Quinine

• Chloroquine-resistant P. falciparum in pregnancy (with clindamycin)
• Severe malaria when IV artesunate unavailable

Inhibits haem polymerisation; muscle-relaxant effect at neuromuscular junction.

• Tinnitus, headache, visual blur = cinchonism
• Stimulates insulin → check glucose 4-hourly

Oral

Quinine sulfate 650 mg PO q8h × 3–7 d + clindamycin 300 mg q8h × 7 d

Severe (IV)

Loading 20 mg/kg over 4 h, then 10 mg/kg q8h

• AbsoluteG6PD deficiency
• AbsoluteLong QT, optic neuritis, myasthenia gravis

• Cinchonism (tinnitus, headache, visual)
• Hypoglycaemia (insulin release)
• QT prolongation, arrhythmia
• Haemolysis (G6PD)

• • Therapeutic doses considered safe — benefit > risk in falciparum malaria
• • High-dose abortifacient effect at toxic levels only

• QT-prolonging drugs

  Avoid

  Torsades

• Warfarin

  Avoid

  ↑↑ INR

• Digoxin

  Caution

  ↑ levels

• Cimetidine

  Caution

  ↑ quinine

• 💡 Always pair with clindamycin in pregnancy — improves cure rate, ↓ resistance
• 💡 Glucose monitoring mandatory, esp. with IV use