Quinine Dihydrochloride (Intravenous Quinine)
General Information
Unlicensed Restricted formulary antimicrobial: For details see OUH netFormulary
- Quinine dihydrochloride is the injectable formulation of quinine. It is available by special-order only. Please contact a pharmacist for further information.
For all information regarding contra-indications, interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).
Dosing
|
Indication |
Intravenous dose (Doses are for quinine salt) |
|
Falciparum malaria |
Loading dose*: 20 mg/kg (max. per dose = 1.4 g) (infused over 4 hours) Then Maintenance dose** 10 mg/kg tds (max. per dose = 700mg) Reduce maintenance dose to 5-7 mg/kg if iv treatment is required for more than 48 hours |
|
Falciparum malaria (in intensive care unit) |
Loading dose: 7 mg/kg (infused over 30 mins) followed immediately by 10 mg/kg Then Maintenance dose** 10 mg/kg tds (max. per dose = 700 mg) Reduce maintenance dose to 5–7 mg/kg if parenteral treatment is required for more than 48 hours. |
|
Non-falciparum malaria, if patient is unable to take oral therapy |
10 mg/kg tds (max. per dose = 700 mg) Reduce dose to 5–7 mg/kg if parenteral treatment is required for more than 48 hours. |
*Loading dose of 20 mg/kg should not be used if the patient has received quinine or mefloquine during the previous 12 hours
** Maintenance dose to be given 8 hours after the start of the loading dose and infused over 4 hours.
Renal and hepatic impairment
Dose in renal impairment
|
eGFR (mL/min/1.73m2) |
IV dose (Doses are for quinine salt) |
|
More than 50 |
Dose as in normal renal function |
|
20-50 |
5-7mg/kg tds |
|
10-20 |
5-7 mg/kg bd-tds |
|
less than 10 |
5-7mg/kg od |
|
HD/HDF/High Flux/PD |
Dialysed; Give doses after haemodialysis on dialysis days Dose as in eGFR less than 10ml/min/1.73m2 |
Note: Doses are based on Renal Drug Database
Use in hepatic impairment
Caution, risk of prolonged half-life. Dose reduction may be needed in hepatic disease. Discuss with Micro/ID.
MHRA Drug Safety Updates
MHRA Drug Safety Update (November 2017) Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
References
- Phebra. Quinine Dihydrochloride 6% solution for injection 600mg in 10ml. Summary of Product Characteristics (SPC). Available from: https://www.phebra.com/wp-content/uploads/2018/10/Quinine-PI-V10.pdf Accessed 29/9/26
- The Renal Drug Database. Quinine. Last updated 23/11/17. Accessed via https://renaldrugdatabase.com Accessed 29/9/26.
- British National Formulary. Quinine. BNF online, accessed via www.medicinescomplete.com. Accessed 29/9/26.
- MHRA. Drug Safety update (November 2017) Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions. Accessed via https://www.gov.uk/drug-safety-update/quinine-reminder-of-dose-dependent-qt-prolonging-effects-updated-medicine-interactions Accessed 29/9/26
- Sanford Guide [online]. Quinine Dihydrochloride. Last updated 1/7/26. Accessed via https://webedition.sanfordguide.com Accessed 29/9/26