Kaletra and Quinine Sulfate Capsules

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using quiNINE together with ritonavir is generally not recommended. Combining these medications may significantly increase the blood levels and effects of quiNINE. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Let your doctor know if you experience increased side effects of quiNINE such as headache, flushing, sweating, nausea, vomiting, diarrhea, abdominal pain, dizziness, ringing in the ears, hearing impairment, blurred vision, vision impairment, and irregular heart rhythm. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

GENERALLY AVOID: Coadministration with ritonavir may significantly increase the plasma concentrations of quinine. The mechanism is ritonavir inhibition of the metabolic clearance of quinine via CYP450 3A4. In ten healthy nonsmoking volunteers, administration of a single 600 mg oral dose of quinine sulfate following pretreatment with ritonavir 200 mg twice a day for 7 days resulted in approximately 4-fold increases in quinine peak plasma concentration (Cmax) and systemic exposure (AUC) and a 4.5-fold decrease in oral clearance (Cl/F) compared to administration alone. Ritonavir also reduced the Cmax and AUC of the metabolite 3-hydroxyquinine by 50% and 60%, respectively, and reduced the metabolic ratio (i.e., ratio of the AUC of metabolite to that of parent drug) by 90%. Clinically, high plasma levels of quinine may increase the risk of QT interval prolongation, which has been associated with ventricular arrhythmias including torsade de pointes and sudden death. The risk of other quinine toxicities such as cinchonism may also be increased. In the same study, single-dose quinine increased the Cmax, AUC, elimination half-life and plasma trough concentration (Cmin) of ritonavir by 15%, 21%, 32% and 66%, respectively. The mechanism may involve quinine inhibition of CYP450 3A4 and 2D6, the isoenzymes responsible for the metabolism of ritonavir.

MANAGEMENT: The use of quinine in combination with ritonavir should generally be avoided. Caution is advised if no alternatives exist and concomitant use is required. Patients should be monitored closely for adverse reactions associated with quinine such as hematologic toxicities and cardiac arrhythmias including torsade de pointes and atrial fibrillation. A dosage reduction of quinine may be necessary. Patients should be advised to contact their physician if they experience increased side effects such as headache, flushing, sweating, nausea, vomiting, diarrhea, abdominal pain, tinnitus, dizziness, vertigo, hearing impairment, blurred vision, vision impairment, and irregular heart rhythm.

Kaletra

Generic Name: lopinavir / ritonavir

Brand name: Kaletra

Synonyms: n.a.

What is Kaletra?

Quinine Sulfate Capsules

Generic Name: quinine

Brand name: Qualaquin, QM-260, Quinamm

Synonyms: Quinine, QuiNINE

What is Quinine Sulfate Capsules?