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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Quinine - Drugs and Lactation Database (LactMed®) - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]">
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<meta name="citation_title" content="Quinine">
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<meta name="citation_publisher" content="National Institute of Child Health and Human Development">
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<meta name="citation_date" content="2020/02/17">
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<meta name="citation_keywords" content="Quinine">
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<meta name="citation_keywords" content="Chinin">
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<meta name="citation_keywords" content="Chinine">
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<meta name="citation_keywords" content="(-)-Quinine">
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<meta name="citation_keywords" content="Quinine anhydrous">
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<meta name="citation_keywords" content="(8S,9R)-Quinine">
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<meta name="citation_keywords" content="Chinin [German]">
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<meta name="citation_keywords" content="6-Methoxycinchonine">
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<meta name="citation_keywords" content="130-95-0">
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<meta name="citation_keywords" content="Quinine [BAN:NF]">
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<meta name="citation_keywords" content="6'-Methoxycinchonan-9-ol">
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<meta name="citation_keywords" content="(8-alpha,9R)-6'-Methoxycinchonan-9-ol">
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<meta name="citation_keywords" content="(R)-(-)-Quinine, 6-methoxycinchonidine">
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<meta name="citation_keywords" content="Cinchonan-9-ol, 6'-methoxy-, (8alpha,9R)-">
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<meta name="description" content="Because of the low levels of quinine in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. The dosage in milk is far below those required to treat an infant for malaria.[1] However, quinine should not be used in mothers with an infant who is glucose-6-phosphate dehydrogenase (G6PD) deficient.[2] Even the relatively small amounts of quinine in tonic water ingested by the mother have caused hemolysis in G6PD-deficient infants.">
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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501164_"><span class="title" itemprop="name">Quinine</span></h1><p class="fm-aai"><a href="#_NBK501164_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 2 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><p>CASRN: 130-95-0</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/134973208" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134973208" alt="image 134973208 in the ncbi pubchem database" /></a><div id="LM303.Drug_Levels_and_Effects"><h2 id="_LM303_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM303.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Because of the low levels of quinine in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. The dosage in milk is far below those required to treat an infant for malaria.[<a class="bibr" href="#LM303.REF.1" rid="LM303.REF.1">1</a>] However, quinine should not be used in mothers with an infant who is glucose-6-phosphate dehydrogenase (G6PD) deficient.[<a class="bibr" href="#LM303.REF.2" rid="LM303.REF.2">2</a>] Even the relatively small amounts of quinine in tonic water ingested by the mother have caused hemolysis in G6PD-deficient infants.</p></div><div id="LM303.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> One old study measured quinine levels in the milk of 6 women at varying times after 2 to 3 doses of 300 or 640 mg of quinine.[<a class="bibr" href="#LM303.REF.3" rid="LM303.REF.3">3</a>] Milk levels ranged from traces to 4.4 mg/L, with an average of about 0.8 mg/L. The time of peak milk levels varied from 1.5 to 6.4 hours after the dose.</p><p>An unpublished study found that milk levels approximated one-third of simultaneous plasma levels. The author estimated that an infant would receive 1.5 to 3 mg daily of quinine base with maternal treatment.[<a class="bibr" href="#LM303.REF.4" rid="LM303.REF.4">4</a>]</p><p>One group of investigators studied 30 women who received quinine while breastfeeding intravenously or orally. Two publications reported data from the same group of women. In one paper, the milk levels reported after intravenous quinine appeared to be the levels following oral quinine and vice versa.[<a class="bibr" href="#LM303.REF.5" rid="LM303.REF.5">5</a>] This was apparently corrected in the later publication which is summarized as follows: twenty-five women received quinine sulfate 600 mg every 8 hours orally for 7 days had random breastmilk quinine levels averaging 2.6 mg/L (range 0.5 to 3.6 mg/L). In 3 of the women who had just initiated lactation, colostrum levels were 0.4, 0.9 and 1.9 mg/L. Five women who received a daily dosage of quinine dihydrochloride 10 mg/kg (8.3 mg/kg of quinine base) intravenously for 2 to 7 doses had random breastmilk quinine levels averaging 3.4 mg/L (range 0.5 to 8 mg/L).[<a class="bibr" href="#LM303.REF.6" rid="LM303.REF.6">6</a>]</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM303.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Four breastfed infants of 3 mothers, 3 boys and 1 girl (one set of twins) developed severe hemolysis following maternal ingestion of beverages containing quinine (e.g., tonic water). All infants had low levels of G6PD and were jaundiced on admission. Cessation of breastfeeding and tonic water and phototherapy and/or transfusion resolved the jaundice. One of the infants who was severely jaundiced had abnormal brainstem automatized evoked potentials at discharge. At 4 months of age he had a slight decrease in reactivity and a profound bilateral deafness. The breastmilk of one of the mothers was qualitatively positive for quinine.[<a class="bibr" href="#LM303.REF.7" rid="LM303.REF.7">7</a>] The hemolysis was probably caused by quinine in breastmilk.</p></div><div id="LM303.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM303.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/n/lactmed/LM287/?report=reader">Chloroquine</a>, <a href="/books/n/lactmed/LM290/?report=reader">Hydroxychloroquine</a></p></div><div id="LM303.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM303.REF.1">Fulton B, Moore LL. Antiinfectives in breastmilk. Part II: sulfonamides, tetracyclines, macrolides, aminoglycosides and antimalarials. <span><span class="ref-journal">J Hum Lact. </span>1992;<span class="ref-vol">8</span>:221–3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1288560" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1288560</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="LM303.REF.2">Mathew JL. Effect of maternal antibiotics on breast feeding infants. <span><span class="ref-journal">Postgrad Med J. </span>2004;<span class="ref-vol">80</span>:196–200.</span> [<a href="/pmc/articles/PMC1742963/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1742963</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15082839" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15082839</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="LM303.REF.3">Terwilliger WG, Hatcher RA. The elimination of morphine and quinine in human milk. <span><span class="ref-journal">Surg Gynecol Obstet. </span>1934;<span class="ref-vol">58</span>:823–6.</span></div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="LM303.REF.4">White NJ. Clinical pharmacokinetics of antimalarial drugs. <span><span class="ref-journal">Clin Pharmacokinet. </span>1985;<span class="ref-vol">10</span>:187–215.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3893840" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3893840</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="LM303.REF.5">Phillips RE, Looareesuwan S, White NJ, et al. Quinine pharmacokinetics and toxicity in pregnant and lactating women with falciparum malaria. <span><span class="ref-journal">Br J Clin Pharmacol. </span>1986;<span class="ref-vol">21</span>:677–83.</span> [<a href="/pmc/articles/PMC1400988/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1400988</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/3527243" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3527243</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="LM303.REF.6">Looareesuwan S, White NJ, Silamut K, et al. Quinine and severe falciparum malaria in late pregnancy. <span><span class="ref-journal">Acta Leidensia. </span>1987;<span class="ref-vol">55</span>:115–20.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3321826" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3321826</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="LM303.REF.7">Bichali S, Brault D, Masserot C, et al. Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children. <span><span class="ref-journal">Eur J Pediatr. </span>2017;<span class="ref-vol">176</span>:1415–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28828525" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28828525</span></a>]</div></dd></dl></dl></div></div><div id="LM303.Substance_Identification"><h2 id="_LM303_Substance_Identification_">Substance Identification</h2><div id="LM303.Substance_Name"><h3>Substance Name</h3><p>Quinine</p></div><div id="LM303.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>130-95-0</p></div><div id="LM303.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Anti-infective Agents</p><p>Antiparasitic Agents</p><p>Antimalarials</p><p>Antiprotozoal Agents</p><p>Foodborne Diseases</p><p>Glucosephosphate Dehydrogenase Deficiency</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501164_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">February 17, 2020</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Quinine. [Updated 2020 Feb 17].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/LM235/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/quizartinib/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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