QUININE SULFATE (Generic for QUALAQUIN)

Quinine Sulfate 324mg, Oral capsule

Tobacco

· Severity: Mild

· Notes for Consumers: Tobacco smoking may reduce the effectiveness of Quinine in treating your condition. Tobacco smoke contains substances that speed the removal of Quinine from the body, which in theory can make this drug less effective. Make sure your prescriber is aware that you smoke Tobacco or if you plan to stop smoking.

· Notes for Professionals: Tobacco used in cigarette smoking induces the CYP1A2 isoenzyme and thereby my decrease quinine concentrations. In healthy male smokers, the single dose AUC of quinine was reduced 44% and the Cmax was 18% lower than in non-smokers. However, in malaria patients receiving a 7 day course of quinine, the AUC was only reduced by 25% and the Cmax decreased 16.5% in smokers. Acute malaria may already reduce quinine concentrations. Additive reduction of quinine concentrations by cigarette smoking may be diminished in these patients. Additionally, cigarette smoking did not appear to influence therapeutic outcomes; therefore, increasing the dose of quinine in smokers is not recommended.

Quinine Sulfate 324mg, Oral capsule

Marijuana

· Severity: Moderate

· Notes for Consumers: The effects of marijuana may be increased and side effects may get worse if it is combined with this medicine. Do not drive or operate machinery until you know how this combination will affect you. Contact your health care provider right away if you notice slurred speech, confusion, severe drowsiness, increased heart rate, or any other new or unusual side effects.

· Notes for Professionals: The incidence of marijuana associated adverse effects may change following coadministration with quinine. Quinine is an inhibitor and an inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of marijuana's most psychoactive compound, delta-9-tetrahydrocannabinol (Delta-9-THC). When given concurrently with quinine, the amount of Delta-9-THC converted to the active metabolite 11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) may be altered. These changes in Delta-9-THC and 11-OH-THC plasma concentrations may result in an altered marijuana adverse event profile.

Quinine Sulfate 324mg, Oral capsule

Food

· Severity: Major

· Notes for Consumers: Some food products may contain Quinine (Tonic Water). To avoid additive effects and decrease the potential for side effects while taking medications containing quinine; avoid the use of Tonic Water. Contact your health care provider promptly if you experience side effects such as headache, changes in vision or hearing, or a racing heartbeat while taking Quinine.

· Notes for Professionals: Clinicians should be aware that some food and beverage products contain quinine. Tonic water commonly contains quinine and may have additive effects when taken with quinine medications. One study reported that the concentrations of quinine in tonic water are not significant enough to result in drug interactions with CYP2D6 substrates.

Quinine Sulfate 324mg, Oral capsule

Grapefruit juice

· Severity: Moderate

· Notes for Consumers: These drugs may be taken together only under close supervision from your prescriber. Taking these drugs together can increase the risk of a dangerous change in heartbeat or heart rhythm. Contact your prescriber immediately if you experience chest pain, dizziness, fainting or falling spells, palpitations, shortness of breath, or a change in your heartbeat (such as a fast or irregular heartbeat).

· Notes for Professionals: Quinine pharmacokinetics were not affected by grapefruit juice in a study of 10 healthy volunteers who were administered 5 days of grapefruit juice prior to receiving a single 600 mg quinine dose. However, there is a case report in which a 19 year old patient with known asymptomatic long QT syndrome developed torsade de pointes (TdP) after ingesting excessive amounts of grapefruit juice and quinine-containing tonic water. The TdP stopped 48 hours after discontinuing these drinks. Use of quinine and grapefruit juice should be done with caution, especially with large or multiple doses of quinine or if co-administered in patients with potential cardiac abnormalities.

<b>DISCLAIMER:</b><em> This drug information content is provided for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Patients should always consult their physician with any questions regarding a medical condition and to obtain medical advice and treatment. Drug information is sourced from GSDD (Gold Standard Drug Database ) provided by Elsevier.</em>