Quinine

About Quinine

Quinine works against the malaria parasite by blocking how it makes nucleic acids and proteins and how it uses sugar for energy. Its only approved use is treating uncomplicated malaria caused by Plasmodium falciparum, at 648 mg (two capsules) every 8 hours for 7 days in adults. The label says it is not approved for severe or complicated malaria, for preventing malaria, or for leg cramps, and its safety in children under 16 has not been established, so travelers seeking protection from malaria are prescribed other medicines.

The boxed warning covers night-time leg cramps. Quinine has not been shown to work for them, and it can cause serious, life-threatening blood reactions, including low platelets and hemolytic uremic syndrome or thrombotic thrombocytopenic purpura (HUS/TTP), which has led to lasting kidney damage. The label says the risk outweighs any possible benefit for cramps.

Even for malaria it needs care. It can prolong the QT interval and cause dangerous heart rhythms, so it is not used with a long QT interval or with other QT-prolonging medicines. It can also cause hemolytic anemia, including in G6PD deficiency, low blood sugar (especially in pregnancy), atrial fibrillation and severe allergic or skin reactions. It must not be taken with myasthenia gravis, optic neuritis, or allergy to quinine, mefloquine or quinidine. Almost everyone gets some cinchonism: headache, flushing, nausea, ringing in the ears, dizziness and blurred vision. A Medication Guide comes with it.

Taking Quinine

How to take it

With food, to reduce stomach upset, every 8 hours for the full course the prescriber sets, even if you feel better. Swallow the capsules whole; do not open or crush them.

If you miss a dose

Take the missed dose as soon as you remember. If more than 4 hours have passed since it was due, skip it and continue your regular schedule. Do not take a double dose.

Storage

At room temperature, tightly closed, away from heat and moisture, out of reach of children. Do not refrigerate or freeze it.

Interactions to know about

Rifampin can make treatment fail and is avoided, as are ritonavir, mefloquine, halofantrine and other QT-prolonging medicines. Do not take antacids containing aluminum or magnesium with it. It can raise digoxin levels and the effect of warfarin, so both are monitored. Seek care at once for unusual bruising or bleeding, blood in the urine, a fast or irregular heartbeat, rash or vision changes.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Quinine differs from pharmacy to pharmacy

Quinine has one uncommon approved use, so many pharmacies do not stock it and must order it, and only a few companies make the generic. A pharmacy that seldom fills it may price it as a slow-moving item.

The course is fixed, two capsules every 8 hours for 7 days, so quotes are easy to compare. Malaria treatment cannot wait for an order, so how fast a pharmacy can supply the whole course matters as much as price.

Ways to pay less for Quinine without insurance

• Ask each pharmacy to confirm it has the whole course in stock before the prescription is sent, so treatment starts without delay.
• Make sure the prescription allows generic substitution, since the Qualaquin brand has been discontinued.
• Compare quotes for the full seven-day course from more than one pharmacy.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Quinine

1. 1.Do you have enough capsules in stock for my whole course?
2. 2.I was given this for leg cramps: is that right for me?
3. 3.Is it safe with my heart, diabetes or other medicines?
4. 4.Should I avoid antacids while taking it?
5. 5.Which bleeding, bruising, heartbeat or vision symptoms mean I should stop and get help?

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