{"id":60382,"date":"2024-02-28T06:46:37","date_gmt":"2024-02-28T06:46:37","guid":{"rendered":"https:\/\/medsname.com\/quinin-300\/"},"modified":"2026-04-30T10:23:48","modified_gmt":"2026-04-30T10:23:48","slug":"quinin-300","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/quinin-300\/","title":{"rendered":"Quinin 300"},"content":{"rendered":"

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Rychl\u00e1 odpov\u011b\u010f<\/h3>\n

Quinin 300<\/strong> obsahuje chinin sulf\u00e1t 300 mg<\/strong> (East African Pharmaceuticals (nebo generick\u00fd 300 mg)). Jedn\u00e1 se o druhou volbu peror\u00e1ln\u00ed l\u00e9\u010dby pro chlorochin-rezistentn\u00ed nekomplikovanou mal\u00e1rii P. falciparum<\/strong> \u2014 historicky kombinovan\u00fd s doxycyklinem, tetracyklinem nebo klindamycinem ke zkr\u00e1cen\u00ed l\u00e9\u010dby a sn\u00ed\u017een\u00ed recidivy. Modern\u00ed doporu\u010den\u00ed WHO up\u0159ednost\u0148uje artemisininovou kombina\u010dn\u00ed terapii (ACT)<\/strong> kde je dostupn\u00e1; chinin z\u016fst\u00e1v\u00e1 ve vybran\u00e9m pou\u017eit\u00ed, kde ACT nen\u00ed dostupn\u00e1, je kontraindikov\u00e1na nebo selhala. Standardn\u00ed d\u00e1vkov\u00e1n\u00ed: 650 mg ka\u017ed\u00fdch 8 hodin po dobu 3\u20137 dn\u00ed<\/strong> s doxycyklinem 100 mg 2\u00d7 denn\u011b po dobu 7 dn\u016f. \u010cast\u00e9 a d\u00e1vkov\u00e1n\u00ed limituj\u00edc\u00ed ne\u017e\u00e1douc\u00ed \u00fa\u010dinky (\u201ccinchonismus\u201d \u2014 tinnitus, bolest hlavy, nevolnost, z\u00e1vrat\u011b, rozmazan\u00e9 vid\u011bn\u00ed). NEPOU\u017d\u00cdVAT p\u0159i k\u0159e\u010d\u00edch neklidn\u00fdch nohou<\/strong> (FDA \u010dern\u00e1 v\u00fdstra\u017en\u00e1 tabulka od roku 2010 pro toto pou\u017eit\u00ed mimo schv\u00e1len\u00e9 indikace). NEPOU\u017d\u00cdVEJTE bez l\u00e9ka\u0159sk\u00e9ho dohledu.<\/p>\n<\/div>\n

\ud83c\udfed V\u00fdrobce certifikovan\u00fd WHO-GMP<\/strong>  \u00b7  \ud83d\udce6 Diskr\u00e9tn\u00ed balen\u00ed<\/strong>  \u00b7  \ud83c\udf0d Doprava do cel\u00e9ho sv\u011bta<\/strong>  \u00b7  \u2b50 1,400+ recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a><\/strong><\/div>\n

\ud83d\udee1\ufe0f Ka\u017ed\u00e1 objedn\u00e1vka je kryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, za\u0161leme zdarma n\u00e1hradn\u00ed z\u00e1silku prost\u0159ednictv\u00edm kur\u00fdrn\u00ed slu\u017eby EMS nebo ITPS.<\/p>\n

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

Quinin 300 je z\u00edsk\u00e1v\u00e1n od v\u00fdrobce certifikovan\u00e9ho WHO-GMP a dod\u00e1v\u00e1n po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm balen\u00ed. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a> a podporov\u00e1na na\u0161\u00ed 1,400+ recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>. . Celosv\u011btov\u00e1 doprava bez p\u0159edpisov\u00e9 dokumentace.<\/p>\n

O p\u0159\u00edpravku Quinin 300<\/h2>\n

Quinin 300 je tableta obsahuj\u00edc\u00ed 300 mg s\u00edranu chininu vyr\u00e1b\u011bn\u00e1 spole\u010dnost\u00ed East African Pharmaceuticals (nebo generick\u00e1 300 mg) za podm\u00ednek certifikovan\u00fdch WHO-GMP. Chinin je p\u016fvodn\u00ed antimalarikum \u2013 extrahovan\u00e9 z k\u016fry jihoamerick\u00e9ho chinovn\u00edku jezuitsk\u00fdmi mision\u00e1\u0159i v 17. stolet\u00ed, izolovan\u00e9 v \u010dist\u00e9 form\u011b Pelletierem a Caventouem v roce 1820 a standardn\u00ed l\u00e9\u010dba mal\u00e1rie po dal\u0161\u00edch 100 let p\u0159ed chlorochinem. Z\u016fst\u00e1v\u00e1 na seznamu z\u00e1kladn\u00edch l\u00e9k\u016f WHO jako druh\u00e1 volba pro l\u00e9\u010dbu P. falciparum a jako intraven\u00f3zn\u00ed terapie pro t\u011b\u017ekou mal\u00e1rii, kde nen\u00ed k dispozici intraven\u00f3zn\u00ed artesun\u00e1t.<\/p>\n

Modern\u00ed role.<\/strong> WHO a v\u011bt\u0161ina n\u00e1rodn\u00edch sm\u011brnic nyn\u00ed doporu\u010duje artemisininovou kombinovanou terapii (ACT \u2013 artemether-lumefantrin, dihydroartemisinin-piperaquin, artesun\u00e1t-amodiaquin) jako prvn\u00ed volbu pro nekomplikovanou mal\u00e1rii P. falciparum, proto\u017ee ACT rychleji odstra\u0148uj\u00ed infekce, jsou l\u00e9pe sn\u00e1\u0161eny a sni\u017euj\u00ed recidivy. Chinin z\u016fst\u00e1v\u00e1 platnou druhou volbou tam, kde ACT nejsou k dispozici, jsou kontraindikov\u00e1ny nebo selhaly, v prvn\u00edm trimestru t\u011bhotenstv\u00ed (kde jsou \u00fadaje o ACT omezen\u00e9) a intraven\u00f3zn\u011b pro t\u011b\u017ekou mal\u00e1rii, kde nen\u00ed k dispozici intraven\u00f3zn\u00ed artesun\u00e1t.<\/div>\n
Varov\u00e1n\u00ed p\u0159ed syndromem neklidn\u00fdch nohou.<\/strong> Chinin byl historicky pou\u017e\u00edv\u00e1n pro no\u010dn\u00ed k\u0159e\u010de nohou a syndrom neklidn\u00fdch nohou \u2013 FDA vydala \u010dernou v\u00fdstra\u017enou tabulku v roce 2010 proti tomuto pou\u017eit\u00ed mimo schv\u00e1len\u00e9 indikace<\/strong> po hl\u00e1\u0161en\u00ed fat\u00e1ln\u00edch arytmi\u00ed, t\u011b\u017ek\u00e9 trombocytopenie a hemolyticko-uremick\u00e9ho syndromu. Pom\u011br rizika a p\u0159\u00ednosu je nep\u0159ijateln\u00fd pro nimalarickou indikaci. Quinin 300 je ur\u010den pouze pro l\u00e9\u010dbu mal\u00e1rie<\/strong> \u2013 nikoli pro k\u0159e\u010de nebo neklidn\u00e9 nohy.<\/div>\n

Jak chinin funguje<\/h2>\n

Chinin je chininov\u00fd alkaloid, kter\u00fd naru\u0161uje detoxifikaci hem\u016f parazita v potravn\u00ed vakuole \u2013 stejn\u00fd mechanismus jako chlorochin a meflochin. Je \u00fa\u010dinn\u00fd proti krevn\u00edm stadi\u00edm P. falciparum (v\u010detn\u011b v\u011bt\u0161iny kmen\u016f rezistentn\u00edch na chlorochin), P. vivax, P. ovale a P. malariae. NEodstra\u0148uje dormantn\u00ed hypnozoity \u2013 pro radik\u00e1ln\u00ed l\u00e9\u010dbu vivax\/ovale je nutn\u00fd primachin.<\/p>\n

Chinin m\u00e1 kr\u00e1tk\u00fd polo\u010das (~ 11 hodin) \u2013 b\u011bhem l\u00e9\u010debn\u00fdch cykl\u016f je nutn\u00e9 pod\u00e1v\u00e1n\u00ed t\u0159ikr\u00e1t denn\u011b. M\u00e1 \u00fazk\u00e9 terapeutick\u00e9 okno: \u00fa\u010dinnost je z\u00e1visl\u00e1 na d\u00e1vce, ale stejn\u011b tak i toxicita (chininismus, hypoglyk\u00e9mie, prodlou\u017een\u00ed QT intervalu, vz\u00e1cn\u00e1 kardiotoxicita).<\/p>\n

Indikace a d\u00e1vkov\u00e1n\u00ed<\/h2>\n
\n\n\n\n\n\n\n\n\n
Indikace<\/th>\nD\u00e1vka<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
Nekomplikovan\u00e1 mal\u00e1rie zp\u016fsoben\u00e1 chlorochin-rezistentn\u00edm P. falciparum, dosp\u011bl\u00ed<\/td>\n650 mg peror\u00e1ln\u011b ka\u017ed\u00fdch 8 hodin po dobu 3 dn\u016f (Afrika) nebo 7 dn\u016f (jihov\u00fdchodn\u00ed Asie)<\/td>\nKombinovat s doxycyklinem 100 mg 2\u00d7 denn\u011b po dobu 7 dn\u016f nebo klindamycinem 20 mg\/kg\/den v t\u011bhotenstv\u00ed.<\/td>\n<\/tr>\n
T\u011b\u017ek\u00e1 mal\u00e1rie, nitro\u017eiln\u00ed pod\u00e1n\u00ed v nemocnici (kdy\u017e nen\u00ed k dispozici intraven\u00f3zn\u00ed artesun\u00e1t)<\/td>\n20 mg\/kg \u00favodn\u00ed d\u00e1vka b\u011bhem 4 hodin \u2192 10 mg\/kg ka\u017ed\u00fdch 8 hodin IV<\/td>\nMonitorov\u00e1n\u00ed srde\u010dn\u00ed \u010dinnosti a hladiny gluk\u00f3zy povinn\u00e9. P\u0159echod na peror\u00e1ln\u00ed pod\u00e1n\u00ed 650 mg ka\u017ed\u00fdch 8 hodin, jakmile tolerov\u00e1no.<\/td>\n<\/tr>\n
Babesi\u00f3za (B. microti \/ B. divergens) \u2014 druh\u00e1 volba<\/td>\n650 mg ka\u017ed\u00fdch 6\u20138 hodin s klindamycinem nebo atovakvon-azithromycinem<\/td>\nSpecializovan\u00fd kontext onemocn\u011bn\u00ed p\u0159en\u00e1\u0161en\u00fdch kl\u00ed\u0161\u0165aty.<\/td>\n<\/tr>\n
D\u011btsk\u00e1 nekomplikovan\u00e1 mal\u00e1rie P. falciparum (\u2265 6 kg)<\/td>\n8,3 mg\/kg ka\u017ed\u00fdch 8 hodin po dobu 3\u20137 dn\u016f<\/td>\nS v\u00e1hov\u011b p\u0159im\u011b\u0159enou d\u00e1vkou doxycyklinu (\u2265 8 let) nebo klindamycinu (v jak\u00e9mkoli v\u011bku).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
Cinchonismus \u2014 \u010dast\u00fd a d\u00e1vkov\u011b limituj\u00edc\u00ed.<\/strong> V\u011bt\u0161ina pacient\u016f na terapeutick\u00e9 d\u00e1vce chininu vyvine cinchonismus<\/strong> \u2014 syndrom zahrnuj\u00edc\u00ed tinnitus, m\u00edrnou ztr\u00e1tu sluchu, bolesti hlavy, nevolnost, z\u00e1vrat\u011b a rozmazan\u00e9 vid\u011bn\u00ed. Zvon\u011bn\u00ed v u\u0161\u00edch (tinnitus) a vysokofrekven\u010dn\u00ed ztr\u00e1ta sluchu jsou nejspolehliv\u011bj\u0161\u00edmi \u010dasn\u00fdmi p\u0159\u00edznaky. Cinchonismus nevy\u017eaduje vysazen\u00ed l\u00e9ku p\u0159i m\u00edrn\u00e9m pr\u016fb\u011bhu, ale signalizuje terapeutick\u00e9 hladiny v plazm\u011b. T\u011b\u017ek\u00fd cinchonismus (hluchota, vertigo, siln\u00e1 nevolnost, zm\u011bny ment\u00e1ln\u00edho stavu) vy\u017eaduje revizi d\u00e1vkov\u00e1n\u00ed.<\/div>\n
Kardi\u00e1ln\u00ed a hypoglykemick\u00e9 varov\u00e1n\u00ed (\u010derven\u00fd r\u00e1me\u010dek).<\/strong> Chinin prodlu\u017euje QTc interval a m\u016f\u017ee zp\u016fsobit t\u011b\u017ekou hypoglyk\u00e9mii<\/strong> stimulac\u00ed uvol\u0148ov\u00e1n\u00ed inzulinu z beta bun\u011bk slinivky \u2014 oba efekty jsou zes\u00edleny p\u0159i intraven\u00f3zn\u00edm pod\u00e1n\u00ed a v t\u011bhotenstv\u00ed. Nemocni\u010dn\u00ed intraven\u00f3zn\u00ed pod\u00e1n\u00ed vy\u017eaduje kontinu\u00e1ln\u00ed kardi\u00e1ln\u00ed monitoring + \u010dast\u00e9 m\u011b\u0159en\u00ed glyk\u00e9mie z prstu. Vyvarujte se kombinace s dal\u0161\u00edmi l\u00e9ky prodlu\u017euj\u00edc\u00edmi QT interval (azithromycin, ondansetron, antipsychotika, fluorochinolony, metadon). T\u011b\u017ek\u00e1 n\u00e1hl\u00e1 hypoglyk\u00e9mie je l\u00e9ka\u0159sk\u00e1 pohotovost \u2014 pod\u00e1vejte gluk\u00f3zu intraven\u00f3zn\u011b.<\/div>\n

Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n