Because of the danger of a potentially fatal prolongation of QTc interval, halofantrine must not be given simultaneously with or subsequent of mefloquine.
Concomitant administration of mefloquine and other related compounds (e.g. quinine, quinidine and chloroquine) may produce electrocardiographic abnormalities and increase the risk of convulsions. If these drugs are to be used in the initial treatment of severe malaria, mefloquine administration should be delayed at least 12 hours after the last dose. There is evidence that the use of halofantrine after mefloquine causes a significant lengthening of the QTc interval. Clinically significant QTc prolongation has not been found with mefloquine alone.
What is quinine?
Quinine is approved for use only in treating malaria, a disease caused by parasites. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.
What is the most important information I should know about quinine?
Using this medication improperly or without the advice of a doctor can result in serious side effects or death.
You should not take quinine if you have a history of "Long QT syndrome," or if you have glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, myasthenia gravis, or optic neuritis (inflammation of the nerves in your eyes).
Before taking quinine, tell your doctor if you have heart disease or a heart rhythm disorder, low potassium levels in your blood (hypokalemia), kidney disease, or liver disease.
Serious side effects of quinine include
fever, chills, confusion weakness, severe vomiting or stomach pain, diarrhea, pale or yellowed skin, dark colored urine, chest pain, pounding or fluttering heartbeats, hearing or vision loss, purple spots under your skin, a blistering or peeling skin rash, or urinating less than usual or not at all.
What should I discuss with my healthcare provider before taking quinine?
Do not use this medication if you have ever had an allergic reaction to quinine or similar medicines such as mefloquine (Lariam) or quinidine (Cardioquin, Quinidex, Quinaglute), or if you have:
a history of "Long QT syndrome";
glucose-6-phosphate dehydrogenase (G-6-PD) deficiency;
myasthenia gravis; or
optic neuritis (inflammation of the optic nerve).
If you have any of these other conditions, you may need a dose adjustment or special tests to safely take quinine:
Hypoglycemia (low blood sugar) may be more likely to occur in pregnant women who are taking quinine. Signs of low blood sugar include hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, and fast heartbeat. Talk to your doctor about your specific risk for low blood sugar if you take quinine while you are pregnant. Quinine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
Do not give this medication to a child younger than 16 years old.
How should I take quinine?
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended.
Take with food if quinine upsets your stomach.
Call your doctor if your malaria symptoms do not improve after 2 days of taking quinine, or if your symptoms return after you have finished the medication.
Take this medication for the full prescribed length of time.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If you are more than 4 hours late for your dose, skip the missed dose and take the medicine at your next scheduled dose time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention.
Overdose symptoms may include headache, confusion, dizziness, ringing in your ears, vision or hearing loss, severe nausea or vomiting, sweating, uneven heart rate, feeling light-headed, and fainting or collapse.
What should I avoid while taking quinine?
Quinine will not treat severe forms of malaria, and it should not be taken to prevent malaria. Quinine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. ice. Use only the type of antacid your doctor recommends.
Some antacids can make it harder for your body to absorb quinine.
Quinine side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using quinine and call your doctor at once if you have any of these serious side effects:
fever, chills, confusion, weakness;
severe vomiting, stomach pain, diarrhea;
problems with vision or hearing;
chest pain, trouble breathing;
urinating less than usual or not at all;
fast, pounding, or fluttering heartbeats;
weak or shallow breathing, feeling like you might pass out;
pale skin, easy bruising, purple or red pinpoint spots under your skin;
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or
loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
headache, blurred vision;
dizziness, spinning sensation;
increased sweating;
mild nausea, diarrhea, or stomach pain;
muscle weakness; or
warmth, redness, or tingly feeling under the skin.
Quinine Dosing Information
Usual Adult Dose for Malaria:
Qualaquin (R):
Treatment of uncomplicated Plasmodium falciparum malaria: 648 mg orally every 8 hours for 7 days
Per Centers for Disease Control and Prevention (CDC) guidelines:
542 mg base (650 mg sulfate salt) orally 3 times a day for 3 to 7 days
Treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) infection should be in conjunction with one of the following: doxycycline, tetracycline, or clindamycin. In pregnant women, quinine sulfate plus clindamycin is recommended.
Treatment of uncomplicated malaria due to chloroquine-resistant P vivax infection should be in conjunction with either doxycycline or tetracycline plus primaquine phosphate. In pregnant women, quinine sulfate alone for 7 days is recommended.
Usual Pediatric Dose for Malaria:
Qualaquin (R):
Treatment of uncomplicated P falciparum malaria:
16 years or older: 648 mg orally every 8 hours for 7 days
Per CDC guidelines:
8.3 mg base/kg (10 mg sulfate salt/kg) orally 3 times a day for 3 to 7 days; pediatric dose should never exceed adult dose
Less than 8 years:
Treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) infection should be combined with clindamycin.
Treatment of uncomplicated malaria due to chloroquine-resistant P vivax infection should be combined with primaquine phosphate.
8 years or older:
Treatment of uncomplicated malaria due to chloroquine-resistant (or unknown resistance) P falciparum (or species not identified) infection should be in conjunction with one of the following: doxycycline, tetracycline, or clindamycin.
Treatment of uncomplicated malaria due to chloroquine-resistant P vivax infection should be in conjunction with either doxycycline or tetracycline plus primaquine phosphate.
What other drugs will affect quinine?
Many drugs can interact with quinine. Below is just a partial list. Tell your doctor if you are using:
arsenic trioxide (Trisenox);
atorvastatin (Lipitor);
cimetidine (Tagamet), cisapride (Propulsid), or ranitidine (Zantac);
dextromethorphan (cough medicine);
digoxin (digitalis, Lanoxin);
droperidol (Inapsine);
metoprolol (Toprol);
rifampin (Rifadin, Rimactane, Rifater);
aminophylline (Phyllocontin, Truphylline) or theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl);
a blood thinner such as warfarin (Coumadin);
an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), levofloxacin (Levaquin), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam), or tetracycline (Brodspec, Tetracap);
an antidepressant such as amitriptylline (Elavil, Vanatrip), clomipramine (Anafranil), desipramine (Norpramin), or paroxetine (Paxil);
other anti-malaria medications such as chloroquine (Arelan), or mefloquine (Lariam);
heart rhythm medicine such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), disopyramide (Norpace), ibutilide (Corvert), procainamide (Pronestyl), propafenone (Rythmol), quinidine (Quin-G), or sotalol (Betapace);
medicine to prevent or treat nausea and vomiting, such as dolasetron (Anzemet) or ondansetron (Zofran);
medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (FazaClo, Clozaril), haloperidol (Haldol), pimozide (Orap), thioridazine (Mellaril), or ziprasidone (Geodon);
migraine headache medicine such as sumatriptan (Imitrex) or zolmitriptan (Zomig);
narcotic medication such as levomethadyl (Orlaam), or methadone (Dolophine, Methadose); or
seizure medication such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Luminal, Solfoton), or phenytoin (Dilantin).
This list is not complete and other drugs may interact with quinine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Where can I get more information?
- Your pharmacist can provide more information about quinine.
This is a guide only - to supplement data for the specific use of my patients - after I have discussed this with them. You should read this and verify all information with your doctor.
What is Malarone?
Malarone contains a combination of atovaquone and proguanil. Atovaquone and proguanil are medications used to treat malaria, a disease caused by parasites. Malarone works by interfering with the growth of parasites in the red blood cells of the human body.
Malarone is used to treat or prevent malaria.
Important information about Malarone
Do not use Malarone if you are allergic to atovaquone or proguanil. You should not use this medication to prevent malaria if you have
severe kidney disease.
Before using Malarone, tell your doctor if you have liver or kidney disease, severe complications from infection with malaria, or uncontrolled vomiting or diarrhea.
Take Malarone at the same time each day with food or a milky drink. If you vomit within 1 hour after taking this medicine, take another dose. If your vomiting continues, call your doctor.If you are taking this medicine to prevent malaria, start taking it 1 or 2 days before entering an area where malaria is common. Take the medication every day during your stay and for at least 7 days after you leave. If you stop taking the medicine early for any reason, contact a healthcare professional about another form of malaria prevention.
If you are taking Malarone to treat malaria, take the medication every day for 3 days in a row.
Take Malarone for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.
In addition to taking Malarone, use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria.
Contact your doctor as soon as possible if you have been exposed to malaria, or if you have a fever or other symptoms of illness during or after a stay in an area where malaria is common.
No medication is 100% effective in treating or preventing malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.
Before taking Malarone
Do not use Malarone if you are allergic to atovaquone or proguanil. You should not use this medication to prevent malaria if you have severe kidney disease.
Before using Malarone, tell your doctor if you are allergic to any drugs, or if you have:
If you have any of these conditions, you may need a dose adjustment or special tests to safely take Malarone.
How should I take Malarone?
Take Malarone exactly as it was prescribed for you.
Take Malarone at the same time each day with food or a milky drink. If you vomit within 1 hour after taking this medication, take another dose. If your vomting continues, call your doctor.If you are taking this medicine to prevent malaria:
Start taking the medicine 1 or 2 days before entering an area where malaria is common. Continue taking the medicine every day during your stay and for at least 7 days after you leave the area.
If you stop taking the medicine early for any reason, contact a healthcare professional about another form of malaria prevention.
If you are taking Malarone to treat malaria:
In addition to taking Malarone, use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria.
To be sure Malarone is not causing harmful effects, your liver function may need to be tested with blood tests on a regular basis. Do not miss any scheduled appointments.
Contact your doctor as soon as possible if you have been exposed to malaria, or if you have fever or other symptoms of illness during or after a stay in an area where malaria is common.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much Malarone.
Overdose symptoms may include stomach discomfort, vomiting, mouth sores, hair loss, easy bruising or bleeding, and peeling of the skin on your hands or feet.
Malarone side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
severe or uncontrolled vomiting or diarrhea;
fever;
nausea, stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
mouth sores;
unusual aches and pains, tired feeling, weight loss;
severe skin rash; or
easy bruising or bleeding.
Less serious Malarone side effects may include:
cough;
headache;
weakness;
dizziness; or
itching.
This is not a complete list of side effects and others may occur.
What other drugs will affect Malarone?
The following drugs can interact with Malarone. Tell your doctor if you are using any of these:
a blood thinner such as warfarin (Coumadin);
rifabutin (Mycobutin);
rifampin (Rifadin, Rifater, Rifamate, Rimactane);
tetracycline (Brodspec, Panmycin, Sumycin, Tetracap); or
metoclopramide (Reglan).
This list is not complete and there may be other drugs that can interact with Malarone. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.
Where can I get more information?
- Your pharmacist can provide more information about Malarone. You should not use this info except under the direct guidance of a medical doctor.
keep up the good works! i'll follow your updates and make revision thru dis. thanks a lot!
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