Each capsule contains: Quinine bark 450 mg. Other Ingredients: Gelatin, Water.
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Below is general information about the effectiveness of the known ingredients contained in the product Quinine 450 mg. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
There is insufficient reliable information available about the effectiveness of cinchona.
Below is general information about the safety of the known ingredients contained in the product Quinine 450 mg. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
LIKELY SAFE ...when used orally as a flavoring in tonic water and alcoholic beverages. The US Code of Federal Regulations allows not more than 83 parts per million (ppm) of total cinchona alkaloids in finished beverages (93229).
POSSIBLY UNSAFE ...when used orally in medicinal amounts. Cinchona derivatives marketed as over-the-counter (OTC) medicines are required to carry the warning, "Caution - discontinue use if ringing in the ears, deafness, skin rash, or visual disturbances occur" (93231). Cinchona contains the alkaloid quinine that was previously available OTC in the US for treatment and prevention of nocturnal leg muscle cramps. In 1994 the US Food and Drug Administration (FDA) determined that quinine was not generally recognized as safe and effective for this indication, citing serious adverse reactions and its narrow therapeutic index (93232,93233). A final ban on marketing of OTC quinine products was implemented by the FDA in 2007, and a Risk Evaluation and Mitigation Strategy (REMS) to reduce off-label use of prescription quinine products for night-time leg cramps was introduced in 2010 (93232).
LIKELY UNSAFE ...when excessive amounts are used orally. Cinchona contains the alkaloids quinine and quinidine, which are used as prescription medicines and have been associated with significant adverse effects at doses of 2 grams per day or more (505). The amount of these constituents in cinchona products is variable (13).
PREGNANCY: LIKELY UNSAFE
when used orally.
Cinchona is reported to have uterine stimulant and abortifacient activity, and to be fetotoxic and teratogenic, causing visual and auditory defects (12,19). Avoid using.
LACTATION: POSSIBLY UNSAFE
when used orally.
The cinchona alkaloids quinine and quinidine are reported to be excreted in breast milk and may be toxic to infants (19).
Below is general information about the interactions of the known ingredients contained in the product Quinine 450 mg. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Theoretically, due to reports that it increases stomach acid, cinchona might decrease the effectiveness of antacids (19). Also theoretically, some antacids such as magnesium or aluminum hydroxide might increase the risk of quinidine toxicity from cinchona. Increased urinary pH increases the proportion of excreted quinidine in the nonionized state, allowing more to be reabsorbed in the renal tubules (3046).
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Theoretically, cinchona can increase the drug effects and risk of bleeding with anticoagulant and antiplatelet drugs. There is in vitro evidence that the alkaloids quinine, quinidine, and cinchonine present in cinchona inhibit platelet aggregation (19,93228).
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Cinchona can increase serum drug levels of carbamazepine due to its quinine content (11016).
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Theoretically, cinchona might inhibit cytochrome P450 2D6 (CYP2D6) and increase levels of drugs metabolized by this enzyme. Cinchona contains quinidine, which has been shown to inhibit CYP2D6-mediated metabolism in humans (3046,95687).
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Theoretically, cinchona can increase serum levels of digoxin. Quinine and quinidine, which are present in cinchona, increase serum digoxin levels by decreasing its clearance from the body (3046).
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Theoretically, due to reports that it increases stomach acid, cinchona might decrease the effectiveness of H2-blockers (19). The H2 blockers include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid).
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Cinchona can increase serum drug levels of phenobarbital due to its quinine content (504).
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Theoretically, due to reports that it increases stomach acid, cinchona might decrease the effectiveness of PPIs (19). PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).
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Theoretically, due to its quinidine and quinine content, cinchona might have an additive effect with drugs that prolong the QT interval. This may increase the risk of ventricular arrhythmias (3046). Drugs that prolong the QT interval include amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn), ibutilide (Corvert), procainamide (Pronestyl), sotalol (Betapace), thioridazine (Mellaril), and many others.
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Cinchona contains quinidine; concomitant use with cinchona can increase the therapeutic and adverse effects of quinidine (505).
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Cinchona contains quinine; concomitant use with cinchona can increase the therapeutic and adverse effects of quinine (505).
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Below is general information about the adverse effects of the known ingredients contained in the product Quinine 450 mg. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General
...Information on the adverse effects of cinchona is limited.
Orally, prolonged use of high doses of cinchona or its alkaloids are associated with a toxicity syndrome known as cinchonism (6,12,19,505,93232). Topical use or occupational exposure to cinchona bark can cause contact dermatitis and urticarial reactions (11,93234).
Cinchona contains the alkaloids quinine and quinidine, which have been associated with numerous adverse and toxic effects. The most common adverse effects of quinine include nausea and vomiting, diarrhea, ringing in the ears, and vision disturbances (6,8,12). Quinidine and quinine can also prolong the QT interval on the electrocardiogram, cause cardiac arrhythmias, and has been associated with serious, sometimes fatal, hematological disorders including thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (3046,93232,93233).
Cardiovascular ...Cinchona contains the alkaloids quinidine and quinine that can prolong the QT interval on the electrocardiogram, and cause potentially fatal cardiac arrhythmias such as torsades de pointes (3046,93232)
Dermatologic ...Topical use of cinchona bark extracts and occupational exposure to cinchona bark dust can cause contact dermatitis and other urticarial reactions (11,93234). A 31-year old man developed itching, erythema, and edema of the face and upper chest after occupational exposure to dust from cinchona bark. Skin testing produced reactions to ethanol and ether extracts of the bark, but not to the individual alkaloids quinine and quinidine (93234).
Gastrointestinal ...Cinchona stimulates secretion of stomach acid and has been associated with nausea, vomiting, and diarrhea (6,19).
Hematologic ...Quinine, which is present in cinchona, has been associated with serious, sometimes fatal, hematological disorders including thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (hemolytic anemia, acute renal failure, and thrombocytopenia) (93232,93233). Initial symptoms may include bleeding from the gums, nose or gastrointestinal tract, easy bruising, and petechiae (93233). Bone marrow depression and thrombocytopenia have also been associated with quinidine (505).
Immunologic ...Oral use of quinine, an alkaloid present in cinchona, has been associated with severe allergic skin reactions, as well as anaphylaxis (19,93232).
Ocular/Otic ...Cinchona contains quinine that can cause dose-related adverse effects on hearing and vision, including tinnitus, deafness, vision changes, and blindness (6,8,12,93232).
Other ...Orally, prolonged use of high doses of cinchona or its alkaloids, or a single dose of 3 grams or more of the alkaloid quinine are associated with a toxicity syndrome known as cinchonism. Symptoms include headache, dizziness, nausea and vomiting, diarrhea, hemolysis, hypotension, cardiac arrhythmias, tinnitus, deafness, vision changes, blindness, abdominal pain, delirium, convulsions, paralysis, and collapse (6,12,19,505,93232). Doses of 10-15 grams of quinine may be fatal (18).