QUININE DIHYDRO. INJ

Quinine injection works primarily by interfering with the normal structural arrangement and function of DNA in the malaria parasite, specifically the Plasmodium falciparum species. It exerts its antimalarial effect by inhibiting the heme polymerase enzyme, disrupting the detoxification process of heme, which is released during the digestion of host hemoglobin by the parasite. This accumulation of toxic heme complexes within the parasite contributes to its destruction. Quinine also displays a unique ability to bind to plasmodial food vacuole membranes, further enhancing its antimalarial activity. The drug's mechanism involves multiple processes, ultimately leading to the disruption of the parasite's cellular functions and contributing to its elimination from the body.

Antimalarial

Injection

The following are the uses of Quinine Injection:

• Used for treating severe falciparum malaria, a life-threatening form of the disease.
• Used for its ability to reduce fever and alleviate symptoms like shivering and muscle pain associated with malaria.
• Used for its antiparasitic properties to kill the Plasmodium parasites responsible for malaria.
• Used for managing nocturnal leg cramps, providing temporary relief from sudden, painful muscle contractions.
• Used for its potential off-label use in treating babesiosis, a parasitic infection transmitted by ticks.
• Used for its historical significance in the treatment of malaria, serving as a benchmark for modern antimalarial drugs.
• Used for educating medical professionals and students about the management of severe malaria cases.

In the case of an overdose of Quinine Injection, several symptoms may manifest. These include severe gastrointestinal distress, such as nausea, vomiting, and diarrhea, as well as potential cardiovascular issues like hypotension and abnormal heart rhythms. Additionally, neurological symptoms like dizziness, headaches, and seizures may occur. Prompt medical intervention is necessary to manage these symptoms and prevent further complications, which can be life-threatening if left untreated.

In the case of a missed dose of Quinine Injection, it is important to contact your healthcare provider or pharmacist for guidance. They will be able to advise you on the appropriate action to take. Generally, if you miss a dose, administer it as soon as you remember, but if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for a missed one as this may increase the risk of side effects.

To administer the Quinine Injection, clean the injection site with an alcohol swab, insert the needle at a 90-degree angle, and slowly inject the prescribed dose as directed by your healthcare provider, ensuring the entire medication is delivered before withdrawing the needle.

Here are the conditions and situations when Quinine Injection should not be administered:

• Must not be used in individuals with a known allergy or hypersensitivity to quinine or any other quinidine-related compounds.
• Contraindicated in patients with a history of thrombocytopenia or a low platelet count.
• Should not be used in individuals with myasthenia gravis due to the risk of exacerbating muscle weakness.
• Not recommended for patients with a known heart rhythm disorder or a family history of long QT syndrome.
• Contraindicated in individuals with optic neuritis or vision problems.
• Should be avoided in patients with severe kidney or liver disease, as it may lead to further deterioration.
• Not suitable for pregnant or breastfeeding women due to potential risks to the fetus and infant.
• Must not be administered to individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, as it can trigger hemolytic anemia.
• Avoid using in patients with known blackwater fever, as quinine can aggravate this condition.
• Should not be used in individuals with a history of seizures or epilepsy, as it may lower the seizure threshold.

The side effects of Quinine Injection may include:

• Skin reactions such as flushing, itching, or rashes.
• Nausea and vomiting.
• Dizziness or lightheadedness.
• Headache.
• Visual disturbances, including blurred vision or changes in color vision.
• Ringing in the ears (tinnitus).
• Diarrhea or abdominal pain.
• Confusion or restlessness.

Following are the precautions and warnings:

• Quinine Injection should be used with extreme caution in individuals with known allergies or sensitivity to quinine or related compounds. Anaphylactic reactions can occur.
• This medication can cause life-threatening heart rhythm problems, especially in people with existing heart issues or when taking other medications that affect heart rhythm. Regular ECG monitoring is essential.
• It may cause severe skin reactions and blisters. Discontinue use and seek medical attention if any skin rashes or blisters appear.
• Quinine Injection can lower blood sugar levels. Patients with diabetes should monitor their blood sugar closely.
• Caution is advised in patients with kidney or liver disease, as the dosage may need adjustment.
• It may cause dizziness or lightheadedness. Avoid driving or operating heavy machinery until you know how this medication affects you.
• Pregnant or breastfeeding women should consult their healthcare provider before using Quinine Injection, as it can pass into breast milk and may harm the baby.

Following are the drug interactions for Quinine Injection:

• Concomitant use with mefloquine or chloroquine can increase the risk of cardiovascular adverse effects, including QT prolongation and arrhythmias.
• Quinine may reduce the efficacy of antimalarial drugs like artemether-lumefantrine, and their combination should be avoided.
• The risk of bleeding may increase when used with anticoagulants such as warfarin or heparin, requiring close monitoring.
• When combined with digoxin, quinine can increase digoxin levels, leading to potential toxicity.
• Caution is advised with drugs that affect the QT interval, like antiarrhythmics or certain antipsychotics, as quinine may further prolong the QT interval.
• It can decrease the effectiveness of oral contraceptives, requiring alternative contraceptive methods during and after treatment.
• The concentration of quinine may be reduced by drugs that induce liver enzymes, potentially decreasing its therapeutic effect.

Following are the food interactions for Quinine Injection:

• Avoid grapefruit and grapefruit juice as they can alter the blood levels of Quinine, potentially increasing the risk of side effects like irregular heart rhythm.
• Alcohol consumption should be avoided as it may increase the risk of adverse effects, particularly affecting the central nervous system.
• Caffeine intake should be monitored as Quinine can enhance its effects, leading to increased alertness and potential sleep disturbances.
• Limit the consumption of foods rich in vitamin B1 (thiamine) as Quinine may reduce its absorption, which is crucial for energy metabolism.
• Be cautious with foods containing high levels of potassium, as Quinine can cause potassium levels to rise, potentially affecting heart function.
• Avoid excessive salt (sodium) intake, as Quinine may impact sodium levels, and high sodium can lead to fluid retention and increased blood pressure.
• Ensure adequate fluid intake to maintain hydration, as Quinine can cause fluid shifts and potential electrolyte imbalances.
• Consult your healthcare provider for specific dietary recommendations, especially if you have existing medical conditions or are taking other medications.

Store Quinine Injection in a controlled room temperature environment, typically between 68°F and 77°F (20°C and 25°C), and protect it from light. Keep the injection in its original packaging until use to maintain sterility. Do not freeze the solution as it may affect its potency. Once opened, the injection should be used promptly and any unused portion discarded. Dispose of all injection materials, including needles and syringes, in a safe and appropriate manner, such as a designated sharps container. It is crucial to keep this medication out of sight and reach of children and pets to prevent accidental exposure. Always consult a healthcare professional or pharmacist for specific storage instructions and disposal regulations in your area.

Following are the quick tips for Quinine Injection:

• Quinine injections should be administered by trained medical professionals only.
• Ensure the injection site is clean and disinfected before administering the injection.
• Follow the prescribed dosage and duration as directed by your doctor.
• Report any side effects or unusual symptoms to your healthcare provider immediately.
• Do not inject if the solution appears cloudy or contains particles.
• Store the injection as directed on the packaging, away from direct sunlight and extreme temperatures.
• Do not reuse or share needles; dispose of them safely after use.
• Keep a record of your injection dates and dosages for reference.