Quinine: Difference between revisions

(Replace manual dosing with dynamic SMW tables)
(Restore original dosing content alongside dynamic SMW tables)
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==General==
==Administration==
*Type: [[Antimalarial]]
*Type: Atypical [[antipsychotic]]
*Dosage Forms: PO 324 (IM and IV formulations available outside US)
*Dosage Forms: 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg; 1mg/mL
*Common Trade Names: Qualaquin
*Routes of Administration: Oral, IM
*Common Trade Names: Risperdal


==Adult Dosing==
==Adult Dosing==
===[[Schizophrenia]]===
*<65 yo, 1st episode
**1-3 mg/day PO divided qd/bid
***Max: 16mg/day
*<65 yo, maintenance
**1-4 mg/day PO divided qd/bid
*65+ yo
**1-4 mg/day PO divided qd/bid
***Doses >4 mg/day rarely more effective
===[[Bipolar disorder]], Type 1, Acute manic===
*1-6 mg/day PO divided qd/bid
**Max: 6 mg/day
===Tourette Syndrome===
*0.25-3 mg/day PO divided qd-bid
**Max 6 mg/day
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Quinine]] [[Has Population::Adult]]
{{#ask: [[Has DrugName::Quinine]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
|format=table
|limit=50
|limit=50
|mainlabel=-
|mainlabel=-
|headers=show
|headers=show
|sort=Treats disease
|sort=Treats disease
}}
}}


==Pediatric Dosing==
==Pediatric Dosing==
===Pediatric procedural sedation===
*0.01mg/kg/dose IM (typically 0.25-4mg/dose)
===[[Schizophrenia]]===
*1-6 mg/day PO divided qd/bid
===[[Bipolar disorder]], Type 1, Acute mania===
*0.5-6mg/day PO divided qd/bid
===Irritability, Autistic disorder associated===
*0.5-3 mg/day PO divided qd/bid
===Tourrette syndrome===
*0.75-3 mg/day PO divided qd/bid
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Quinine]] [[Has Population::Pediatric]]
{{#ask: [[Has DrugName::Quinine]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
|format=table
|limit=50
|limit=50
|mainlabel=-
|mainlabel=-
|headers=show
|headers=show
|sort=Treats disease
|sort=Treats disease
}}
}}


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation: Probably safe
*[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out
*Renal Dosing
*Renal:
**Adult
**Adult:
***Severe chronic renal failure: 648mg PO x 1 then 324mg PO q12h
***CrCl <30: Start 0.5 mg BID then increase by 0.5mg BID weekly
***If on HD give after dialysis
***HD: Not defined
**Pediatric
**Pediatric:
***Not defined
***Not defined, see adult dosing.
*Hepatic Dosing
*Hepatic:
**Adult and Pediatric
**Adult:
***No adjustment for Child-Pugh Class A or B
***Child-Pugh Class C: Start 0.5 mg BID and increase by 0.5mg BID weekly
***Avoid in Child-Pugh Class C
**Pediatric:
***Not defined, see adult dosing.


==Contraindications==
==Contraindications==
===Black Box Warnings===
*Hematologic Toxicity with use for nocturnal leg cramps
**Thrombocytopenia
**[[HUS]]/[[TTP]]
===General===
*Allergy to class/drug
*Allergy to class/drug
*Allergy to mefloquine or quinidine
*Caution:
*Black water fever
**Pediatric/adolescent pts
*ITP/[[TTP]]/[[HUS]]
**Pregnancy 3rd trimester
*Thrombocytopenia
**Elderly pts
*[[Glucose-6-Phosphate Deficiency (G6PD)]]
**Dementia-related psychosis
*[[Myasthenia gravis]]
**Renal impairment
*[[Optic neuritis]]
**Hepatic impairment
*QT prolongation/Congenital long QT syndrome
**Parkinson's Disease
*Electrolyte abnormalities
**[[Neuroleptic malignant syndrome]] history
*Bradycardia
**Seizure history
*Ventricular arrhythmias
**Cardiovascular disease
*[[CHF]]
**[[Diabetes mellitus]]
*Recent MI
**Suicide risk
===Caution===
*[[Torsades de pointes]]
*[[Atrial fibrillation]]/[[Atrial flutter]]
*Pregnancy
*Hepatic impairment


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Cinchonism
*[[Hypotension]], [[syncope]]
*[[QT prolongation]]
*Extrapyramidal symptoms: [[tardive dyskinesia]]
*[[Torsades de pointes]]
*[[Neuroleptic malignant syndrome]], [[hyperthermia]]
*[[Anaphylaxis]]
*[[Hyperglycemia]], [[diabetes mellitus]], [[DKA]]
*[[Angioedema]]
*[[Seizure]], [[Priapism]], [[Stroke]], [[TIA]]
*Bronchospasm
*Dysphagia
*[[Thrombocytopenia]]
*[[Leukopenia]], [[Neutropenia]], [[Agranulocytosis]]
*[[TTP]]/[[HUS]]
*Suicidality
*Hemolytic anemia
*[[Pancreatitis]]
*Black water fever
*[[Stevens-Johnson syndrome and toxic epidermal necrolysis]]
*Intestinal nephritis
*Renal impairment
*Hepatitis
*Leukopenia
*Neutropenia
*[[DIC]]
*[[Hypoglycemia]]
*[[Myasthenia gravis]] exacerbation
*[[Lupus]]
*[[Optic neuritis]]
*Blindness
*Deafness


===Common===
===Common===
*Cinchonism
*Akathisia, dystonia, parkinsonism, tremor
*Headache
*Sedation/[[fatigue]], [[dizziness]], blurred vision, [[anxiety]], confusion
*Vasodilation
*[[Rash]]
*Diaphoresis
*Hyperprolactinemia, weight gain, increased appetite
*Nausea/Vomiting
*[[Constipation]], [[diarrhea]], [[nausea]]/[[vomiting]]
*Tinnitus
*Urinary incontinence
*Impaired hearing
*[[Cough]], URI
*Vertigo
*[[Photosensitivity]], visual disturbance
*Visual impairment
*Fever
*Flushing
*asthenia
*Rash
*Pruritus
*Urticaria
*[[Diarrhea]]
*Abdominal pain
*Photosensitivity


==Pharmacology==
==Pharmacology==
*Half-life: 9-12 hours
*Half-life: 20h (PO); 3-6 day (IM)
*Metabolism: Liver 80%, CYP450
*Metabolism: Hepatic, CYP2D6
*Excretion: Urine
*Excretion: Urine 70%, Feces 14%
*Mechanism of Action:  Unknown


==Administration==
==Mechanism of Action==
*Give with food
*Unknown
 
*5HT-2 inhibitor, weaker D2 inhibitor
==Toxicity==
==Comments==
*Mild
**Nausea
**Vomiting
**Tinnitus
**Vertigo
**Deafness
*Severe
**Ataxia
**Convulsions
**Coma
**QRS/QT prolongation
**Arrhythmia
*Retinal Toxicity
**Blurry vision
**Impaired visual fields
**Blindness


==See Also==
==See Also==
*[[Malaria]]
[[Antipsychotics]]
*[[Babesiosis]]
 
==References==
==References==
*Epocrates
<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]]
[[Category:ID]]
[[Category:Psychiatry]]

Revision as of 02:39, 20 March 2026

Administration

  • Type: Atypical antipsychotic
  • Dosage Forms: 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg; 1mg/mL
  • Routes of Administration: Oral, IM
  • Common Trade Names: Risperdal

Adult Dosing

Schizophrenia

  • <65 yo, 1st episode
    • 1-3 mg/day PO divided qd/bid
      • Max: 16mg/day
  • <65 yo, maintenance
    • 1-4 mg/day PO divided qd/bid
  • 65+ yo
    • 1-4 mg/day PO divided qd/bid
      • Doses >4 mg/day rarely more effective

Bipolar disorder, Type 1, Acute manic

  • 1-6 mg/day PO divided qd/bid
    • Max: 6 mg/day

Tourette Syndrome

  • 0.25-3 mg/day PO divided qd-bid
    • Max 6 mg/day


Indications by Disease

DiseaseDoseContext
Babesiosis650mg TIDSevere parasitemia with Clindamycin use IV for severe
Malaria648mg PO q8h x 7 daysUncomplicated malaria, use with doxycycline or clindamycin

Pediatric Dosing

Pediatric procedural sedation

  • 0.01mg/kg/dose IM (typically 0.25-4mg/dose)

Schizophrenia

  • 1-6 mg/day PO divided qd/bid

Bipolar disorder, Type 1, Acute mania

  • 0.5-6mg/day PO divided qd/bid

Irritability, Autistic disorder associated

  • 0.5-3 mg/day PO divided qd/bid

Tourrette syndrome

  • 0.75-3 mg/day PO divided qd/bid


Indications by Disease

DiseaseDoseContext
Babesiosis8mg/kg PO q8h x 7-10 days (Max: 648mg/dose)Severe parasitemia with Clindamycin
Malaria30mg/kg/day PO q8h x 3-7 days (Max: 648mg/dose)Uncomplicated malaria, use with clindamycin

Special Populations

  • Pregnancy Rating: C
  • Lactation risk: Infant risk cannot be ruled out
  • Renal:
    • Adult:
      • CrCl <30: Start 0.5 mg BID then increase by 0.5mg BID weekly
      • HD: Not defined
    • Pediatric:
      • Not defined, see adult dosing.
  • Hepatic:
    • Adult:
      • Child-Pugh Class C: Start 0.5 mg BID and increase by 0.5mg BID weekly
    • Pediatric:
      • Not defined, see adult dosing.

Contraindications

  • Allergy to class/drug
  • Caution:
    • Pediatric/adolescent pts
    • Pregnancy 3rd trimester
    • Elderly pts
    • Dementia-related psychosis
    • Renal impairment
    • Hepatic impairment
    • Parkinson's Disease
    • Neuroleptic malignant syndrome history
    • Seizure history
    • Cardiovascular disease
    • Diabetes mellitus
    • Suicide risk

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 20h (PO); 3-6 day (IM)
  • Metabolism: Hepatic, CYP2D6
  • Excretion: Urine 70%, Feces 14%

Mechanism of Action

  • Unknown
  • 5HT-2 inhibitor, weaker D2 inhibitor

Comments

See Also

Antipsychotics

References

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