quinine
Quinine (Qualaquin) is used to treat malaria in people ages 16 years and older. It's not used for preventing malaria. It's available as a capsule taken every 8 hours. Side effects of quinine (Qualaquin) include nausea, stomach pain, and vomiting. Taking it with food can ease some stomach-related side effects. It's typically not a first-choice option because it has a lot of side effects, drug interactions, and needs to be taken in combination with either doxycycline (Vibramycin, Doryx) or certain other antimalarial medications.
What is Quinine (Qualaquin)?
What is Quinine (Qualaquin) used for?
Treatment of uncomplicated malaria caused by Plasmodium falciparum in people ages 16 years and older
How Quinine (Qualaquin) works
Quinine (Qualaquin) is an antimalarial medication. It kills one form of malaria, Plasmodium falciparum, by stopping several cellular processes that are needed to grow and survive.
Drug Facts
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What are the side effects of Quinine (Qualaquin)?
Common Side Effects
- Headache
- Sweating
- Ringing in the ears
- Hearing loss
- Dizziness
- Blurry vision
- Changes in how you see color
Other Side Effects
- Nausea
- Stomach pain
- Vomiting
- Diarrhea
Serious Side Effects
- Hemolytic anemia (low red blood cell count): tiredness, dizziness, weakness, high heart rate, yellowing of the skin or eyes, dark-colored urine
- Bleeding: blood in your urine or stool, unexplained bruising, bleeding that takes longer than usual to stop
- Abnormal heart rhythm (QT prolongation): chest pounding, short of breath, chest pain, feeling faint or lightheaded
- Serious allergic and skin reactions: sore throat, fever, fatigue, rash, hives, painful blisters, skin reddening, skin peeling, difficulty breathing, itching, fast heartbeat, tightness in the throat, swelling in the face or tongue
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
change in color vision
changes in behavior
confusion
hearing loss
ringing in the ears
stomach cramps or pain
vomiting
Less common
behavior change, similar to drunkenness
black, tarry stools
bloody urine
blurred vision or change in vision
chills
cold sweats
confusion
cool pale skin
difficulty concentrating
drowsiness
excessive hunger
fast heartbeat
headache
hoarseness
loss of consciousness
lower back or side pain
nervousness
nightmares
painful or difficult urination
pinpoint red spots on the skin
restless sleep
seizures
shakiness
slurred speech
unusual bleeding or bruising
unusual tiredness or weakness
Rare
Difficulty breathing or swallowing
disturbed color perception
double vision
increased sweating
muscle aches
night blindness
reddening of the skin, especially around ears
ringing or buzzing in the ears
swelling of the eyes, face, inside of the nose, fingers, feet, or lower legs
Incidence not known
Back, leg, or stomach pains
bleeding gums
bleeding under the skin
blindness
blistering, peeling, or loosening of the skin
bloody nose
blue-yellow color blindness
change in mental status
cold sweats
confusion
cool, pale skin
dark urine
decreased frequency or amount of urine
decreased vision
difficulty breathing
difficulty in moving
difficulty speaking
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast, pounding, or irregular heartbeat or pulse
general body swelling
general feeling of discomfort, illness, or weakness
hoarseness
heavier menstrual periods
hoarseness
increased hunger
increased or decreased urination
increased sensitivity of the skin to sunlight
increased thirst
irregular heartbeat, recurrent
irritation
itching, skin rash
joint pain, stiffness, or swelling
light-colored stools
loss of appetite
muscle cramps, weakness, or stiffness
nervousness
nightmares
nosebleeds
painful or difficult urination
pale color of the skin
pale skin
red skin lesions, often with a purple center
red, irritated eyes
redness or other discoloration of the skin
severe
sunburn
sores, ulcers, or white spots in the mouth or on the lips
tightness in the chest
troubled swallowing
upper right abdominal pain
weakness
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of an overdose
Blindness
blurred vision or change in vision
dizziness
double vision
fainting
lightheadedness
rapid or irregular heartbeat
sleepiness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Quinine (Qualaquin)
Pros
Only need to take for a week to treat malaria
Taken by mouth
Available as a lower-cost generic
Cons
Taken every 8 hours
Only available as a capsule
Interacts with a lot of medications, including certain antiseizure medications and antibiotics
Pharmacist tips for Quinine (Qualaquin)
Before taking quinine (Qualaquin), your healthcare provider might test you to see if you have any problems with a special enzyme called glucose-6-phosphate dehydrogenase. If you're missing this enzyme, then you have a higher risk of low red blood cell count from quinine (Qualaquin), so your provider might give you a different medication.
Review your travel itinerary and see if you need to take preventative medication for malaria before traveling. This could help prevent you from getting infected with malaria and needing quinine (Qualaquin).
Take quinine (Qualaquin) with food to lower the chances of upset stomach.
If nausea or vomiting continue to be a problem, contact your provider. You might need nausea medication or a different antimalarial medication.
Quinine (Qualaquin) can cause unusual bleeding. Tell your healthcare provider if you notice any unusual signs of bleeding, such as easy bruising on your body, bloody nose, unusual bleeding from your gums with teeth brushing, or changes in the color of your stool or urine.
Quinine (Qualaquin) can make your skin more sensitive to light, which can last for up to several months after stopping the medication. Lower your risk by wearing sunscreen and avoiding direct sunlight and tanning beds.
Quinine (Qualaquin) interacts with several medications, such as rifampin (Rifadin), macrolide antibiotics, certain antiseizure medications, and anticoagulants like warfarin (Coumadin). This isn't a complete list. Make sure to tell your provider and pharmacist about all of the medications you're taking before and during treatment with quinine (Qualaquin).
Take quinine (Qualaquin) exactly as prescribed to you and finish your entire course. Stopping the medication earlier than prescribed raises your chances of your infection coming back and being harder to treat.
If you miss a dose of quinine (Qualaquin) and it has been less than 4 hours from when your dose was due, take your normal dose of quinine (Qualaquin). If it has been more than 4 hours from when your dose was due, skip this dose, and take your next scheduled dose. Don't try to double your next dose to catch-up on any missed doses.
Frequently asked questions about Quinine (Qualaquin)
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What are the risks and warnings for Quinine (Qualaquin)?
Quinine (Qualaquin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for leg cramps
Quinine (Qualaquin) is only FDA-approved for malaria treatment and shouldn't be used for treating leg cramps. This is because the evidence for using quinine (Qualaquin) for leg cramps isn't consistent and it can also cause severe and life-threatening side effects (e.g., heart problems, kidney problems, bleeding).
Low platelet counts (thrombocytopenia)
Quinine (Qualaquin) can cause your platelet levels to drop. This can lead to severe (serious) bleeding. Tell your healthcare provider if you notice any unusual signs of bleeding, such as easy bruising on your body, bloody nose, unusual bleeding from your gums with teeth brushing, or changes in the color of your stool or urine. Typically, your platelet levels will return to normal range once quinine (Qualaquin) is stopped. Make sure you're making regular appointments with your healthcare provider and getting your blood levels checked.
Hemolytic anemia (low red blood cells)
Quinine (Qualaquin) can cause hemolytic anemia, which is when your red blood cells are broken down. Your provider will monitor your blood cell counts before and during treatment. Contact your provider if you experience symptoms such as tiredness, dizziness, and weakness.
Life-threatening abnormal heart rhythm
Risk factors: Low blood potassium or magnesium levels | Older age | Heart rhythm or other heart problems | Family history of long QT syndrome | Taking other medications that cause QT prolongation | Taking high doses of quinine (Qualaquin)
Quinine (Qualaquin) can affect the time it takes for your heart to pump and then relax. This is known as QT prolongation. Your risk for QT prolongation is higher if you have certain factors, including abnormal electrolyte levels and heart rhythm problems. Your risk is also higher if you're taking other medications that cause heart rhythm problems, such as amiodarone (Pacerone) and quetiapine (Seroquel), among others. If you feel your chest pounding, have shortness of breath, have chest pain, or feel faint or lightheaded while taking quinine (Qualaquin), call 911 right away.
Low blood sugar
Risk factors: Pregnancy | Taking blood sugar-lowering medications
Quinine (Qualaquin) raises insulin levels, which can make your blood sugar low. It's best to carry with you some form of fast-acting sugar (e.g., glucose tablets, hard candy, fruit juice) at all times while you're taking this medication because you can use these to raise your blood sugar quickly if it becomes too low. If you experience symptoms of low blood sugar (e.g., shakiness, anxiety, unusual hunger or thirst, confusion), contact your provider.
Severe skin and allergic reactions
Severe allergic reactions to quinine (Qualaquin) are possible, including life-threatening reactions like facial swelling and anaphylaxis (e.g., closing of the throat). Quinine (Qualaquin) can also cause serious skin reactions (e.g., Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN)) and blood problems (e.g., thrombotic thrombocytopenic purpura (a blood clotting problem)). If you notice changes in your skin (e.g., sore throat, fever, fatigue, rash, painful blisters, skin reddening, skin peeling) or symptoms of blood problems (e.g., tiredness, dizziness, and weakness, headache, confusion), stop using quinine (Qualaquin) and get medical attention right away.
Quinine (Qualaquin) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 324mg | 30 capsules | $35.10 | $1.17 |
Typical dosing for Quinine (Qualaquin)
The typical dose is 648 mg (2 capsules) by mouth every 8 hours with food for 7 days.
Your dose might differ if you have kidney problems.
Interactions between Quinine (Qualaquin) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Astemizole
- Aurothioglucose
- Bepridil
- Cisapride
- Dronedarone
- Eliglustat
- Fluconazole
- Ketoconazole
- Mesoridazine
- Nelfinavir
- Pimozide
- Piperaquine
- Posaconazole
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfuzosin
- Aluminum Carbonate, Basic
- Aluminum Hydroxide
- Aluminum Phosphate
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Azithromycin
- Buprenorphine
- Buserelin
- Carbamazepine
- Ceritinib
- Chloroquine
- Chlorpromazine
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Codeine
- Crizotinib
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Digoxin
- Dihydrocodeine
- Dihydroxyaluminum Aminoacetate
- Dihydroxyaluminum Sodium Carbonate
- Disopyramide
- Dolasetron
- Domperidone
- Donepezil
- Droperidol
- Efavirenz
- Encorafenib
- Entrectinib
- Erythromycin
- Escitalopram
- Fingolimod
- Fluoxetine
- Formoterol
- Foscarnet
- Fostemsavir
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Histrelin
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Inotuzumab Ozogamicin
- Ivabradine
- Ivosidenib
- Lacosamide
- Lapatinib
- Lefamulin
- Lenvatinib
- Levofloxacin
- Lofexidine
- Lumefantrine
- Macimorelin
- Magaldrate
- Magnesium Carbonate
- Magnesium Hydroxide
- Magnesium Trisilicate
- Mefloquine
- Methadone
- Metronidazole
- Mifepristone
- Mirtazapine
- Moxifloxacin
- Nafarelin
- Nebivolol
- Nevirapine
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Pancuronium
- Panobinostat
- Pasireotide
- Pazopanib
- Pimavanserin
- Pitolisant
- Ponesimod
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinidine
- Ranolazine
- Ribociclib
- Rifampin
- Ritonavir
- Selpercatinib
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- Succinylcholine
- Sulpiride
- Sunitinib
- Tacrolimus
- Tamoxifen
- Telavancin
- Telithromycin
- Tetrabenazine
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Troleandomycin
- Tubocurarine
- Vandetanib
- Vardenafil
- Vemurafenib
- Vinflunine
- Voclosporin
- Voriconazole
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Quinine (Qualaquin) cost?
Quinine (Qualaquin) contraindications
History of blood problems from quinine (Qualaquin)
Allergy to mefloquine or quinidine
Optic neuritis (damaged eye nerve)
What are alternatives to Quinine (Qualaquin)?
Treatment of uncomplicated malaria caused by Plasmodium falciparum in people ages 16 years and older
Prevention and treatment of malaria caused by Plasmodium falciparum species
Treatment of uncomplicated malaria
Prevention of malaria in areas of the world where there's no quinine (Qualaquin) resistance
Extraintestinal amebiasis (a type of parasitic infection)
Quinine (Qualaquin) images
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References
Best studies we foundAl-Akchar, M., et al. (2022). Long QT syndrome. StatPearls.
Al-Khatib, S. M., e tal. (2003). What clinicians should know about the QT interval. Journal of the American Medical Association.
American Red Cross. (n.d.). Platelets and thrombocytopenia.
Bykowski, A., et al. (2023). Cinchonism. StatPearls.
Centers for Disease Control and Prevention. (2018). Intermittent preventive treatment of malaria for pregnant women (IPTp).
Centers for Disease Control and Prevention. (2021). Malaria information and prophylaxis, by country [A].
Centers for Disease Control and Prevention. (2022). Disease.
Centers for Disease Control and Prevention. (2023). Frequently asked questions (FAQs).
Centers for Disease Control and Prevention. (2023). Treatment of malaria: Guidelines for clinicians (United States).
Drugs and Lactation Database (LactMed). (2020). Quinine. National Institute of Child Health and Human Development.
Elmusa, E., et al. (2022). Quinine water-triggered atrial tachyarrhythmia. Cureus.
Guay, D. R. (2008). Are there alternatives to the use of quinine to treat nocturnal leg cramps? The Consultant Pharmacist.
Lupin Pharmaceuticals, Inc. (2023). Quinine sulfate capsule [package insert]. DailyMed.
Menakuru, S. R., et al. (2021). Disseminated intravascular coagulation due to drinking tonic water. Cureus.
National Heart, Lung, and Blood Institute. (2022). Hemolytic anemia.
Richardson, S. R., et al. (2022). Glucose-6-phosphate dehydrogenase deficiency. StatPearls.
Stanley, M., et al. (2023). Thrombotic thrombocytopenic purpura. StatPearls.
U.S. Food and Drug Administration. (2012). Serious risks associated with using quinine to prevent or treat nocturnal leg cramps. FDA News for Health Professionals.
You and Your Hormones. (2021). Insulin.
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