of Quinine dihydrochloride for injections you will receive and for how long you will receive it. This depends on your medical condition and other factors including your weight.
If you are given too much (overdose)
Quinine dihydrochloride for injections is given by a doctor or nurse so an overdose is not likely to occur. Immediately contact your doctor or go to the Emergency Department at the nearest hospital if you notice the symptoms of an overdose. Symptoms of an overdose are similar to the symptoms of the side effects experienced with this medicine and are listed under Side Effects section.
Dosage and directions to use
In severe or complicated malaria, when the patient is unable to take oral medication, a slow intravenous infusion of quinine is used. In severely ill adults, a loading dose of 20 mg quinine dihydrochloride per kg may be administered by slow, constant rate intravenous infusion diluted in either isotonic fluid or 5% glucose solution (5-10 mL per kg bodyweight depending on the patient’s overall fluid balance) over four hours provided that the patient has not received quinine, quinidine or mefloquin during the previous twelve to twenty-four hours, and reliable hospital facilities are available, including cardiac monitoring.
The maintenance dose is 10 mg of quinine dihydrochloride per kg in 250 to 500 mL of diluent, preferably 5% glucose solution, by intravenous infusion over four hours, repeated at eight to twelve hourly intervals.
For children, a dose of 25 to 30 mg per kg body-mass daily in three divided doses has been recommended. Oral therapy should be substituted as soon as possible and a total of at least seven days therapy should be completed. If, after forty-eight hours of parenteral treatment, the patient is still unable to take oral treatment, or if there is evidence of significant hepatic impairment, the maintenance dose should be reduced by half. The recommended drug dosage adjustment for patients with impaired renal function (ie. a GFR less than 10), is a third of the normal dose. However, the loading dose of quinine should not be reduced in patients with renal and hepatic impairment.
If intravenous infusion is not possible, quinine dihydrochloride may be given by intramuscular injection of 10 mg per kg, although this may cause pain and local tissue necrosis. Monitoring of blood levels and side-effects is recommended during quinine therapy. NB: Quinine should never be given by rapid intravenous “push” or bolus injections as this may cause severe or even fatal cardiovascular toxicity.
Quinine should not be withheld from pregnant women with life-threatening malaria if other less hazardous agents are unavailable or inappropriate. Pregnant women seem to be particularly prone to quinine-induced hyper-insulinaemia and hypoglycaemia. Excessive doses may induce abortion, and congenital malformation of the optic and auditory nerves have been reported after failure to induce abortion with quinine. When administered intravenously to pregnant patients, the infusion rate should not exceed 10 mg/kg every eight hours.
Possible side effects
Tell your doctor or nurse as soon as possible if you do not feel well while you are being given Quinine dihydrochloride for injections. This medicine may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects. Tell your doctor or nurse if you notice any of the following and they worry you:
- Ringing in the ears or difficulty hearing
- Headache, confusion
- Disturbed vision
- Nausea, vomiting, diarrhoea, stomach pain
If any of the following happen tell your doctor or nurse immediately or go to the Emergency Department at your local hospital:
- Skin rash, itching, swelling of the face, flushing of the skin
- Wheezing, difficulty breathing
- Irregular heartbeat, chest pain
- Symptoms of liver disease such as yellowing of the eyes and skin
- Reduced or no urine produced or discoloured urine
- Increase in bruising or bleeding
- Muscle weakness
How to store Quinine dihydrochloride for injections
Quinine dihydrochloride for injections will usually be stored in the doctor’s surgery, pharmacy or clinic. The medicine is kept in a cool dry place where the temperature stays below 25°C. It should be protected from light. Quinine dihydrochloride for injections will be opened for use on you. It will be used only once and then it will be discarded. It will never be stored after it is opened or used for more than one person.