'''Quinine''' is a natural white [[crystal]]line [[alkaloid]] having [[antipyretic]] (fever-reducing), [[antimalarial drug|antimalarial]], [[analgesic]] (painkilling), and [[anti-inflammatory]] properties and a bitter taste. It is a [[stereoisomer]] of [[quinidine]] which, unlike quinine, is an [[antiarrhythmic]]. Quinine contains two major fused-ring systems: the [[aromatic]] [[quinoline]] and the [[bicyclic]] [[quinuclidine]].
Though it has been synthesized in the laboratory, quinine occurs naturally in the bark of the [[cinchona]] tree. The medicinal properties of the cinchona tree were originally discovered by the [[Quechuas|Quechua]], who are indigenous to [[Peru]] and [[Bolivia]]; later, the [[Jesuits]] were the first to bring cinchona to Europe.
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Quinine was the first effective treatment for [[malaria]] caused by ''[[Plasmodium falciparum]]'', appearing in therapeutics in the 17th century. It remained the antimalarial drug of choice until the 1940s, when other drugs such as [[chloroquine]] that have fewer unpleasant side effects replaced it. Since then, many effective antimalarials have been introduced, although quinine is still used to treat the disease in certain critical circumstances, such as severe malaria, and in impoverished regions due to its low cost. Quinine is available with a prescription in the United States and over-the-counter, in minute quantities, in [[tonic water]]. Quinine is also used to treat [[Systemic lupus erythematosus|lupus]] and [[arthritis]]. Quinine was also frequently prescribed in the US as an [[off-label]] treatment for [[Cramps#Nocturnal leg cramps|nocturnal leg cramps]], but this has become less prevalent due to a [[Food and Drug Administration]] statement warning against the practice.<ref>{{cite web | url = http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm218202.htm | title = FDA Drug Safety Communication: New risk management plan and patient Medication Guide for Qualaquin (quinine sulfate) | accessdate = 2011-02-21 | date = 2010-08-07 | publisher = [[Food and Drug Administration]] }}</ref>
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Quinine is highly [[fluorescence|fluorescent]] ([[quantum yield]] ~0.58) in 0.1 [[Molar concentration|M]] [[sulfuric acid]] solution and it is widely used as a standard for fluorescence quantum yield measurement.<ref>Joseph R. Lakowicz. [http://books.google.co.in/books?id=-PSybuLNxcAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Principles of Fluorescence Spectroscopy] 3rd edition. [[Springer Science+Business Media|Springer]] (2006). ISBN 978-0387-31278-1. Chapter 2. page 54.</ref><ref>[http://omlc.ogi.edu/spectra/PhotochemCAD/html/081.html Quinine sulfate] ''ogi.edu''. Retrieved 16 August 2013</ref>
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==Mechanism of Action==
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As with other quinoline antimalarial drugs, the mechanism of action of quinine has not been fully resolved. The most widely accepted hypothesis of its action is based on the well-studied and closely related quinoline drug, [[chloroquine]]. This model involves the inhibition of [[hemozoin]] [[biocrystallization]], which facilitates the aggregation of [[cytotoxic]] [[heme]]. Free cytotoxic heme accumulates in the parasites, causing their deaths.
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Black Box Warning
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See full prescribing information for complete Boxed Warning.
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Overview
Quinine is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
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Guideline-Supported Use
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There is limited information regarding Off-Label Guideline-Supported Use of Quinine in adult patients.
Non–Guideline-Supported Use
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Quinine in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
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Dosing Information
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There is limited information regarding FDA-Labeled Use of Quinine in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
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Developed by:
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Strength of Evidence:
Dosing Information
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There is limited information regarding Off-Label Guideline-Supported Use of Quinine in pediatric patients.
Non–Guideline-Supported Use
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Quinine in pediatric patients.
Contraindications
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See full prescribing information for complete Boxed Warning.
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Content
Description
Precautions
Description
Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Quinine in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Quinine in the drug label.