Cinkona (Quinine Sulphate 300mg) Tablets

Cinkona general information

What is Cinkona used for?

Cinkona tablets 300mg are use treat malaria, an infection caused by the protozoan (single cell) parasitic organism Plasmodium that is carried by mosquitoes.  Plasmodium is transmitted by a mosquito bite into the blood, where it migrates to the liver, grows and multiplies and is then released into the blood causing destruction of red blood cells.  Malaria is a life-threatening disease that causes symptoms including, fever, shivering, headache, vomiting, muscle pain, joint pain.  First symptoms usually appear 10 to 15 days after the mosquito bite; however, if left untreated, malaria can quickly become life-threatening causing anaemia and brain damage and disrupting the blood supply to vital organs.  Cinkona tablets 300mg kill the infective stage of the parasite in the blood, which breaks the life cycle of the plasmodium as well as preventing further destruction of red blood cells.  However, Cinkona 300 is not effective for tissue forms of the malaria parasite that can remain dormant in the liver and, therefore, will not prevent relapse of the disease.  Cinkona tablets 300mg are used particularly for malaria that is resistant to chloroquine, another similar drugs, and in conjunction with other medication. 

How does Cinkona work?

Cinkona tablets 300mg contain quinine sulphate, a synthetic form of natural quinine, an alkaloid found in the bark of the cinchona tree.  Quinine sulphate in Cinkona tablets 300mg tablets is a rapidly acting blood schizontocide that is used to treat malaria by killing the asexual schizont stage of the parasite that causes malaria.  The infective stage of the immature plasmodium parasite is transmitted by a mosquito bite into the blood and migrates to the liver where it infects the liver cells and may lie dormant for weeks, or months and then begins to mature to the next stage of the life cycle.  Once mature the parasite releases the next infective stage the merozoite, which infects red blood cells where it grows and multiplies. Some merozoites form the schizonts that burst the red blood cell, releasing the large numbers of merozoites to infect more red blood cells.  Some of the merozoites develop into gametophytes, the sexual form of the parasite, which are taken back into the mosquito and develop into sporozoites in the salivary gland of the mosquito, ready to begin the life cycle over again.  During the destruction of red blood cells, the schizont stage of the plasmodium parasite digests the oxygen carrying protein haemoglobin forming the toxic compound haem, which is converted to the insoluble crystalline form haemozoin that is not toxic to plasmodium.  Although the exact mechanism of action of quinine sulphate in Cinkona tablets 300mg is not clear, there are several possibilities.  Binding to haem prevents the conversion of haem to haemozoin and causes an accumulation of haem in the parasitic cell, which destroys the cell; also, its ability to concentrate within the parasitic cell is thought to disrupt intracellular activity of the parasite.  These actions of quinine sulphate in Cinkona 300 kill the schizont stage of the plasmodium parasite, which prevents the spread of the malarial infection. 

What does Cinkona contain?

Qinarsol tablets 300mg contain the active ingredient quinine sulphate, a schizontocide that is used to treat malaria by killing the schizont stage of the parasite that causes malaria.

Treating malaria with Cinkona

Cinkona tablets 300mg tablets contain quinine, a schizontocide that is used to treat malaria, an infection caused by the protozoan (single cell) parasitic organism Plasmodium, carried by mosquitoes.  Symptoms of malaria include, fever, shivering, headache, vomiting, muscle pain, joint pain and the infection can become life-threatening resulting in anaemia, disruption of blood supply to vital organs and brain damage.  The infective stage of the plasmodium parasite is transmitted by a mosquito bite into the blood and migrates to the liver where it infects the liver cells and matures to the next stage of the life cycle.  Once mature the parasite is released into the blood and infects red blood cells then grows, multiplies, destroys the red blood cell and re-infects more red blood cells.  During the destruction of red blood cells, the schizont stage of the plasmodium parasite digests the oxygen carrying protein haemoglobin forming the toxic compound haem which is converted to the insoluble crystalline form haemozoin that is not toxic to plasmodium.  Although the exact mechanism of action of quinine sulphate in Cinkona tablets 300mg is not clear, it is thought that it binds to haem prevents the conversion of haem to haemozoin causing an accumulation of haem in the parasitic cell, which destroys the cell; also, its ability to concentrate within the parasitic cell is thought to disrupt intracellular activity of the parasite.  These actions of quinine sulphate in Cinkona tablets 300mg tablets kill the schizont stage of the plasmodium parasite, which prevents the spread of the malarial.  Cinkona tablets 300mg is not effective for the tissue forms of the malaria parasite that can remain dormant in the liver and, therefore, will not prevent relapse of the disease. 

What are the side effects of Cinkona?

The most commonly reported side effects when taking Cinkona tablets 300mg include cinchonism (named after the cinchona tree which is the only natural source of quinine), with symptoms like tinnitus (ringing in the ears), impaired hearing, disturbed vision, headache, gastrointestinal upset (vomiting, diarrhoea, abdominal pain), skin rash, flushing.

When should Cinkona not be used?

You should not use Cinkona tablets 300mg if you:

• are allergic to quinine or any ingredients in Cinkona tablets 300mg
• are pregnant or are breastfeeding
• have tinnitus (ringing in the ears) or optic neuritis (inflammation of the optic nerve that can cause blindness)
• have haemolysis, a condition that affects your red blood cells
• have had Blackwater fever (a complication of malaria)
• have myasthenia gravis, a condition causing muscle weakness
• have irregular heart beat or other heart problems
• have glucose-6-phosphate dehydrogenase deficiency (G6PD), an inherited condition
• are taking medicines that interact with Cinkona tablets 300mg, including: anticoagulants like warfarin, digoxin for heart problems, the antiarrhythmic flecainide, cimetidine for ulcers, pimozide or thioridazine antipsychotics, the antibacterial rifampicin, amantadine for Parkinsons disease, other antimalarials like mefloquine, the immunosuppressant ciclosporin, antihistamines like terfenadine

What medications interact with Cinkona?

Several medications interact with Cinkona tablets 300mg and should either not be taken while you are taking Cinkona or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Cinkona: anticoagulants like warfarin, pimozide or thioridazine antipsychotics, other antimalarials like mefloquine, antihistamines like terfenadine
• Drugs that affect Cinkona tablets 300mg: cimetidine for ulcers, the antibacterial rifampicin
• Drugs that are affected by Cinkona tablets 300mg: digoxin for heart problems, the antiarrhythmic flecainide, amantadine for Parkinsons disease, the immunosuppressant ciclosporin

How should Cinkona be taken?

You should take your Cinkona tablets 300mg with a glass of water and with food every 8 hours for 7 days.  The dose of Cinkona tablets 300mg that you take for malaria depends on the type of malaria you have been infected with and your doctor’s recommendations; you may also be taking other medication.  You should continue to take your Cinkona tablets 300mg tablets for 7 days or as long as recommended by your doctor.

How long should you take Cinkona?

You should continue to take your Cinkona tablets 300mg tablets for 7 days or as long as recommended by your doctor.

Missed dose of Cinkona

If you miss a dose of Cinkona tablets 300mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Cinkona be stored?

You should store your Cinkona tablets 300mg below 25°C in a cool dry place.