Quinin 300
✅ Malaria symptom relief
✅ Fever reduction
✅ Parasite eradication
✅ Improved recovery
✅ Prevention of relapse
Quinin contains Quinine Sulphate.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
Quick Answer
Quinin 300 contains quinine sulfate 300 mg (East African Pharmaceuticals (or generic 300 mg)). It is a second-line oral treatment for chloroquine-resistant uncomplicated P. falciparum malaria — historically combined with doxycycline, tetracycline, or clindamycin to shorten treatment and reduce recrudescence. Modern WHO guidance prefers artemisinin combination therapy (ACT) where available; quinine remains in selected use where ACTs are unavailable, contraindicated, or have failed. Standard treatment dose: 650 mg every 8 hours for 3–7 days with doxycycline 100 mg BID for 7 days. Side-effect cluster (“cinchonism” — tinnitus, headache, nausea, dizziness, blurred vision) is common and dose-limiting. NOT for restless legs cramping (FDA black-box warning since 2010 for that off-label use). Do NOT use without medical supervision.
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About Quinin 300
Quinin 300 is a 300 mg quinine sulfate tablet manufactured by East African Pharmaceuticals (or generic 300 mg) under WHO-GMP certified conditions. Quinine is the original antimalarial — extracted from the bark of the South American cinchona tree by Jesuit missionaries in the 17th century, isolated in pure form by Pelletier and Caventou in 1820, and the standard malaria treatment for the next 100 years before chloroquine. It remains on the WHO Essential Medicines list for second-line P. falciparum treatment and as IV therapy for severe malaria where IV artesunate is unavailable.
How quinine works
Quinine is a cinchona alkaloid that interferes with parasite haem detoxification in the food vacuole — the same mechanism family as chloroquine and mefloquine. It is active against blood-stage P. falciparum (including most chloroquine-resistant strains), P. vivax, P. ovale, and P. malariae. It does NOT clear dormant hypnozoites — primaquine is needed for radical cure of vivax / ovale.
Quinine has a short half-life (~ 11 hours) — three-times-daily dosing is needed during treatment courses. It has a narrow therapeutic window: efficacy is dose-related, but so is toxicity (cinchonism, hypoglycaemia, QT prolongation, rare cardiotoxicity).
Indications and dosing
| Indication | Dose | Notes |
|---|---|---|
| Uncomplicated chloroquine-resistant P. falciparum malaria, adult | 650 mg PO every 8 h for 3 days (Africa) or 7 days (Southeast Asia) | Combine with doxycycline 100 mg BID for 7 days, or clindamycin 20 mg/kg/day in pregnancy. |
| Severe malaria, hospital IV (where IV artesunate unavailable) | 20 mg/kg loading over 4 h → 10 mg/kg every 8 h IV | Cardiac monitoring + glucose monitoring mandatory. Switch to oral 650 mg q8h once tolerated. |
| Babesiosis (B. microti / B. divergens) — second-line | 650 mg q6–8h with clindamycin or atovaquone-azithromycin | Specialist tick-borne disease context. |
| Paediatric uncomplicated P. falciparum (≥ 6 kg) | 8.3 mg/kg every 8 h for 3–7 days | With weight-appropriate doxycycline (≥ 8 years) or clindamycin (any age). |
Side effects
- Common (cinchonism, ≥ 30 %): tinnitus, headache, nausea, dizziness, blurred vision, mild high-frequency hearing loss — usually reversible after stopping.
- GI: abdominal pain, vomiting, diarrhoea.
- Cardiovascular: QTc prolongation, hypotension (especially with rapid IV bolus — never push IV quinine), palpitations.
- Endocrine: hypoglycaemia (can be severe, especially in pregnancy or in IV use).
- Haematological: thrombocytopenia, haemolytic anaemia (in G6PD-deficient patients), haemolytic-uraemic syndrome (rare but serious — can be fatal).
- Hypersensitivity: rash, urticaria, angioedema, anaphylaxis, drug-induced lupus.
- Neurological: rare seizures, optic neuritis, sudden hearing loss.
Drug interactions
| Interaction | Effect | Management |
|---|---|---|
| Mefloquine / chloroquine / hydroxychloroquine | Additive cardiotoxicity + lowered seizure threshold | Avoid combination — use one antimalarial. |
| Halofantrine | Severe additive QTc prolongation | Absolute contraindication. |
| Digoxin | Quinine raises digoxin level 2–3 fold | Halve digoxin dose; monitor digoxin level closely. |
| Warfarin | Quinine potentiates anticoagulant effect | Increase INR monitoring frequency. |
| QT-prolonging drugs (azithromycin, ondansetron, fluoroquinolones, antipsychotics, methadone) | Additive QTc prolongation | Avoid combination, especially in patients with electrolyte disturbance. |
| Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) | Raise quinine level → cinchonism / cardiotoxicity | Dose reduction; avoid combination where possible. |
| Strong CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, St John’s wort) | Lower quinine level → treatment failure | Avoid combination; choose alternative antimalarial. |
| Insulin / sulfonylureas | Additive hypoglycaemia | Monitor blood glucose closely. |
Contraindications and cautions
- Absolute: hypersensitivity to quinine, quinidine, or related cinchona alkaloids; pre-existing optic neuritis; tinnitus; G6PD deficiency (haemolysis); myasthenia gravis (worsens neuromuscular block); severe cardiac conduction abnormality (high-grade AV-block, severe bradycardia, prolonged QTc); concurrent halofantrine; thrombocytopenic purpura associated with prior quinine.
- Strong caution: renal or hepatic impairment, atrial fibrillation with conduction defects, hypoglycaemia-prone patients (insulin / sulfonylurea-treated diabetics, severe malaria), pregnancy (hypoglycaemia risk).
- Pregnancy: compatible (with clindamycin partner). Hypoglycaemia risk is amplified — close glucose monitoring required.
- Breastfeeding: compatible — small amounts in breast milk insufficient for infant prophylaxis or harm.
Storage
Store below 25 °C in a dry place, in original packaging. Keep out of reach of children.
Frequently Asked Questions
Is Quinin 300 first-line for malaria?
No. Modern WHO guidance recommends artemisinin combination therapy (artemether-lumefantrine, dihydroartemisinin-piperaquine, artesunate-amodiaquine) as first-line for uncomplicated P. falciparum malaria. Quinine is a second-line option where ACTs are unavailable, contraindicated, or have failed.
Why combine quinine with doxycycline or clindamycin?
Quinine alone has a slow parasite-clearance rate and significant recrudescence (relapse from remaining parasites) when used as monotherapy in modern resistant strains. Adding a partner drug (doxycycline, tetracycline, or clindamycin in pregnancy) shortens the effective treatment course, lowers recrudescence, and improves outcomes.
What is cinchonism and is it dangerous?
Cinchonism is the cluster of tinnitus, headache, nausea, dizziness, and mild high-frequency hearing loss seen at therapeutic quinine doses. It is uncomfortable but usually reversible after stopping. Severe cinchonism (deafness, vertigo, severe nausea, mental change) warrants dose review or switching antimalarial.
Can Quinin 300 be used in pregnancy?
Yes — quinine combined with clindamycin (not doxycycline, which is contraindicated in pregnancy) is a recognised option for pregnancy P. falciparum treatment, especially in the first trimester where ACT safety data are limited. Hypoglycaemia risk is amplified — closer glucose monitoring required.
Can I use Quinin 300 for night-time leg cramps?
No. The FDA issued a black-box warning in 2010 against quinine for nocturnal leg cramps or restless legs syndrome — fatal arrhythmia, severe thrombocytopenia, and haemolytic-uraemic syndrome have been reported. The risk-to-benefit is unacceptable for non-malarial use.
Is quinine related to quinidine?
Yes — they are stereoisomers (mirror-image molecules) of each other, both extracted from cinchona bark. Quinidine has more potent class-Ia antiarrhythmic effects and is no longer used as an antimalarial. Quinine retains some antiarrhythmic effect — explaining the QT prolongation and cardiac signal.
What should I do if I get tinnitus or hearing loss?
Mild tinnitus is common and signals therapeutic plasma levels — continue at the prescribed dose. Severe tinnitus, vertigo, or hearing loss → seek medical review. Sudden severe hearing loss can be permanent; do not “wait it out”.
Why is glucose monitoring needed?
Quinine stimulates pancreatic beta-cell insulin release. Severe hypoglycaemia is most dangerous in pregnancy, in IV use, and in patients with sepsis or severe malaria. Sudden confusion, sweating, tachycardia, or coma in a patient on quinine → check glucose immediately and give IV dextrose if low.
Can I drink alcohol while taking Quinin 300?
Avoid alcohol during the treatment course — it amplifies CNS effects (dizziness, headache) and adds liver stress. Resume after the course completes.
What about quinine in tonic water?
Tonic water contains a tiny amount of quinine (FDA limit ~ 83 mg/L) — far below therapeutic doses. A 250 mL serving has ~ 20 mg quinine, vs the 650 mg per dose in malaria treatment. Tonic water has no clinically significant antimalarial or harmful effect.
What if I miss a dose?
Take the missed dose as soon as you remember. Do not double up. The 11-hour half-life means a missed 8-hourly dose has a measurable effect on plasma trough — strict 8-hourly timing matters during the active treatment course.
Other Malaria Tablets
- Cendox 100 mg — Doxycycline — standard partner drug for quinine in chloroquine-resistant P. falciparum
- Mefque 250 mg — Mefloquine — once-weekly prophylaxis option for resistant areas
- Lariago 250 mg — Chloroquine — for chloroquine-sensitive areas only
- Primaquine 15 mg — Radical cure for vivax / ovale relapsing malaria — G6PD test required
- HCQS 200/400 mg — Hydroxychloroquine — antimalarial + autoimmune indications
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Quinin 300
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Quinin 300
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