Quinimax Uses

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What is Quinimax?

Quinimax is used to treat malaria, a disease caused by parasites. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Quinimax will not treat severe forms of malaria, and it should not be taken to prevent malaria. Quinimax also should not be taken to treat or prevent night-time leg cramps.

Using this medication improperly or without the advice of a doctor can result in serious side effects or death. Quinimax is approved for use only in treating malaria. Some people have used Quinimax to treat leg cramps, but this is not an FDA-approved use.

The U.S. Food and Drug Administration has banned the sale of all non-approved brands of Quinimax. As of December 2006, Quinimax is the only brand of Quinimax that is approved by the FDA.

Quinimax may also be used for purposes not listed in this medication guide.

Quinimax indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Oral

Malaria

Adult: As sulfate: 648 mg 8 hrly for 7 days.

Child: As sulfate: ≥8 yr10 mg/kg 8 hrly for 7 days.

Renal impairment: Severe: Initially, 648 mg followed after 12 hr by maintenance doses of 324 mg 12 hrly.

Hepatic impairment: Mild to moderate (Child-Pugh class A and B): No dosage adjustment needed.

Reconstitution: Dilute in NaCl 0.9% to a concentration of diHCl 60-100 mg/mL.

Intravenous

Malaria

Adult: As diHCl: Initially, 20 mg/kg to max 1.4 g over 4 hr w/ maintenance infusion started after 8 hr. Maintenance infusions: 10 mg/kg to max 700 mg over 4 hr 8 hrly. Loading dose should not be given if patient received Quinimax, quinidine, halofantrine or mefloquine during the previous 12 hr.

Child: ≤5 mg/kg/hr by slow IV infusion.

Renal impairment: Severe: Reduce maintenance dose to 5-7 mg/kg of Quinimax salt 8 hrly.

Hepatic impairment: Mild to moderate (Child-Pugh class A and B): No dosage adjustment needed. Severe: Reduce maintenance dose to 5-7 mg/kg of Quinimax salt 8 hrly.

Reconstitution: Dilute in NaCl 0.9% to a concentration of diHCl 60-100 mg/mL.

How should I use Quinimax?

Use Quinimax capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Quinimax capsules.

Uses of Quinimax in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Malaria, uncomplicated, due to Plasmodium falciparum (treatment): Treatment of uncomplicated chloroquine-resistant P. falciparum malaria, in combination with other antimalarial agents

Off Label Uses

Babesiosis

Clinical experience suggests the utility of Quinimax (in combination with clindamycin) for the treatment of Babesia microti infection.

Based on the Infectious Diseases Society of America (IDSA) guidelines for the Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis, Quinimax (in combination with clindamycin) is an effective and recommended initial therapy in the treatment of babesiosis.

Malaria, uncomplicated, due to Plasmodium vivax (treatment)

Based on the Centers for Disease Control and Prevention (CDC) Guidelines for Treatment of Malaria in the United States, Quinimax (in combination with other antimalarial agents) is effective and recommended in the treatment of uncomplicated chloroquine-resistant P. vivax malaria.

Quinimax description

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An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Coco-Quinimax is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Coco-Quinimax is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood.

Quinimax dosage

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule,

Oral, as sulfate:

Quinimax: 324 mg

Generic: 324 mg

Dosing: Adult

Note: Dosage expressed in terms of the salt; 1 capsule Quinimax = 324 mg of Quinimax sulfate = 269 mg of base; Canadian products contain 200 mg of Quinimax sulfate = 167 mg of base or 300 mg of Quinimax sulfate = 250 mg of base.

Malaria, uncomplicated, due to chloroquine-resistant P. falciparum (treatment):

Oral:

CDC guidelines: 648 mg every 8 hours, in combination with doxycycline, tetracycline, or clindamycin (preferred in pregnancy). Note: Administer Quinimax for 3 days unless the infection was acquired in Southeast Asia, in which case Quinimax duration of therapy is 7 days. Duration of concomitant agent is 7 days, regardless of geographic region (CDC 2013).

Canadian product: 600 mg every 8 hours for 3 to 7 days. Note: Use in combination with tetracycline, doxycycline, or clindamycin.

Malaria, uncomplicated, due to chloroquine-resistant P. vivax (treatment) (off-label use):

Oral: 648 mg every 8 hours, in combination with doxycycline or tetracycline plus primaquine. Note: Quinimax in combination with clindamycin is an alternative regimen for pregnant patients. Administer Quinimax for 3 days unless the infection was acquired in Southeast Asia, in which case Quinimax duration of therapy is 7 days. Duration of concomitant agent is 7 days (doxycycline, tetracycline, clindamycin) or 14 days (primaquine), regardless of geographic region (CDC 2013).

Babesiosis (off-label use):

Oral: 650 mg every 6 to 8 hours for at least 7 to 10 days with clindamycin (Vannier 2012; Wormser 2006). Relapsing infection may require at least 6 weeks of therapy (Vannier 2012). Note: US manufactured Quinimax sulfate capsule is 324 mg; 2 capsules (648 mg Quinimax sulfate) should be sufficient for adult dosing.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Dosage expressed in terms of the Quinimax sulfate salt; 324 mg capsule Quinimax sulfate = 269 mg of base. Canadian products: 200 mg capsule of Quinimax sulfate = 167 mg of base or 300 mg capsule of Quinimax sulfate = 250 mg of base.

Malaria: Children and Adolescents; regardless of HIV status (HHS [OI pediatric 2013]): Limited data available in ages <16 years: Note: Duration of Quinimax treatment for malaria dependent upon the geographic region or pathogen. Lack of an appropriate Quinimax dosage form may restrict use in some smaller patients.

P. falciparum (chloroquine resistant), uncomplicated; treatment:

Oral: 10 mg/kg/dose Quinimax sulfate every 8 hours for 3 to 7 days depending on region; maximum dose: 650 mg/dose; use in combination with tetracycline, doxycycline, or clindamycin (dependent upon patient age) (CDC 2013)

P. vivax (chloroquine resistant), uncomplicated; treatment:

Oral: 10 mg/kg/dose Quinimax sulfate every 8 hours for 3 to 7 days depending on region; maximum dose: 650 mg/dose; use in combination with primaquine and tetracycline or doxycycline (dependent upon patient age) (CDC 2013)

Severe malaria:

Oral Quinimax, using the regimens previously described (dose and duration), may be used following IV quinidine including antimicrobial regimen once parasite density is <1% and patient is able to tolerate oral medications (CDC 2013)

Babesiosis: Limited data available: Children and Adolescents:

Oral: 10 mg/kg/dose Quinimax sulfate every 8 hours for 7 to 10 days; maximum dose: 650 mg/dose (Red Book [AAP 2015]; Wittner 1982); use in combination with clindamycin as a first-line treatment option (IDSA [Wormser 2006])

Quinimax interactions

See also:
What other drugs will affect Quinimax?

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Effects Of Drugs And Other Substances On Quinimax Pharmacokinetics

Quinimax is a P-gp substrate and is primarily metabolized by CYP3A4. Other enzymes, including CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP2E1 may contribute to the metabolism of Quinimax.

Antacids

Antacids containing aluminum and/or magnesium may delay or decrease absorption of Quinimax. Concomitant administration of these antacids with Quinimax should be avoided.

Antiepileptics (AEDs) (carbamazepine, phenobarbital, and phenytoin)

Carbamazepine, phenobarbital, and phenytoin are CYP3A4 inducers and may decrease Quinimax plasma concentrations if used concurrently with Quinimax.

Cholestyramine

In 8 healthy subjects who received Quinimax sulfate 600 mg with or without 8 grams of cholestyramine resin, no significant difference in Quinimax pharmacokinetic parameters was seen.

Cigarette Smoking (CYP1A2 inducer)

In healthy male heavy smokers, the mean Quinimax AUC following a single 600 mg dose was 44% lower, the mean Cmax was 18% lower, and the elimination half-life was shorter (7.5 hours versus 12 hours) than in their non-smoking counterparts. However, in malaria patients who received the full 7-day course of Quinimax therapy, cigarette smoking produced only a 25% decrease in median Quinimax AUC and a 16.5% decrease in median Cmax, suggesting that the already reduced clearance of Quinimax in acute malaria could have diminished the metabolic induction effect of smoking. Because smoking did not appear to influence the therapeutic outcome in malaria patients, it is not necessary to increase the dose of Quinimax in the treatment of acute malaria in heavy cigarette smokers.

Grapefruit juice (P-gp/CYP3A4 inhibitor)

In a pharmacokinetic study involving 10 healthy subjects, the administration of a single 600 mg dose of Quinimax sulfate with grapefruit juice (full-strength or half-strength) did not significantly alter the pharmacokinetic parameters of Quinimax. Quinimax may be taken with grapefruit juice.

Histamine H2-receptor blockers [cimetidine, ranitidine (nonspecific CYP450 inhibitors)]

In healthy subjects who were given a single oral 600 mg dose of Quinimax sulfate after pretreatment with cimetidine (200 mg three times daily and 400 mg at bedtime for 7 days) or ranitidine (150 mg twice daily for 7 days), the apparent oral clearance of Quinimax decreased and the mean elimination half-life increased significantly when given with cimetidine but not with ranitidine. Compared to untreated controls, the mean AUC of Quinimax increased by 20% with ranitidine and by 42% with cimetidine (p < 0.05) without a significant change in mean Quinimax Cmax. When Quinimax is to be given concomitantly with a histamine H2-receptor blocker, the use of ranitidine is preferred over cimetidine. Although cimetidine and ranitidine may be used concomitantly with Quinimax, patients should be monitored closely for adverse events associated with Quinimax.

Isoniazid

Isoniazid 300 mg/day pretreatment for 1 week did not significantly alter the pharmacokinetic parameter values of Quinimax. Adjustment of Quinimax dosage is not necessary when isoniazid is given concomitantly.

Ketoconazole (CYP3A4 inhibitor)

In a crossover study, healthy subjects (N=9) who received a single oral dose of Quinimax hydrochloride (500 mg) concomitantly with ketoconazole (100 mg twice daily for 3 days) had a mean Quinimax AUC that was higher by 45% and a mean oral clearance of Quinimax that was 31% lower than after receiving Quinimax alone. Although no change in the Quinimax dosage regimen is necessary with concomitant ketoconazole, patients should be monitored closely for adverse reactions associated with Quinimax.

Macrolide Antibiotics (erythromycin, troleandomycin) (CYP3A4 inhibitors)

In a crossover study (N=10), healthy subjects who received a single oral 600 mg dose of Quinimax sulfate with the macrolide antibiotic, troleandomycin (500 mg every 8 hours) exhibited a 87% higher mean Quinimax AUC, a 45% lower mean oral clearance of Quinimax, and a 81% lower formation clearance of the main metabolite, 3-hydroxyquinine, than when Quinimax was given alone.

Erythromycin was shown to inhibit the in vitro metabolism of Quinimax in human liver microsomes, an observation confirmed by an in vivo interaction study. In a crossover study (N=10), healthy subjects who received a single oral 500 mg dose of Quinimax sulfate with erythromycin (600 mg every 8 hours for four days) showed a decrease in Quinimax oral clearance (CL/F), an increase in half-life, and a decreased metabolite (3hydroxyquinine) to Quinimax AUC ratio, as compared to when Quinimax was given with placebo.

Therefore, concomitant administration of macrolide antibiotics such as erythromycin or troleandomycin with Quinimax should be avoided.

Oral Contraceptives (estrogen, progestin)

In 7 healthy females who were using single-ingredient progestin or combination estrogen-containing oral contraceptives, the pharmacokinetic parameters of a single 600 mg dose of Quinimax sulfate were not altered in comparison to those observed in 7 age-matched female control subjects not using oral contraceptives.

Rifampin (CYP3A4 inducer)

In patients with uncomplicated P. falciparum malaria who received Quinimax sulfate 10 mg/kg concomitantly with rifampin 15 mg/kg/day for 7 days (N=29), the median AUC of Quinimax between days 3 and 7 of therapy was 75% lower as compared to those who received Quinimax monotherapy. In healthy subjects (N=9) who received a single oral 600 mg dose of Quinimax sulfate after 2 weeks of pretreatment with rifampin 600 mg/day, the mean Quinimax AUC and Cmax decreased by 85% and 55%, respectively. Therefore, the concomitant administration of rifampin with Quinimax should be avoided.

Ritonavir

In healthy subjects who received a single oral 600 mg dose of Quinimax sulfate with the 15 dose of ritonavir (200 mg every 12 hours for 9 days), the mean ritonavir AUC, Cmax, and elimination half-life were slightly but not significantly increased compared to when ritonavir was given alone. However, due to the significant effect of ritonavir on Quinimax pharmacokinetics, the concomitant administration of Quinimax capsules with ritonavir should be avoided.

Theophylline Or Aminophylline (CYP1A2 substrate)

In 19 healthy subjects who received multiple doses of Quinimax 648 mg every 8 hours x 7 days with a single 300 mg oral dose of theophylline, the mean theophylline AUC was 10% lower than when theophylline was given alone. There was no significant effect on mean theophylline Cmax. Therefore, if Quinimax is co-administered to patients receiving theophylline or aminophylline, plasma theophylline concentrations should be monitored frequently to ensure therapeutic concentrations.

Warfarin And

Oral Anticoagulants

Cinchona alkaloids, including Quinimax, may have the potential to depress hepatic enzyme synthesis of vitamin K-dependent coagulation pathway proteins and may enhance the action of warfarin and other oral anticoagulants. Quinimax may also interfere with the anticoagulant effect of heparin. Thus, in patients receiving these anticoagulants, the prothrombin time (PT), partial thromboplastin time (PTT), or international normalization ratio (INR) should be closely monitored as appropriate, during concurrent therapy with Quinimax.

Drug/Laboratory Interactions

Quinimax may produce an elevated value for urinary 17-ketogenic steroids when the Zimmerman method is used.

Quinimax may interfere with urine qualitative dipstick protein assays as well as quantitative methods (e.g., pyrogallol red-molybdate).

Quinimax side effects

See also:
What are the possible side effects of Quinimax?

Applies to Quinimax: oral capsule, oral tablet, oral tablet extended release

As well as its needed effects, Quinimax (the active ingredient contained in Quinimax) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking Quinimax, check with your doctor immediately:

More common:

Less common: Rare

If any of the following symptoms of overdose occur while taking Quinimax, get emergency help immediately:

Symptoms of an overdose

Quinimax contraindications

See also:
What is the most important information I should know about Quinimax?

Quinimax Sulfate Capsules are contraindicated in patients with the following:

Prolonged QT interval. One case of a fatal ventricular arrhythmia was reported in an elderly patient with a prolonged QT interval at baseline, who received Quinimax sulfate intravenously for P. falciparum malaria.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Hemolysis can occur in patients with G6PD deficiency receiving Quinimax.
Known hypersensitivity reactions to Quinimax.
These include, but are not limited to, the following :
Thrombocytopenia
Idiopathic thrombocytopenia purpura (ITP) and Thrombotic thrombocytopenic purpura (TTP)
Hemolytic uremic syndrome (HUS)
Blackwater fever (acute intravascular hemolysis, hemoglobinuria, and hemoglobinemia)
Known hypersensitivity to mefloquine or quinidine: cross-sensitivity to Quinimax has been documented.
Myasthenia gravis. Quinimax has neuromuscular blocking activity, and may exacerbate muscle weakness.
Optic neuritis. Quinimax may exacerbate active optic neuritis.



Active ingredient matches for Quinimax:

Quinine in France, Ghana, Kenya, Nigeria, Tanzania, Uganda.

Cinchonine Hydrochloride/Quinidine Gluconate Or Quinidine Hydrochloride/Quinine Gluconate Or Quinine Hydrochloride

Cinchonidine hydrochloride/cinchonine hydrochloride/quinidine gluconate or quinidine hydrochloride/Quinine gluconate or quinine hydrochloride in France.


Unit description / dosage (Manufacturer)Price, USD
Injectable; Injection; Cinchonidine Hydrochloride 0.85 mg; Cinchonidine Hydrochloride 0.85 mg; Quinidine Hydrochloride 3.3 mg; Quinine Hydrochloride 120 mg / ml
Tablet, Film-Coated; Oral; Cinchonidine Hydrochloride 0.85 mg; Cinchonidine Hydrochloride 0.85 mg; Quinidine Hydrochloride 3.3 mg; Quinine Hydrochloride 120 mg
Tablet, Film-Coated; Oral; Cinchonidine Hydrochloride 3.4 mg; Cinchonidine Hydrochloride 3.4 mg; Quinidine Hydrochloride 13.2 mg; Quinine Hydrochloride 480 mg

List of Quinimax substitutes (brand and generic names):

Tablet; Oral; Quinine Sulfate 250 mg (Merck (India) Ltd (Merck Ltd))
Tablet; Oral; Quinine Sulfate 500 mg (Merck (India) Ltd (Merck Ltd))
Tablet; Oral; Quinine Sulfate 300 mg (Merck (India) Ltd (Merck Ltd))
Capsule; Oral; Quinine Sulfate 200 mg (Merck (India) Ltd (Merck Ltd))
Capsule; Oral; Quinine Sulfate 300 mg (Merck (India) Ltd (Merck Ltd))
Capsule; Oral; Quinine Sulfate 324 mg (Merck (India) Ltd (Merck Ltd))
Tablet; Oral; Quinine Sulfate 260 mg (Merck (India) Ltd (Merck Ltd))
Quinine sulfate powd ultrex (Merck (India) Ltd (Merck Ltd))$ 25.86
Apo-Quinine 300 mg Capsule (Merck (India) Ltd (Merck Ltd))$ 0.39
Novo-Quinine 300 mg Capsule (Merck (India) Ltd (Merck Ltd))$ 0.39
Apo-Quinine 200 mg Capsule (Merck (India) Ltd (Merck Ltd))$ 0.25
Novo-Quinine 200 mg Capsule (Merck (India) Ltd (Merck Ltd))$ 0.25
QUININE Injection / 300mg/ml / 2ml units (Merck (India) Ltd (Merck Ltd))$ 0.21
QUININE Capsule/ Tablet / 300mg / 10 units (Merck (India) Ltd (Merck Ltd))$ 0.83
QUININE Capsule/ Tablet / 600mg / 10 units (Merck (India) Ltd (Merck Ltd))$ 1.55
Quinine 100 mg (Merck (India) Ltd (Merck Ltd))
300 mg x 1 mL x 2ml (Merck (India) Ltd (Merck Ltd))$ 0.28
300 mg x 10's (Merck (India) Ltd (Merck Ltd))$ 0.83
600 mg x 10's (Merck (India) Ltd (Merck Ltd))$ 1.55
Quinine 300 mg Tablet (Merck (India) Ltd (Merck Ltd))$ 0.08
Quinine 600 mg Tablet (Merck (India) Ltd (Merck Ltd))$ 0.15
QUININE / MERCK inj 300 mg x 1 mL x 2ml (Merck (India) Ltd (Merck Ltd))$ 0.21
QUININE / MERCK tab 300 mg x 10's (Merck (India) Ltd (Merck Ltd))$ 0.83
QUININE / MERCK tab 600 mg x 10's (Merck (India) Ltd (Merck Ltd))$ 1.55
Quinine Acdhon 300 mg x 1000's
Tablet; Oral; Quinine Hydrochloride 250 mg
Tablet; Oral; Quinine Hydrochloride 500 mg
Quinine Dihydrochloride ANB 600 mg x 2 mL x 10's
Quinine GPO 300 mg x 1000's
Quinine GPO 600 mg/2 mL x 50 x 1's

References

  1. DailyMed. "QUININE SULFATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "Quinine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "Quinine". http://www.drugbank.ca/drugs/DB00468 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Quinimax are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Quinimax. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

Consumer reported useful

No survey data has been collected yet


Consumer reported price estimates

No survey data has been collected yet


2 consumers reported time for results

To what extent do I have to use Quinimax before I begin to see changes in my health conditions?
As part of the reports released by ndrugs.com website users, it takes 2 weeks and a few days before you notice an improvement in your health conditions.
Please note, it doesn't mean you will start to notice such health improvement in the same time frame as other users. There are many factors to consider, and we implore you to visit your doctor to know how long before you can see improvements in your health while taking Quinimax. To get the time effectiveness of using Quinimax drug by other patients, please click here.
Users%
2 weeks1
50.0%
2 days1
50.0%


13 consumers reported age

Users%
30-454
30.8%
16-292
15.4%
> 602
15.4%
46-602
15.4%
1-51
7.7%
< 11
7.7%
6-151
7.7%


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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