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Quinine dihydrochloride Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Consult with microbiology/infectious diseases recommended
- See under 'Dose' for adjustments required in renal impairment
- Given by intravenous infusion for patients who are seriously ill or unable to take tablets - see GUH antimicrobial guidelines (GAPP app)
- Change to oral therapy as soon as possible
- Emergency supply available in ED
- Baseline ECG required - see monitoring
- Unlicensed preparation
Available preparations
Quinine dihydrochloride 300mg per 10ml ampoule (Ipswich NHS trust)
Reconstitution
Already in solution
Dilute further prior to administration
Infusion fluids
Glucose 5% (preferably) or Sodium chloride 0.9%
Methods of intravenous administration
Intermittent intravenous infusion (administer using an electronically controlled device)
- Add required dose to 250 to 500ml infusion fluid and administer over four hours (ref 1)
Dose in adults
Treatment of severe and complicated malaria
Loading dose
- Give 20mg/kg (up to maximum 1.4g) over four hours
- Loading dose should NOT be used if the patient has received quinine or mefloquine in previous 12 hours
- See below for alternative loading regimen in ICU
Maintenance dose (to be commenced eight hours after start of loading dose infusion)
- Give 10mg/kg (up to maximum 700mg) administered over four hours, repeated every eight hours
- Reduce maintenance dose to 5 to 7mg/kg if parenteral treatment required for more than 48 hours
- See further information below for adjustment in renal or hepatic impairment
Intensive Care setting where rapid treatment required
- As an alternative to the above regimen, the loading dose can be given by infusing a 7mg/kg dose over 30 minutes
- This should be followed immediately by the first of the maintenance doses of 10mg/kg (up to maximum 700mg) over four hours
- After eight hours (from the start of the previous infusion), continue with the usual maintenance dose
Renal impairment
- Note: The guidance for renal impairment differs between sources (BNF,WHO guidelines, Renal Drug Database)
- If the patient with severe malaria has persisting acute kidney injury, reduce the maintenance dose of quinine by one-third to 5 to 7mg/kg every eight hours or 10mg/kg (max 700mg) every twelve hours (ref 3, BNF)
Hepatic impairment
- Reduce maintenance dose to 5 to 7mg/kg in severe hepatic impairment
Monitoring
- Monitor ECG particularly in elderly patients or in cardiac disease (atrial fibrillation, conduction defects, heart block) (ref 1)
- Monitor blood glucose (every two hours in the acute situation), and electrolytes during treatment (parenteral treatment may cause hypoglycaemia)
- Extravasation may cause tissue damage
Storage
Store below 250C
References
1: Injectable Medicines Adminstration Guide, Medusa downloaded 02/06/2022
2: GUH antimicrobial guidelines 2022
3: WHO Guidelines for the treatment of malaria 31st March 2022
BNF accessed online 02/06/2022
Therapeutic classification
Antimalarials