Indications
Requin Tablet is used for:
Malaria, Nocturnal leg cramps
Adult Dose
Oral
Malaria
Adult: As sulfate: 648 mg 8 hrly for 7 days.
Nocturnal leg cramps
Adult: 200-300 mg once at night.
Hepatic impairment: Mild to moderate (Child-Pugh class A and B): No dosage adjustment needed.
Child Dose
Oral
Malaria
Child: As sulfate: >8 yr10 mg/kg 8 hrly for 7 days.
Renal Dose
Renal impairment: Severe: Initially, 648 mg followed after 12 hr by maintenance doses of 324 mg 12 hrly.
Administration
Should be taken with food. Take w/ food to minimise GI discomfort.
Contra Indications
Hypersensitivity to quinine, mefloquine or quinidine. Patients w/ nocturnal leg cramps; prolonged QT interval, tinnitus or optic neuritis, myasthenia gravis, G6PD deficiency, haemolysis and who had suffered from black water fever. Concomitant use w/ ritonavir, mefloquine, rifampicin, class IA and class III antiarrhythmic agents, neuromuscular blocking agents, other drugs known to cause QT prolongation, and Al- and/or Mg-containing antacids.
Precautions
Patients w/ cardiac conduction defects, heart block or AF. Pregnancy and lactation. Monitoring Parameters Monitor for signs of cardiotoxicity. Monitor blood glucose levels, CBC w/ platelet count, LFT, ECG; ophthalmologic exam.
Pregnancy-Lactation
Pregnancy
No evidence that quinine causes uterine contractions at doses recommended for malaria treatment
May stimulate the pregnant uterus at doses several-times higher than those used to treat malaria
There are extensive published data but few well-controlled studies of quinine sulfate in pregnant women
Published data on over 1,000 pregnancy exposures to quinine did not show an increase in teratogenic effects over the background rate in the general population; however, the majority of these exposures were not in the first trimester
Used during pregnancy only if the potential benefit justifies the potential risk to the fetus
Clinical considerations
Treatment of malaria in pregnancy is important
P falciparum malaria carries a higher risk of morbidity and mortality in pregnant women than in the general population
Pregnant women with P falciparum malaria have an increased incidence of fetal loss (including spontaneous abortion and stillbirth), preterm labor and delivery, intrauterine growth retardation, low birth weight, and maternal death
Hypoglycemia, due to increased pancreatic secretion of insulin, associated with quinine use, particularly in pregnant women
Lactation
Low levels of quinine in breast milk; amounts ingested by infant are small and would not be expected to cause any adverse effects
Dosage in milk is far below those required to treat an infant for malaria
Do not use in mothers with an infant who is glucose-6-phosphate dehydrogenase (G6PD) deficient
Relatively small amounts of quinine in tonic water ingested by breastfeeding women have caused hemolysis in G6PD-deficient infants
Interactions
Reduced renal clearance of amantadine. Reduced clearance w/ cimetidine. Increased anticoagulant effect of warfarin and other anticoagulants. Reduced plasma levels of ciclosporin. Increased plasma levels of digoxin. Increased risk of myopathy and rhabdomyolysis w/ atorvastatin. May enhance hypoglycaemic effects of oral antidiabetics.
Potentially Fatal: Increased risk of QT prolongation and torsade de pointes w/ mefloquine, class IA antiarrhythmic agents (e.g. quinidine, procainamide, disopyramide) and class III antiarrhythmic agents (e.g. amiodarone, sotalol, dofetilide) and other drugs known to cause QT prolongation (e.g. halofantrine, pimozide, thioridazine). Potentiates neuromuscular blockade w/ neuromascular blocking agents. Decreased plasma levels w/ rifampicin. Increased serum levels w/ ritonavir. May delay or decrease absorption w/ Al- and/or Mg-containing antacids.
Side Effects
Side effects of Quinine Sulphate :
<1%
Flushing of the skin, Anginal symptoms, Fever, Rash, Pruritus, Hypoglycemia, Epigastric pain, Hemolysis in G6PD deficiency, Thrombocytopenia, Hepatitis, Nightblindness, Diplopia, Optic atrophy, Impaired hearing, Hypersensitivity reaction
Frequency Not Defined
Severe headache, Nausea, Vomiting, Diarrhea, Blurred vision, Tinnituscinchonism (risk of cinchonism is directly related to dose and duration of therapy)
Potentially Fatal: Sinus arrest, AV block, ventricular fibrillation and sudden death especially with IV use.
Mode of Action
Quinine is a cinchona alkaloid and a 4-methanolquinoline. It rapidly acts on blood schizontocide by interfering w/ lysosomal function or nucleic acid synthesis in the Plasmodia spp. It has no activity against exoerythrocytic forms.
Note
Requin 300 mg Tablet generic name is Quinine Sulphate. Requin 300 mg Tablet is manufactured by Rephco Pharmaceuticals Ltd.Requin is availble in all over Bangladesh.
Mes BD drug index information on Requin Tablet is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.