Hemolysis and methemoglobinemia.
e. Supply. Dapsone tablets each contain 25-mg of dapsone.
a. Uses. Quinine is used to treat acute attacks of malaria because of strains of
P. falciparum resistant to chloroquine. It can also suppress the symptoms of an acute
attack of the other three types of malaria (P. vivax, P.malariae, and P. ovale), but since
it does not kill the tissue schizonts, it is incapable of curing these three relapsing
malarias. When quinine is used to treat chloroquine- resistant strains of P. falciparum, it
is more effective when combined with pyrimethamine or dapsone and pyrimethamine.
b. Administration as an Antimalarial.
(1) Oral dosage. Two quinine sulfate tablets (324-mg per tablet) are given
three times daily after meals for 14 days. Care must be exercised not to use old tablets
of quinine, which may have hardened, since such tablets will fail to be absorbed in the
(2) Intravenous administration. One 2-ml ampule of quinine dihydrochloride
injection (containing 300-mg per ml) is diluted in 300-ml of normal saline, dextrose-
saline, plasma, or other intravenous fluid appropriate to the client's condition, and given
slowly (not less than 30 minutes), since low blood pressure may occur if it is infused too
rapidly. The blood pressure and pulse should be monitored constantly while the
infusion is running to detect a fall in blood pressure or the appearance of an abnormal
rhythm of the pulse. This dosage may be repeated every 6 to 8 hours, as necessary,
but not more than three such doses (a total of 2-gm of quinine dihydrochloride) should
be administered during a 24-hour period. Oral administration should be substituted or
resumed as soon as possible. If falciparum malaria recurs a few days after treatment
with quinine, re-administration as described above may be required for a duration of 10
to 21 days.
(1) If too much quinine is used, an effect called cinchonism results.
Cinchonism may include headache, ringing of the ears, symptoms of cerebral
congestion, flushing, sweating, nausea, diarrhea, and blurred vision. When it is severe,
there may be deafness, skin rashes, drowsiness, damage to vision, cardiac arrhythmia,
and abdominal pain.
(2) Administration of quinine can cause effects such as GI discomfort when
given orally, painful noninfected abscesses when given IM, and damage to the lining of
the blood vessels and even clotting when given IV.
(3) Some authorities believe that quinine is responsible for the condition
called blackwater fever, found among people where malaria is endemic. It is