PAXELADINE 40mg Price

Overview

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This medicine contains an important and useful components, as it consists of
Oxeladine citrateis available in the market in concentration

Name

Quinine Dihydrochloride

Precaution

Before initiating treatment with **Quinine Dihydrochloride**, it is crucial for patients to consult their healthcare provider to assess the appropriateness of the drug for their individual condition. Several precautions must be considered: - **Cardiac Issues**: Quinine can prolong the **QT interval** (the time it takes for the heart to recover after each beat), leading to **arrhythmias** (irregular heartbeats). This can be dangerous for those with underlying heart conditions such as **congenital long QT syndrome** or those on medications that also affect the QT interval. - **Hepatic Impairment**: Since quinine is metabolized in the liver, patients with **liver disease** should be closely monitored, and dose adjustments may be required. - **Kidney Dysfunction**: In patients with **renal insufficiency**, quinine may accumulate in the body, increasing the risk of **toxicity**. Dose reductions may be needed. - **Pregnancy and Breastfeeding**: Quinine should be used cautiously during pregnancy, particularly in the first trimester, as it may harm the fetus. It is also excreted in breast milk, and breastfeeding should be avoided while on this medication unless recommended by a healthcare provider. - **G6PD Deficiency**: Patients with **glucose-6-phosphate dehydrogenase (G6PD) deficiency** are at higher risk for **hemolysis** (destruction of red blood cells) when using quinine, potentially leading to **hemolytic anemia**. Testing for G6PD deficiency is recommended before starting therapy. - **Allergic Reactions**: Rarely, quinine can cause severe allergic reactions, including **anaphylaxis**, **angioedema** (swelling), or **rash**. Patients should seek immediate medical help if symptoms of an allergic reaction occur.

Indication

**Quinine Dihydrochloride** is primarily used for the treatment of **malaria** and some other parasitic infections. Its indications include: - **Treatment of Malaria**: Quinine is traditionally used for the **treatment of uncomplicated malaria** caused by **Plasmodium falciparum** and other species. It is particularly useful in cases where **artemisinin-based therapies** are not available or suitable. - **Severe Malaria**: In some instances, quinine is used in the treatment of **severe malaria**, often in combination with other antimalarial drugs to manage symptoms and reduce the risk of complications. - **Leg Cramps**: In some cases, **quinine** may be prescribed off-label for the treatment of **nocturnal leg cramps**, though this use is not universally recommended due to its potential side effects. It is important to follow a healthcare provider’s guidance on the use of quinine, especially in non-malaria indications, as side effects can outweigh the benefits in certain situations.

Contra indication

There are several conditions and situations where **Quinine Dihydrochloride** should be avoided: - **Hypersensitivity**: Quinine should not be used in individuals who are allergic to it or any of its components. Signs of an allergic reaction can include rash, swelling, or difficulty breathing. - **Cardiac Conditions**: Quinine is contraindicated in patients with **severe heart conduction disorders**, including **long QT syndrome**, **bradycardia**, or **heart block**, due to the potential for **arrhythmias** and other cardiac issues. - **G6PD Deficiency**: Patients with **G6PD deficiency** should avoid quinine due to the risk of **hemolytic anemia**. - **Myasthenia Gravis**: Quinine may worsen the symptoms of **myasthenia gravis**, a condition that weakens the voluntary muscles. It should not be used in such patients unless absolutely necessary and under close medical supervision. - **Renal Impairment**: In patients with severe renal impairment, **quinine** should be avoided unless no other options are available. Dose adjustments are critical if it is used in these patients. - **Pregnancy**: Quinine should generally be avoided during pregnancy, particularly in the first trimester, as it can pose risks to the fetus, including **congenital defects** and **miscarriage**.

Side Effect

While **Quinine Dihydrochloride** can be effective in treating malaria and other conditions, it can also cause a variety of side effects. Common and serious side effects include: **Common Side Effects**: - **Gastrointestinal Issues**: Nausea, vomiting, abdominal pain, and diarrhea are relatively common with quinine use. Taking the drug with food may help minimize these effects. - **Tinnitus**: Ringing in the ears, known as **tinnitus**, is a well-known side effect of quinine, particularly at higher doses. If tinnitus becomes severe, the drug should be discontinued. - **Headache**: Some patients may experience headaches, especially during the early stages of treatment. - **Dizziness**: Quinine can cause dizziness or lightheadedness, particularly in the standing position. **Severe Side Effects**: - **Hypoglycemia**: Quinine may increase the risk of **low blood sugar** (hypoglycemia), especially when taken in high doses or with other medications that lower blood sugar. - **Cardiac Arrhythmias**: Prolonged use or high doses of quinine can lead to **QT prolongation**, **ventricular arrhythmias**, or **heart block**. - **Severe Allergic Reactions**: Signs of an allergic reaction may include **swelling of the face**, **lips**, **tongue**, or **throat**, and **difficulty breathing**. This requires immediate medical attention. - **Cinchonism**: A condition known as **cinchonism** occurs with **quinine toxicity** and involves symptoms such as **dizziness**, **blurred vision**, **confusion**, and **ringing in the ears**. It is a sign that the dose may need to be reduced or discontinued. - **Hemolytic Anemia**: In patients with **G6PD deficiency**, quinine can trigger **hemolysis**, leading to anemia and jaundice.

Pregnancy Category ID

3

Mode of Action

**Quinine Dihydrochloride** works by interfering with the **plasmodium parasite** that causes malaria. Its mechanism of action includes: - **Inhibition of Hemoglobin Digestion**: Quinine binds to the heme molecule, which is released when the **Plasmodium parasite** digests red blood cells. This disrupts the parasite’s ability to process heme, causing toxic buildup and killing the parasite. - **Modulation of Parasite Metabolism**: Quinine also inhibits **enzyme activity** in the parasite, disrupting its metabolism and survival within red blood cells. - **Immune System Activation**: Quinine may also have a **modulatory effect** on the immune system, enhancing the body’s ability to fight the infection by increasing **phagocytosis** (the engulfment of the parasite by immune cells). This combination of effects helps eliminate the parasite from the bloodstream, thereby treating malaria.

Interaction

Quinine can interact with a number of drugs and substances, which may affect its effectiveness or cause dangerous side effects. Important interactions include: - **CYP450 Enzyme Inhibitors and Inducers**: Quinine is metabolized by the liver, and interactions with **CYP450 enzyme inhibitors** (such as **ketoconazole**, **ritonavir**) or **inducers** (like **rifampin**) can alter its levels, either increasing the risk of side effects or reducing its efficacy. - **Anticoagulants**: **Quinine** can increase the effects of **warfarin** and other **anticoagulants**, increasing the risk of **bleeding**. Close monitoring of blood clotting parameters (e.g., **INR**) is recommended. - **Cardiovascular Medications**: Quinine can exacerbate the effects of drugs that prolong the **QT interval**, such as **antiarrhythmics** (e.g., **amiodarone**) or certain **antipsychotics**. Combining quinine with these medications may increase the risk of **life-threatening arrhythmias**. - **Digoxin**: **Quinine** can increase the plasma concentration of **digoxin**, a medication used to treat heart conditions, potentially leading to **digoxin toxicity**. - **Antiepileptics**: Drugs like **phenytoin** and **carbamazepine** can decrease the effectiveness of quinine by inducing the **CYP3A4 enzymes** that metabolize it. Close monitoring is necessary if quinine is used in combination with these drugs. Patients should inform their healthcare provider of all medications they are taking, including over-the-counter medications, supplements, and herbal products, to avoid harmful interactions.

Pregnancy Category Note

Information not available

Adult Dose

The typical adult dosage for **Quinine Dihydrochloride** depends on the condition being treated: - **Malaria**: The usual dose for **uncomplicated malaria** caused by **Plasmodium falciparum** is **600 mg** every **8 hours** for **7 days**. For **severe malaria**, the dose may be higher and administered intravenously in a hospital setting. - **Leg Cramps**: Quinine is sometimes used off-label for **nocturnal leg cramps**, with a typical dose of **200–300 mg** taken at **bedtime**. Dosing adjustments are required for patients with renal or hepatic impairment, and the treatment duration should not exceed the recommended limits to avoid toxicity.

Child Dose

The use of **Quinine Dihydrochloride** in pediatric patients is generally based on body weight and condition severity: - **Malaria**: For children, the dose is typically **10 mg/kg** every **8 hours** for **7 days** for uncomplicated malaria. The dose may be adjusted for severe cases depending on the severity and the child’s response to treatment. - **Leg Cramps**: Quinine is rarely used in children for leg cramps, as safer alternatives are generally preferred for younger populations. The safety and dosage of quinine in children must be carefully considered, and therapy should only be initiated under the supervision of a healthcare provider.

Renal Dose

For patients with **renal impairment**, particularly those with **severe renal insufficiency**, quinine dosing should be reduced to avoid **accumulation** and **toxicity**. **Renal function** should be monitored closely, and dosage adjustments made accordingly. In patients with **end-stage renal disease (ESRD)** on dialysis, quinine should be used with extreme caution, and the benefits should outweigh the risks.

Administration

Information not available