Quinine is the primary alkaloid of cinchona bark, which was used for centuries in the treatment of malaria. Quinine has been replaced to a large extent in modern therapy by the synthetic agents, but is still used for the relief of skeletal muscle cramps. It may also be found as an adulterant in heroin and is also present in small amounts in tonic water.
Adverse reactions to quinine include tinnitus, deafness, dizziness, visual difficulties and gastrointestinal disturbances; this spectrum of effects is known as cinchonism. Convulsions, cyanosis, hypotension, cardiac arrhythmias, coma, blindness and renal damage have been noted in cases of acute poisoning; haemodialysis or peritoneal dialysis was usually effective in attenuating the intoxication.
For TDM, sample should be taken prior to dose. If toxicity is suspected, take sample at earliest opportunity
Quinine measured by HPLC-DAD.
Therapeutic range: 1.0 - 7.0 mg/L. Toxic: >10 mg/L. (Schulz et al. Critical Care 2012, 16:R136).
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