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

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3.5 Ecological Status Moderately threatened by logging and harvesting for medicine, though medicinal harvesting has been greatly reduced by availability of cultivated stock. 3.6 Cultivation Extremely complex and difficult, but now widely established in India, Indonesia and Zaire. 3.7 Wildcrafting Unclear to what extent this is still practiced due to large-scale cultivated supplies. 4 Advanced Clinical Information 4.1 Additional Actions ¯ Schizontocidal against Plasmodium spp, useful for treatment and suppression. ¯ Anti-ameba (Borris and Schaeffer 1992) ¯ Inhibition of muldrug resistance pump ¯ Negative inotropic ¯ Insulin secratagogue Cinchona alkaloids act primarily as blood schizonticides. Schizonts are the form of malaria that exist in red blood cells before giving rise to merozoites, which reinvade red blood cells and split into sexual forms that penetrate into mosquitoes. Quinine also kills these sexual forms (gametocytes) for the P. malariae and P. vivax forms. Though quinine and related alkaloids may have some effect against sporozoites that come out of mosquitoes and actually start a malaria infection, they are not well-established for preventing malaria, though historical reports suggest they might be protective. Quinine and related alkaloids do not appear to affect the hynozoites that persist in the liver or any exoerythrocytic forms of malaria, and thus cannot completely eradicate (cause a so-called radical cure) malaria on their own in patient infected with P. ovale or P. vivax, which have exoerythrocytic forms. 4.2 Additional Indications ¯ Leg cramps ¯ Babesiosis ¯ Amebiasis ¯ Cancer chemotherapy resistance reversal Mixed results in controlled clinical trials led to FDA revoking the over-the-counter status for quinine used to treat leg cramps in 1995 (Man-Son-Hing and Wells 1995). In a phase I trial, intravenous cinchonine appeared to reverse multidrug resistance in patients with lymphoproliferative syndromes treated with chemotherapy, but there was concern about potential for 8
arrhythmias, as QT prolongation was seen frequently (Solary, et al. 2000). The purported mechanism of action is inhibition of the MDR pump in cancer cells. 4.3 Constituents ¯ Quinine ¯ Quinidine ¯ Cinchonine ¯ Cinchonidine 4.4 Pharmacokinetics Quinine is rapidly and about 80% absorbed orally, even in patients with severe diarrhea. It distributes widely throughout the body. Quinine is 70-80% protein-bound in the blood (this rises above 90% in patients with cerebral malaria, as well as in children and pregnant women). The elimination half-life from plasma is 8-21 h in patients with malaria and shorter (7-12 h) in healthy adults. The elimination half-lives in children are about half those in adults. All alkaloids in Cinchona undergo hepatic metabolism primarily. Metabolites, mostly hydroxylated forms, are excreted primarily by the kidneys. Alkaline urine doubles the excretion rate for quinine compared to alkaline urine. Quinine does enter breast milk. 4.5 Classic Formulations King’s American Dispensatory Tinctura Cinchonae Composita (U. S. P.)—Compound Tincture of Cinchona. SYNONYMS: Compound tincture of Peruvian bark, Huxham’s tincture of bark. ¯ Red cinchona, 100 g ¯ Bitter orange peel, 80 g ¯ Serpentaria, 20 g ¯ Glycerin, 75 ml ¯ Ethanol 100%, 1,000 ml ¯ Water, 1,000 ml Mix the glycerin with 850 ml ehtanol and 75 ml water. Mix and powder the herbs (to number 60 fineness). Moisten the powder with 200 ml menstruum and macerate for 24 h in a percolator cone. Slowly percolate, adding more menstruum mixed in the same proportions as above, until 1,000 ml of tincture is prepared. Indication: bitter stomachic, 2-3 fluid drams dose. Related Tinctures.—TINCTURA CINCHONAE COMPOSITA, Compound tincture of Peruvian bark. The following is the old London formula modified by Prof. King: ”Take of calisaya bark, in fine powder, 4 ounces; bitter orange peel, 3 ounces; Virginia snakeroot, in moderately fine powder, 6 drachms; saffron, in coarse powder, 2 drachms; cochineal, in fine powder, 1 drachm; good diluted alcohol, 20 fluid ounces, or a sufficient quantity”(Lond.). Form it into a tincture by maceration or 9
Page 1 and 2: Cinchona officinalis L (Peruvian ba
Page 3 and 4: ¯ Antimicrobial ¯ Bitter digestiv
Page 5 and 6: Acute malaria, adult: 0.5-1 ml (pos
Page 7: 2.13 Drug Interactions Quinine and
Page 11 and 12: A Manual of Organic Materia Medica
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Page 15: 7 Contributors Primary author: Eric

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

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