Daniel in The Lion's Den | 930: Mosquitoes and Malaria XX – Quinine: Side-Effects / Conditions and Diseases it could cause

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930: Mosquitoes and Malaria XX – Quinine: Side-Effects / Conditions and Diseases it could cause

05 November, 2009

Malaria – prevention is better than cure, and cure is better than endure, because the treatments and the drugs are most of the time very bitter, painful, and as dangerous as the disease itself since they often cause very serious side-effects and complications…

Although highly effective, Quinine is not recommended for prevention – prophylaxis – because of its side-effects and poor tolerance. When used for prophylaxis, the dosage for quinine sulfate is 300–324mg, once daily, beginning one week prior to, and during, travel and continuing for four weeks after returning.

Side effects / Conditons and Diseases:

Therapeutic doses for quinine usually cause cinchonism and, in rare cases, it may even cause death – usually by pulmonary edema. The development of mild cinchonism is not a reason for stopping or interrupting quinine therapy since the risk of death by malaria is higher and the patient should be reassured. Blood-glucose levels and electrolyte concentrations must be monitored when quinine is given by injection; the patient should also be under cardiac monitoring when the first quinine injection is given – and these are precautions that are unavailable in developing countries where malaria is most malicious.

Cinchonism or quinism is a pathological condition in humans caused by an overdose of quinine or its natural source, cinchona bark. Symptoms of mild cinchonism, which may occur from standard therapeutic doses of quinine, include flushed and sweaty skin, ringing of the ears or tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, lichenoid, photosensitivity, vertigo, dizziness, dysphoria, nausea, vomiting, and diarrhea

Pulmonary: relating to or affecting the lungs

Edema: a buildup of excess serous fluid between tissue cells

Serous: relating to, resembling, or producing serum – Look up the meanings of any words that draw your attention and/or interest – Msn-Encarta

Large doses of quinine may lead to severe symptoms of cinchonism: skin rashes, deafness (reversible), somnolence, diminished visual acuity or blindness, anaphylactic shock, and disturbances in cardiac rhythm and death from cardio-toxicity. Quinine overdose can also result in a rare form of hypersensitivity reaction termed black-water fever that results in massive hemolysis, hemoglobinemia, hemoglobinuria, and renal failure. Patients treated with quinine may also suffer from hypoglycemia – the medical condition of having an unusually low level of sugar in the blood – especially when administered intravenously, and hypotension – low blood pressure.

Most symptoms of cinchonism – except in severe cases – are reversible and disappear once the quinine dosage or treatment is withdrawn or ended.

It is much less common when quinine is given by mouth, but oral quinine is not well tolerated – quinine is exceedingly bitter and many patients will vomit after ingesting quinine tablets – other drugs such as Fansidar: sulfadoxine; sulfonamide antibiotic, with pyrimethamine, or Malarone: proguanil with atovaquone, are often used when oral therapy is required. Blood-glucose, electrolyte, and cardiac monitoring are not necessary when quinine is given orally.

Fansidar is an anti-malarial agent, each tablet contains 500mg sulfadoxine and 25mg pyrimethamine…also cornstarch, gelatin, lactose, magnesium stearate, and talc.

Fatalities associated with the administration of Fansidar have occurred due to severe reactions to the drug, including Stevens-Johnson syndrome and Toxic Epidermal Necrolysis. Prophylactic treatments must be stopped at the first appearance of skin-rash, or if a significant reduction in the count of any formed blood-elements is noticed, or upon the occurrence of active bacterial or fungal infections.

Stevens–Johnson syndrome is a life-threatening condition affecting the skin in which cell-death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex affecting the skin and the mucous membranes. Although the majority of cases are idiopathic, diseases or disorders that have no known cause, the main class of known causes is medications, followed by infections and (rarely) cancers.

Toxic Epidermal Necrolysis, also known as Lyell's syndrome, is a life-threatening dermatological condition that is frequently induced by a reaction to medications.It is characterized by the detachment of the top layer of skin (the epidermis) from the lower layers of the skin (the dermis) all over the body.

Alan Lyell (1917-2007) was a Scottish dermatologist who described Lyell's syndrome.

There is broad agreement in medical literature that TEN can be considered a more severe form of S-J syndrome, and debate whether it falls on a spectrum of disease that includes erythema multiforme, a skin condition of unknown etiology, the branch of medicine that investigates the causes and origins of diseases – possibly mediated by deposition of immune complex in the superficial microvasculature of the skin and oral mucous membrane that usually follows an antecedent infection or drug exposure. It is a common disorder, with peak incidence in the second and third decades of life.

Quinine can cause paralysis if accidentally injected into a nerve. It is extremely toxic in overdose and the advice of a poison-specialist should be sought immediately.

Some studies have related the use of quinine to hearing impairment, which can cause some high-frequency loss, but it has not been conclusively established whether such impairment is temporary or permanent – i.e. reversible, or irreversible.

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