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Quinine toxicity when given with doxycycline and mefloquine
J Karbwang1, K N Bangchang, A Thanavibul
1Clinical Pharmacology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Summary
This case study highlights potential interactions between quinine, doxycycline, and mefloquine in malaria treatment. Quinine may affect mefloquine levels and cause side effects like hearing loss.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Medicine
Background:
- Falciparum malaria requires effective antimalarial drug combinations.
- Understanding drug-drug interactions is crucial for optimizing treatment efficacy and safety.
Observation:
- A patient with falciparum malaria received intravenous quinine and oral doxycycline, followed by oral mefloquine.
- The patient experienced adverse effects including nausea, tinnitus, and temporary hearing loss.
- Drug level monitoring revealed higher plasma quinine and lower whole blood mefloquine concentrations than anticipated.
Findings:
- Quinine administration appeared to influence the pharmacokinetics of mefloquine.
- Mefloquine concentrations increased after quinine was discontinued.
- Quinine toxicity, including hearing loss, was observed during treatment.
Implications:
- Clinicians should be aware of potential pharmacokinetic interactions between quinine and mefloquine.
- Careful monitoring of drug levels and adverse effects is recommended when using these antimalarials concurrently.
- Further research into the interactions of these antimalarials is warranted to guide clinical practice.