QUININE
Drugs in Pregnancy and Lactation.
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Name: QUININE
Class: Antimalarial
Risk Factor: D*
Fetal Risk Summary
Nishimura and Tanimura (1) summarized the human case reports of teratogenic effects linked with quinine in 21 infants who were exposed during the 1st trimester after unsuccessful abortion attempts (some infants had multiple defects and are listed more than once):
Central nervous system (CNS) anomalies (6 with hydrocephalus) (10 cases)
Limb defects (3 dysmelias) (8 cases)
Facial defects (7 cases)
Heart defects (6 cases)
Digestive organ anomalies (5 cases)
Urogenital anomalies (3 cases)
Hernias (3 cases)
Vertebral anomaly (1 case)
The malformations noted are varied, although CNS anomalies and limb defects were the most frequent. Auditory defects and optic nerve damage have also been reported (1,2,3,4 and 5). These reports usually concern the use of quinine in toxic doses as an abortifacient. Quinine has also been used for the induction of labor in women with intrauterine fetal death (6). Epidemiologic observations do not support an increased teratogenic risk or increased risk of congenital deafness over non-quinine-exposed patients (1,7). Neonatal and maternal thrombocytopenia purpura and hemolysis in glucose-6-phosphate dehydrogenase–deficient newborns has been reported (8,9).
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 35 newborns had been exposed to quinine during the 1st trimester (F. Rosa, personal communication, FDA, 1993). Two (5.7%) major birth defects were observed (one expected). No anomalies were observed in six defect categories (cardiovascular defects, oral clefts, spina bifida, polydactyly, limb reduction defects, and hypospadias) for which specific data were available.
Quinine has effectively been replaced by newer agents for the treatment of malaria. Although no increased teratogenic risk can be documented, its use during pregnancy should be avoided. One manufacturer considers the drug to be contraindicated in pregnancy (10). However, some investigators believe quinine should be used for the treatment of chloroquine-resistant Plasmodium falciparum malaria (11).
[*Risk Factor X according to manufacturer—Merrell Dow, 1993.]
Breast Feeding Summary
Quinine is excreted into breast milk. Following 300- and 640-mg oral doses in six patients, milk concentrations varied up to 2.2 µg/mL with an average level of 1 µg/mL at 3 hours (12). No adverse effects were reported in the nursing infants. Patients at risk for glucose-6-phosphate dehydrogenase deficiency should not be breast-fed until this disease can be ruled out. The American Academy of Pediatrics considers quinine to be compatible with breast feeding (13).
References
- Nishimura H, Tanimura T. Clinical Aspects of The Teratogenicity of Drugs. New York, NY: American Elsevier, 1976:140–3.
- Robinson GC, Brummitt JR, Miller JR. Hearing loss in infants and preschool children. II. Etiological considerations. Pediatrics 1963;32:115–24.
- West RA. Effect of quinine upon auditory nerve. Am J Obstet Gynecol 1938;36:241–8.
- McKinna AJ. Quinine induced hypoplasia of the optic nerve. Can J Ophthalmol 1966;1:261.
- Morgon A, Charachon D, Brinquier N. Disorders of the auditory apparatus caused by embryopathy or foetopathy. Prophylaxis and treatment. Acta Otolaryngol (Stockh) 1971;291(Suppl):5.
- Mukherjee S, Bhose LN. Induction of labor and abortion with quinine infusion in intrauterine fetal deaths. Am J Obstet Gynecol 1968;101:853–4.
- Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA: Publishing Sciences Group, 1977:299,302,333.
- Mauer MA, DeVaux W, Lahey ME. Neonatal and maternal thrombocytopenic purpura due to quinine. Pediatrics 1957;19:84–7.
- Glass L, Rajegowda BK, Bowne E, Evans HE. Exposure to quinine and jaundice in a glucose-6-phosphate dehydrogenase-deficient newborn infant. Pediatrics 1973;82:734–5.
- Product information. Quinamm. Merrell Dow, 1990.
- Strang A, Lachman E, Pitsoe SB, Marszalek A, Philpott RH. Malaria in pregnancy with fatal complications: case report. Br J Obstet Gynaecol 1984;91:399–403.
- Terwilliger WG, Hatcher RA. The elimination of morphine and quinine in human milk. Surg Gynecol Obstet 1934;58:823–6.
- Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.
Q&A about Quinine
Quinine treats malaria and tonic water has 20mg of quinine per 375mL can and the dosage required for the treatment of malaria is approximately six 300mg tablets per day. Would drinking tonic water be an effective approach to treat malaria?
1800 mg / 20 mg per bottle of tonic water means you need 90 bottles of tonic water per day.
No, I do not think it is reasonable to assume someone can drink 90 bottles of tonic water a day to treat malaria.
My neighbors are afraid of the quinine tree i plated 30 years ago because it has grown more than 40 feet and if it falls, their houses may be detroyed. However, I want to preserve the tree as much as possible, but would also like to address their concern. I have read that a cinchona (quinine) tree was badly pruned and it died in a park in Hawaii. Please help.
That is a tall tree and you need to know how to deal with large trees before attempting anything!! Consider a professional arborist.
You look at the tree, and see what parts are threats to your neighbor, and what parts would give the tree good balance (visually) if removed.
The process you need to use is Thinning. Pick the most threatening branch and perform a prune cut. 3 cuts to avoid stripping the bark off the main branch - 1/3 through the bottom 12 inches or so back from the branch crotch, then out 4 to 6 inches more and cut through from the top, until the branch snaps and comes off. The last cut is just outside the collar where the stump of the branch joins the main branch. Do not harm the collar, but cut through as close as possible.
This will eventually seal over the wound. No need for paint or tar, that can only trap moisture and promote disease.
If the main trunk is the problem - this is a different name for the cut, but essentially, it is the same process.
If for some reason you are doing this yourself - get lots of 5/8" rope, and tie the branches in a way that allows you to lower them from the tree slowly after being cut. The rope will support the branch after being cut, and be over a branch crotch higher in the tree, then down to the ground wrapped like a capstain around another immovable object. After the cut is made, the branch is held in the air by the rope, then slowly lowered. Be careful not to think you can support hundreds of pounds directly, use pullies or wrap the rope as said above.
Best to get a pro!
Quinine comes from the rainforest i know but does anyone know how Quinine is used by the people of the rainforest??
Thanks!!
Other folk remedies in South America cite quinine bark as a natural remedy for cancer (breast, glands, liver, mesentery, spleen), amebic infections, heart problems, colds, diarrhea, dysentery, dyspepsia, fevers, flu, hangover, lumbago, malaria, neuralgia, pneumonia, sciatica, typhoid, and varicose veins.
My doctor prescribed quinine for night cramps from which I suffer regularley. What I want to know is, in what way does quinine stop/ease cramps. I know it is prescribed to prevent Malaria in some countries when you travel & wonder how that works also? I would prefer answers from actual knowledge or experience, not guesses.
Why do some tonic waters contain quinine? What IS quinine? Thanks!
Nowadays however, the amounts of quinine are so minute that they are far from medicinal. They are just added for the bitter flavor.
My aunt is allergic to iodine and shellfish. Her doctor has prescribed quinine sulfate for her leg pains. Is quinine similar to iodine and would she be allergic to the quinine also?
No, they are not similar at all.... Quinine is a relatively complex compound....
Iodine is a chemical element, and is a common allergen.
Iodine is a common nutrient found in seafood (because of the amount of iodine in ocean water)..
Quinine is not found in ocean water.
Namaste, and Happy New Year,
--Tom
I was wondering, after creating a decoction or tincture of cinchona bark so that it can contain quinine, how long does that mixture keep its effectiveness (potency)?
Also, do you know how long the bark, or bark powder, retains its potency?
I've hear that it is not good for pregnant women to drink liquids containing quinine. Any info would be much appreciated!
BfR believes labelling is needed
The information “contains quinine” is stated on every tonic or bitter lemon beverage. But only few consumers will know why. Even if the enjoyment of quinine-containing beverages is not problematic for most of the population, the consumption of larger amounts can be harmful for some individuals. “Pregnant women, in particular, should refrain from consuming this substance for precautionary reasons”, says BfR President Professor Dr. Dr. Andreas Hensel. People who have been advised against quinine because of a specific clinical picture or an oversensitivity to cinchona alkaloids, should avoid quinine-containing beverages. In order to raise awareness amongst consumers about possible risks, BfR recommends that the previous labelling be extended to include specific information for pregnant women and other specific target groups.
There are conflicting reports on both the safety and effectiveness of daily doses of quinine to releive muscle cramps. What's the medical answer?
Quinine is also used to treat nighttime leg muscle cramps.
Quinine may cause side effects:
* stomach pain
* vomiting
* stomach upset
* dizziness
* headache
* sweating
* restlessness
* confusion
* apprehension
Where can you get quinine other than tonic water? I hate tonic water, but the capsules work for my leg cramps.