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PCE Dispertab and Quinine

Determining the interaction of PCE Dispertab and Quinine and the possibility of their joint administration.

Check result:

PCE Dispertab <> Quinine

Relevance: 03.12.2022 Reviewer: Shkutko P.M., M.D., in

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.

Consumer:

Using quiNINE together with erythromycin is not recommended. Combining these medications may significantly increase the blood levels and effects of quiNINE. You may experience increased side effects 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.

Professional:

GENERALLY AVOID: Coadministration with ketolide and macrolide antibiotics that inhibit CYP450 3A4 may significantly increase the plasma concentrations of quinine, which is primarily metabolized by the isoenzyme. In ten healthy volunteers, administration of a single 600 mg oral dose of quinine sulfate in combination with the potent CYP450 3A4 inhibitor troleandomycin (500 mg orally every 8 hours for 48 hours) significantly increased the mean quinine peak plasma concentration (Cmax), systemic exposure (AUC) and terminal elimination half-life by 26%, 90% and 63%, respectively, and decreased the mean oral clearance (Cl/F) by 45% compared to administration of quinine alone. Troleandomycin also reduced the average Cmax, AUC and apparent formation clearance of the main metabolite, 3-hydroxyquinine, by 75%, 58% and 81%, respectively. Other ketolides and macrolides that may significantly inhibit CYP450 3A4 include clarithromycin, erythromycin, and telithromycin. Azithromycin and dirithromycin are generally believed to have little, if any, effect on CYP450 3A4. 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. In addition, clarithromycin, erythromycin, and telithromycin have all been individually associated with QT interval prolongation, thus additive effects may occur during concomitant use with quinine. Fatal torsade de pointes arrhythmia was reported in an elderly patient who received quinine in combination with erythromycin and dopamine. However, a causal relationship was not established in this case.

MANAGEMENT: The use of quinine in combination with ketolide and macrolide antibiotics that inhibit CYP450 3A4 should generally be avoided. Azithromycin may be a safer alternative during therapy with quinine.

References

Wanwimolruk S, Paine MF, Pusek SN, Watkins PB "Is quinine a suitable probe to assess the hepatic drug-metabolizing enzyme CYP3A4?" Br J Clin Pharmacol 54 (2002): 643-51
Mirghani RA, Ericsson O, Tybring G, Gustafsson LL, Bertilsson L "Quinine 3-hydroxylation as a biomarker reaction for the activity of CYP3A4 in man." Eur J Clin Pharmacol 59 (2003): 23-8
Mirghani RA, Hellgren U, Westerberg PA, Ericsson O, Bertilsson L, Gustafsson LL "The roles of cytochrome P450 3A4 and 1A2 in the 3-hydroxylation of quinine in vivo." Clin Pharmacol Ther 66 (1999): 454-60
Zhang H, Coville PF, Walker RJ, Miners JO, Birkett DJ, Wanwimolruk S "Evidence for involvement of human CYP3A in the 3-hydroxylation of quinine." Br J Clin Pharmacol 43 (1997): 245-52
Zhao XJ, Ishizaki T "A further interaction study of quinine with clinically important drugs by human liver microsomes: determinations of inhibition constant (K-i) and type of inhibition." Eur J Drug Metab Pharm 24 (1999): 272-8
"Product Information. Qualaquin (quinine)." AR Scientific Inc, Philadelphia, PA.
Mirghani RA, Yasar U, Zheng T, et al "Enzyme kinetics for the formation of 3-hydroxyquinine and three new metabolites of quinine in vitro; 3-hydroxylation by CYP3A4 is indeed the major metabolic pathway." Drug Metab Dispos 30 (2002): 1368-71
Mirghani RA, Hellgren U, Bertilsson L, Gustafsson LL, Ericsson O "Metabolism and elimination of quinine in healthy volunteers." Eur J Clin Pharmacol (2003):
Zhao XJ, Ishizaki T "Metabolic interactions of selected antimalarial and non-antimalarial drugs with the major pathway (3-hydroxylation) of quinine in human liver microsomes." Br J Clin Pharmacol 44 (1997): 505-11

PCE Dispertab

Generic Name: erythromycin

Brand name: EES. Granules, EES-400 Filmtab, EryPed 200, EryPed 400, Ery-Tab, Erythrocin Lactobionate, Erythrocin Stearate Filmtab, PCE Dispertab, E. E. S, EryPed, Erythrocin, Erythromycin Filmtabs, Erythromycin Lactobionate - IV

Synonyms: PCE Dispertab (Oral), PCE, PCE (Oral)

What is PCE Dispertab?

Quinine

Generic Name: quinine

Brand name: Qualaquin, QM-260, Quinamm

Synonyms: QuiNINE

What is Quinine?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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