Jasoquin

Indication
Malaria, Nocturnal leg cramps
Adult Dose
Intravenous Malaria Adult: As diHCl: Initially, 20 mg/kg to max 1.4 g over 4 hr w/ maintenance infusion started after 8 hr. Maintenance infusions: 10 mg/kg to max 700 mg over 4 hr 8 hrly. Loading dose should not be given if patient received quinine, quinidine, halofantrine or mefloquine during the previous 12 hr. Hepatic impairment: Mild to moderate (Child-Pugh class A and B): No dosage adjustment needed. Severe: Reduce maintenance dose to 5-7 mg/kg of quinine salt 8 hrly.

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Child Dose
Intravenous Malaria Child: <5 mg/kg/hr by slow IV infusion. _ Renal Dose Renal impairment: Severe: Reduce maintenance dose to 5-7 mg/kg of quinine salt 8 hrly. Contraindication 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. 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. Precaution 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. Side Effect <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. _ Interaction 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. _