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Quinine is also used as an ingredient in tonic water and other beverages to impart a bitter taste. [8] Common side effects include headache, ringing in the ears, vision issues, and sweating. [5] More severe side effects include deafness, low blood platelets, and an irregular heartbeat. [5] Use can make one more prone to sunburn. [5]
Clindamycin should be given in conjunction with quinine as a 300 mg dose (in adults) four times a day for five days. The only side effects recorded in patients taking clindamycin are nausea, vomiting and abdominal pains and cramps. However these can be alleviated by consuming large quantities of water and food when taking the drug.
Quinine was the predominant malarial medication until the 1920s when other medications began to appear. In the 1940s, chloroquine replaced quinine as the treatment of both uncomplicated and severe malaria until resistance supervened, first in Southeast Asia and South America in the 1950s and then globally in the 1980s. [261]
In the United States, the US Food and Drug Administration (FDA) limits the quinine content in tonic water to 83 ppm [8] (83 mg per liter), while the daily therapeutic dose of quinine is in the range of 500–1000 mg, [9] and 10 mg/kg every eight hours for effective malaria prevention (2,100 mg daily for a 70-kilogram (150 lb) adult). [10]
Quinine, the key ingredient in tonic water, is derived from cinchona bark. It was first used as a digestive aid and later became widely known for its effectiveness in treating malaria.
Quinine sulfate 300 to 325 mg once daily: this regimen is effective but not routinely used because of the unpleasant side effects of quinine. Prophylaxis against Plasmodium vivax requires a different approach given the long liver stage of this parasite. [11] This is a highly specialist area.
Loperamide has limited data on the impact it has on pregnancy, but there is an association with cardiovascular malformation in the first trimester. [14] [12] Atropine/diphenoxylate currently has insufficient evidence of teratogenicity in humans, but trials with animals showed evidence of teratogenic effects. [14]
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