Quinine-related adverse drug reactions among malaria patients in Lira Regional Referral Hospital

Abstract

Introduction: Quinine is the most effective second-line antimalarial drug but its clinical use is usually limited due to the numerous side effects. Sex difference in quinine disposition is a possible key determinant of predisposition to quinine-associated adverse events. Objectives: To describe the adverse drug reactions encountered by men and women on quinine therapy in Lira Regional Referral Hospital (LRRH). Methods: Serum levels of clinical biochemical parameters and electrocardiographic (ECG) changes were measured over 24 hours, following administration of three intravenous doses of quinine dihydrochloride (600 mg each) to adult malaria patients and comparisons made between females and males. Questionnaires were also used in collection of subjective data from study participants. Results: More females (93%) reported to have had ADRs with previous quinine exposure, with hearing impairment being the commonest (35%) ADR. Significant sex differences were found for serum levels of ALT, AST, and urea after quinine treatment. No significant sex differences were observed in results of ECG measurements but sinus tachycardia, QTc prolongation and first degree heart blocks were the commonest cardiac related toxicities of quinine treatment. Conclusions: Females reported more quinine ADRs than men but this finding was not supported by the objective assessments performed (the clinical biochemical and ECG tests). Most ADRs (except cardiotoxicity) were reported to have occurred within the first eight hours o initiation of quinine treatment.