Interactions

Drug-Drug

• Concurrent use of Class IA antiarrhythmics ( quinidine , procainamide , disopyramide , Class III antiarrhythmics, mefloquine, pimozide, or macrolide anti-infectives ↑ risk of arrhythmias and should be avoided

• Antacids ↓ absorption

• Cimetidine ↓ metabolism and may ↑ effects

• Rifampin and rifabutin ↑ metabolism and may ↓ effects; concurrent use with rifampin should be avoided

• May ↑ effects of neuromuscular blocking agents

• May ↑ digoxin levels; dose adjustments may be necessary

• May ↑ risk of hemolytic, ototoxic, or neurotoxic reactions when used concurrently with agents sharing these toxicities

• Concurrent use with quinidine may ↑ risk of adverse cardiovascular reactions

• May ↑ risk of bleeding with warfarin

• Concurrent use with mefloquine ↑ risk of seizures and adverse cardiovascular reactions

• Urinary alkalinizers including acetazolamide and sodium bicarbonate may ↑ blood levels

• Quinine inhibits the CYP3A4 and CYP2D6 enzyme systems and can ↑ levels of carbamazepine , phenobarbital , phenytoin , atorvastatin , simvastatin , lovastatin , dextromethorphan , metoprolol , flecainide , and paroxetine

• Carbamazepine , phenobarbital , and phenytoin induce metabolism and ↓ levels of quinine; frequent monitoring recommended

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