Quinimax Dosage

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Dosage of Quinimax in details

The dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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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])

What other drugs will affect Quinimax?

Many drugs can interact with Quinimax. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with Quinimax, especially:

This list is not complete and many other drugs can interact with Quinimax. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Quinimax interactions

Interactions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Quinimax, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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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).


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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. FDA/SPL Indexing Data. "A7V27PHC7A: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
  3. MeSH. "Analgesics, Non-Narcotic". https://www.ncbi.nlm.nih.gov/mesh/68... (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

3 consumers reported frequency of use

How frequently do I need to take Quinimax?
It was reported by ndrugs.com website users that Quinimax should ideally be taken 3 times in a day as the most common frequency of the Quinimax. You should you adhere strictly to the instructions and guidelines provided by your doctor on how frequently this Quinimax should be taken. Get another patient's view on how frequent the capsule should be used by clicking here.
Users%
3 times in a day3
100.0%


6 consumers reported doses

What doses of Quinimax drug you have used?
The drug can be in various doses. Most anti-diabetic, anti-hypertensive drugs, pain killers, or antibiotics are in different low and high doses and prescribed by the doctors depending on the severity and demand of the condition suffered by the patient. In our reports, ndrugs.com website users used these doses of Quinimax drug in following percentages. Very few drugs come in a fixed dose or a single dose. Common conditions, like fever, have almost the same doses, e.g., [acetaminophen, 500mg] of drug used by the patient, even though it is available in various doses.
Users%
201-500mg3
50.0%
501mg-1g1
16.7%
101-200mg1
16.7%
1-5mg1
16.7%


Consumer reviews


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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