[Case Discussion] clinical pharmacology

[hussam abdalgany]

Alsalam alykom
I woud like to ask you a question :
A patient with established diagnosis of cerebral malaria in al khartoum bahri hospital ,, he recieved QUININE 600mg in D5% given IV through 4hrs every 8hrs ,, on the 5th day of treatment , the patient developed tinnitus and his hearing began to deteriorate ,, my questions are :
1) ist a recognized side effect for quinine ttt
2) ist reversible or not
3) what to do in such cases ,,? ,, ist suitable to discontinue the ttt ,, is there any suitable ulternatives for quinine ,, or shoud you continue the ttt with just assuring the paient that this symptoms will reverse automatically when completing the ttt and stoping the quinine ???

[Al-Husein]

wa alaykom alsalam;
therapeutic dose of quinine commonly cause tinnitus, headache, nausea, dizziness, flushing, and visual disturbances, a constellation of symptoms called cinchonism.
mild symptoms of cinchonism do not warrant the discontinuation of therapy.
more severe findings, often after prolonged therapy, include more marked visual and auditory abnormalities, vomiting, diarrhea, and abdominal pain.
in severe cinchonism, quinine should be discontinued.

[Al-Husein]

quinine dose should be reduced in renal insufficiency.

some studies have related the use of quinine and hearing impairment, particularly high-frequency loss, but it has not been conclusively established whether such impairment is temporary or permanent.