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

2.10 Contraindications
These are largely derived from experience with higher doses of isolated quinine, so they may not be
relevant to the whole herb. But conservativism is required due to the serious nature of the potential
negative results.
¯ Allergy to the herb
¯ Ventricular arrhythmias
¯ Glucose-6-phosphate dehydrogenase deficiency (high risk for hemolysis)
¯ Optic neuritis (may aggravate)
¯ Tinnitus (may aggravate)
¯ History of blackwater fever
¯ Thrombocytopenia purpura
¯ Pregnancy, with great caution (fetal toxicity, primarily auditory nerve damage, may occur)
¯ Lactation (does distribute to breast milk)
¯ Mytasthenia gravis (may aggravate)
¯ Congestive heart failure (negatively inotropic)
2.11 Overdose
Cinchonism
¯ tinnitus
¯ high-tone hearing loss
¯ nausea
¯ dysphoria
Dose threshold: roughly 2 g daily (up to 8 g for many people) of quinine for an average size adult.
Treatment: induce emesis or use gastric lavage. Maintain normal blood pressure and renal function.
Urinary acidification may help with excretion but not if hemoglobinuria is present. Quinine is readily
dialyzable. Hypersensitivity reactions may require epinephrine, corticosteroids, or antihistamines.
Hemolytic-uremic syndrome has been known to occur in patients taking quinine for leg cramps.
This appears to be due to anti-quinine antibodies cross-reacting with red blood cells. Treatment is
by plasmapharesis. Incidence of this complication has not been documented to occur with use of
low-doses of whole herb extracts as a bitter.
Hypersensitivity reactions, manifesting as urticaria, fever, tinnitus, dyspena, asthma, hematuria,
or visual disturbances, are indications for immediate discontinuation of treatment.
2.12 Incompatibilities
Salicylates do not mix with quinine. Tannins will precipitate the alkaloids.
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