About quinine for malaria

Malaria is a disease which is passed on to humans by infected mosquitoes. A parasite called plasmodium lives inside the stomachs of infected female mosquitoes and is passed on to humans by a bite. There are four types of plasmodium that cause malaria. Of the four, Plasmodium falciparum is usually the most serious, so this type of malaria is likely to be treated in hospital.

Quinine works by killing the parasites passed into your body from the bites of infected mosquitoes. It is thought to do this by interfering with the way the parasite reproduces.

Before taking quinine

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking quinine it is important that your doctor or pharmacist knows:

• If you are pregnant, trying for a baby or breast-feeding.
• If you have any problems with your eyes, or with your hearing.
• If you have any problems with your kidneys, liver or heart.
• If you have blood in your urine.
• If you have myasthenia gravis (a condition causing muscle weakness).
• If you have glucose 6-phosphate dehydrogenase deficiency (this is an inherited disorder).
• If you are taking other medicines, including those available to buy without a prescription, herbal and complementary medicines.
• If you have ever had an allergic reaction to any medicine, or if you have had a bad reaction to quinine in tonic water or any other soft drink.

How to take quinine

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about quinine, and a full list of possible side-effects from taking it.
• Take quinine exactly as your doctor has told you. If you are being treated in hospital, your nurse will tell you when your tablets are due. If you are being treated at home, your doctor or pharmacist will tell you how many tablets to take and when to take them. Your dose will also be on the label of the pack. Space the doses evenly throughout the day and keep taking the tablets until the course is finished, unless you are told to stop. It is important you do this, even if you feel better.
• You can take the tablets before or after your meals.
• If you forget to take a dose, take it as soon as you remember and then space out the next dose. Do not take two doses together to make up for a forgotten dose.

Getting the most from your treatment

• If you are being treated from home, make sure you keep your regular appointments with your doctor . This is so your doctor can check on your progress.
• Your doctor will have discussed with you the possibility of unwanted side-effects of treatment with quinine. Let your doctor know if you experience any of the following: impaired hearing, ringing noises in your ear, headaches, feeling sick, or problems with your eyesight.
• Quinine is present in drinks such as tonic water and bitter lemon. It is probably best to avoid these while you are on quinine.
• Never take more than the prescribed dose. Taking too much quinine can cause serious problems. Also, quinine is dangerous if it is taken accidentally by a child. If you suspect that someone has taken an overdose of quinine, contact your doctor or go to the accident and emergency department of your local hospital straightaway. Take the container with you, even if it is empty. This is so the doctor knows what has been taken.
• If you take any medicines that you have bought 'over-the-counter', check with a pharmacist that they are suitable to take. This is because some medicines may interfere with quinine.
• If you have diabetes you may need to check your blood glucose more frequently, as these tablets may affect the levels of sugar in your blood. Your doctor will be able to advise you about this.

Can quinine cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. Serious side-effects do sometimes occur with quinine treatment. Speak with your doctor or pharmacist if any of the following side-effects occur.

Important: your doctor will have discussed with you the possibility of serious side-effects that you must let your doctor know about straightaway. These are:

• Any difficulty breathing, or any swelling around your mouth or face. These may be signs of an allergic reaction to quinine.
• Any unexplained bleeding or unusual bruising. These may be signs of a serious blood disorder and your doctor will want to check for this.

How to store quinine

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines