Quinine 300mg Tablet

ASPEN QUININE is indicated mainly in the treatment of resistant strains of plasmodium falciparum malaria. It is also indicated as a muscle relaxant in congenital myotonia and myotonic contraction as well as nocturnal muscle cramps. A secondary indication is its use in the diagnostic test for myasthenia gravis.

Adults: 300 mg to 600 mg given at night for nocturnal cramps. Treatment is discontinued after several cramp-free nights. For the treatment of falciparum malaria, a course usually lasts 7 days.

Adults: 600 mg every eight hours for 7 days

Children: 10 mg per kg body-weight every 8 hours for 7 days

In severe or complicated falciparum malaria or when the patient is unable to take oral medication, quinine should be given parenterally, preferably by slow intravenous infusion, but this can be hazardous and patients generally need monitoring for signs of cardiotoxicity.

• Quinine and its salts, as contained in ASPEN QUININE, are contraindicated in patients with a history of hypersensitivity to quinine and in patients with tinnitus or optic neuritis and especially when this takes the form of cutaneous, angioedematous, visual, or auditory symptoms.
• ASPEN QUININE should be discontinued immediately if evidence of haemolysis appears.
• Pregnancy in a patient with malaria is not generally regarded as a contraindication to the use of ASPEN QUININE, as malaria infection is potentially serious during pregnancy and poses a threat to the mother and foetus, there appears to be little justification in withholding treatment in the absence of a suitable alternative.
• ASPEN QUININE should be avoided in patients with myasthenia gravis, as it may aggravate their condition.

Use of mefloquine with ASPEN QUININE may increase the chance of side effects. Concurrent use with ASPEN QUININE may result in an increased incidence of seizures and of electrocardiogram abnormalities, predisposing the patient to dysrhythmias. It is recommended that mefloquine be administered at least 12 hours after the last dose of ASPEN QUININE. Patients taking weekly mefloquine prophylaxis may be found to have mefloquine-resistant malaria that requires treatment with ASPEN QUININE, because mefloquine has a very long half-life (approximately 20 days) it will remain in the body long after the medicine has been discontinued. Although there is insufficient information available, it is recommended that if ASPEN QUININE must be given that the patient be hospitalised, if possible, and monitored for QT prolongation and possible rhythm disturbances. Seizure activity may also be potentiated in these patients. In patients considered to be at high risk for a seizure, additional precautions and interventions may be indicated.

ASPEN QUININE should be used with caution in patients with atrial fibrillation or other serious heart disease. ASPEN QUININE may also cause haemolysis in some types of glucose-6-phosphate dehydrogenase deficiency and should be used with care.

Hypoglycaemia is now recognised to be a frequent complication encountered in falciparum malaria, it is important to recognise that hypoglycaemia may be the cause of coma rather than cerebral malaria and that hypoglycaemia may also be induced by antimalarial therapy.

See WARNINGS AND SPECIAL PRECAUTIONS.

Pregnancy in a patient with malaria is not generally regarded as a contraindication to the use of ASPEN QUININE, as malaria infection is potentially serious during pregnancy and poses a threat to the mother and foetus, there appears to be little justification in withholding treatment in the absence of a suitable alternative (see CONTRAINDICATIONS).

Administration of ASPEN QUININE in usual therapeutic doses may give rise to a train of symptoms known as cinchonism, characterised by tinnitus, impaired hearing, headache, nausea and disturbed vision in its mild form, with in addition vomiting, abdominal pain, diarrhoea and vertigo, in its more severe manifestations, rashes frequently appear. Visual disturbances consist of blurred vision, disturbed colour perception, photophobia, diplopia, night blindness, constricted visual fields, scotomata, mydriasis, and, very rarely, even blindness. Cinchonism may also occur after small doses in patients hypersensitive to ASPEN QUININE, but urticaria and flushing of the skin with intense pruritus are the most frequent reactions seen in these patients, other effects include fever, skin rashes and dyspnoea. Angioedema especially of the face may also occur and asthma can be precipitated. Thrombocytopenic purpura has been associated with quinine hypersensitivity. Haemoglobinuria occurs rarely. Other adverse effects of ASPEN QUININE may include hypoprothrombinaemia and agranulocytosis.

Main symptoms of overdosage, which can be fatal, include gastrointestinal effects, oculotoxicity, central nervous system disturbances, and cardiotoxicity. Visual disturbances including sudden blindness are usually slowly reversible but there may be residual damage. ASPEN QUININE can produce cardiovascular toxicity similar to that seen with quinidine including conduction disturbances, dysrhythmias, anginal symptoms and hypotension leading to cardiac arrest and circulatory failure.

In acute overdosage with ASPEN QUININE, the stomach should be emptied by lavage if ingestion has been recent. Oral administration of activated charcoal may also be of some benefit. Treatment is mostly symptomatic with attention being given to maintaining blood pressure, respiration and renal function and to treating dysrhythmias. Central nervous system symptoms are noted in more severe grades of poisoning, particularly noted are: headache, fever, vomiting, apprehension, excitement, confusion, delirium, and syncope. Respiration is first stimulated and is then shallow and depressed. The skin becomes cold and cyanotic as poisoning progresses, the body temperature and the blood pressure fall, weakness is extreme, the pulse is feeble, coma ensues, and death occurs from respiratory arrest.