Cinchona officinalis L (Peruvian bark), Rubiaceae ... - AaronsWorld

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R HO H 9 N Figure 2: Quinine, R = OCH3; Cinchonidine, R = H R HO H N 9 Figure 3: Quinidine, R = OCH3; Cinchonine, R = H 4 H H 8 8 N N H H
Acute malaria, adult: 0.5-1 ml (possibly higher) every 2-3 h, adjusted for body size Chronic GI upset, adult: 0.5-1 ml three times per day in water before meals Child: as adult but adjusted for body size Elder: as adult Decoction: 1 g <strong>bark</strong> containing 5-6% quinine in 250 ml water simmered for 10 min, yielding approximately 5-6 mg quinine per cup (more if the water is acidic). 1 cup three times per day before meals for dyspepsia in adults. Quinine sulfate by mouth for acute, mild malaria: 10 mg/kg body weight every 8 h in adults, usually combined with 100 mg doxycycline once daily, for 7 d. This dose will usually lead to development of cinchonism after 2-3 d (the dose threshold for which is approximately 2 g in a day). The dose can be lowered after 3-4 days, if asexual parasitemia has been eliminated, which will relieve cinchonism symptoms (Vieira and Midio 2001). Generally this is only used for severe, drug-resistant P. falciparum infection today. Totaquine: combination of quinine, quinidine, cinchonine, and cinchonidine, containing 7-20% quinine. Developed by Health Organisation of the League of Nations as substitute for quinine, introduced in 1934. Dose 300-600 mg (5-10 grains) three times per day. This does not appear to be available anymore for unknown reasons. Quinine dihydrochloride intravenous, for severe malaria: 20 mg/kg body weight in 5% dextrose or normal saline as a once-only 4 h infusion followed, 4 h later, by quinine dihydrochloride 10 mg/kg body weight infused over 4 h every 8 h. Generally this is only used for severe P. falciparum infection not treatable by other drugs. The loading dose should be halved for patients who have received quinine, quinidine, or mefloquine in the prior 24 h. The maintenance dose should be reduced in patients with renal impairment. Quinine can be given intramuscularly at the same dose as for IV, with the doses divided in half and injected one into each anterior thigh. 2.9 Adverse Effects ¯ Contact dermatitis (principally in workers who made cinchona products) ¯ Nausea, transitory ¯ QT prolongation, torsades de pointes ¯ Hypoglycemia (quinine induces insulin secretion) QT prolongation is primarily an effect of non-quinine alkaloids, and it can be sufficiently serious to cause acute ventricular fibrillation and sudden cardiac death. It is not seen with use of whole plant extracts as a bitter, only with higher doses for attacking malaria. 5
Page 1 and 2: Cinchona officinalis L (Peruvian ba
Page 3: ¯ Antimicrobial ¯ Bitter digestiv
Page 7 and 8: 2.13 Drug Interactions Quinine and
Page 9 and 10: arrhythmias, as QT prolongation was
Page 11 and 12: A Manual of Organic Materia Medica
Page 13 and 14: and when treated with chlorine wate
Page 15: 7 Contributors Primary author: Eric

Cinchona officinalis L (Peruvian bark), Rubiaceae ... - AaronsWorld

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