After the Party’s Over

George, James N.; Morton, Jordan; Liles, Nathan W; Nester, Carla

doi:10.1056/nejmcps1606750

Cited by 17 publications

(7 citation statements)

References 14 publications

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“…[6,7] Although ingestion of the medication for approximately one week is typically required to develop sensitization, drug-dependent antibodies may develop after only a single previous exposure. [3,8] These patients experience a diverse reaction to the drug and many have been shown to have a picture appearing of systemic inflammatory response. [7] What was interesting is that in our case the patient was adamant on not being exposed to any quinine during her lifetime including tonic water, yet after ingestion of one tablet of quinine, she developed signs of rhabdomyolysis, acute liver failure, severe hypothyroidism, progressive renal failure, and thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Quinine induced thrombotic microangiopathy and thrombocytopenia: A teaching hospital's perspective

Franke

Skelton

2019

Adv Gen Pract Med

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Although quinine is an infrequently prescribed drug, with malaria treatment being its only FDA-approved indication, unwitting exposure via beverages (e.g., tonic water), over the counter herbal remedies and illegal recreation drugs still occur. We present a unique case of a female patient who denied any known prior history of quinine exposure, who after being prescribed quinine tablets for restless leg syndrome, developed an immune-related thrombotic microangiopathy with thrombocytopenia and subsequent multi-organ failure. It was later elucidated that her only known potential source of prior quinine exposure was a remote history of crackcocaine use. The patient survived this rare and severe inflammatory response with recovery of renal function and was able to discontinue dialysis.

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Section: Discussionmentioning

confidence: 99%

Quinine induced thrombotic microangiopathy and thrombocytopenia: A teaching hospital's perspective

Franke

Skelton

2019

Adv Gen Pract Med

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“…It can mimic TTP, with severe thrombocytopenia and MAHA. However, AKI is also common 36 . Quinine, including quinine in beverages such as tonic water, is a common cause of immune‐mediated DITMA 36,37 …”

Section: Severe Thrombocytopenia and Maha Caused By Complications Of Pregnancymentioning

confidence: 99%

Severe thrombocytopenia and microangiopathic hemolytic anemia in pregnancy: A guide for the consulting hematologist

et al. 2021

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A hematologist receives a call from a maternal-fetal medicine (MFM) physician about a previously healthy patient who became ill at 25 weeks' gestation. Her mental status is deteriorating. There are signs of fetal distress. Platelet count and hemoglobin are falling. The MFM physician is considering the hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. For the hematologist, everything seems unfamiliar. Our goal is to provide hematologists with the fundamental knowledge required for understanding and managing these patients who become suddenly and seriously ill during pregnancy and in whom thrombocytopenia and microangiopathic hemolytic anemia are part of their presentation.

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“…Quinine can additionally cause severe immune-mediated systemic reactions [39]. A systematic review of adverse reactions to quinine identified 142 patients with definite or probable evidence for a causal association of quinine with acute, immune-mediated reactions.…”

Section: Toxicity Of Quinine and Quinidine Still Limits Their Usementioning

confidence: 99%

“…Quinine is currently approved by the FDA for the treatment of malaria only [46]. However, in some countries, including Canada, tablets can be purchased without a prescription, and quinine-containing beverages are available everywhere [39,40]. Quinine may be also found in cosmetics, e.g., shampoos [47].…”

Section: Current Uses Of Quinine and Quinidinementioning

confidence: 99%

The Fever Tree: from Malaria to Neurological Diseases

Eyal

2018

Toxins

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This article describes the discovery and use of the South American cinchona bark and its main therapeutic (and toxic) alkaloids, quinine and quinidine. Since the introduction of cinchona to Europe in the 17th century, it played a role in treating emperors and peasants and was central to colonialism and wars. Over those 400 years, the medical use of cinchona alkaloids has evolved from bark extracts to chemical synthesis and controlled clinical trials. At the present time, the use of quinine and quinidine has declined, to a large extent due to their toxicity. However, quinine is still being prescribed in resource-limited settings, in severe malaria, and in pregnant women, and quinidine made a limited comeback in the treatment of several cardiac and neurological syndromes. In addition, the article presents more recent studies which improved our understanding of cinchona alkaloids’ pharmacology. The knowledge gained through these studies will hopefully lead to a wider use of these drugs in precision medicine and to design of new generation, safer quinine and quinidine derivatives.

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After the Party’s Over

Cited by 17 publications

References 14 publications

Quinine induced thrombotic microangiopathy and thrombocytopenia: A teaching hospital's perspective

Quinine induced thrombotic microangiopathy and thrombocytopenia: A teaching hospital's perspective

Severe thrombocytopenia and microangiopathic hemolytic anemia in pregnancy: A guide for the consulting hematologist

The Fever Tree: from Malaria to Neurological Diseases

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