Quinine

Indications

  • Leg Cramps

Pharmacology

  • xxx

Administration

  • PO

Adverse Effects

Hematologic Adverse Effects

  • Doubtful Risk of Hemolysis in Patient with G6PD Deficiency (see Glucose-6-Phosphate Dehydrogenase Deficiency, [[Glucose-6-Phosphate Dehydrogenase Deficiency]] and Hemolytic Anemia, [[Hemolytic Anemia]])

  • Thrombotic Thrombocytopenic Purpura (TTP) (see Thrombotic Thrombocytopenic Purpura, [[Thrombotic Thrombocytopenic Purpura]])

    • Quinine is used as food additive and medication
    • In a series of HUS/TTP patients 11% reported taking quinine compared to 6% taking other drugs.88 In sensitized patients the typical clinical pattern is an abrupt onset of chills, myalgia, vomiting, and oliguria immediately after quinine exposure. Anemia is often mild. Patients can be shown to have antibodies that recognize different glycoprotein epitopes on platelets, red cells, and leukocytes.89,90 This interaction is quinine dependent, suggesting that a neoantigen is formed. In platelets, the antibody has been found to cross-react with glycoprotein IIb/ IIIa and sometimes Ib/IX. The disorder is comparatively mild and remits if plasma exchange is started early enough and quinine avoided. ADAMTS13 plasma activity is typically normal.

Other Adverse Effects

  • xxx

References

  • Quinine-innduced immune thrombocytopenia with haemolytic uremic syndrome: clinical and serological findings in nine patients and review of literature. Am J Hematol 1994; 47: 283–289
  • Quinine sensitivity. A new cause of the haemolytic uremic syndrome. Ann Int Med 1993; 119: 243–244
  • Quinine-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: frequency, clinical features and long-term outcomes. Ann Intern Med 2001; 135: 1047–1051
  • Characterization of multiple quinine-dependent antibodies in a patient with episodic haemolytic uremic syndrome and immune agranuocytosis. Blood 1992; 80: 241–248
  • Quinine-induced immune thrombocytopenic purpura followed by hemolytic uremic syndrome. Am J Kidney Dis 1999; 33: 133–137