QUALAQUIN™
brand of
quinine sulfate
CAPSULES USP, 324 mg

Qualaquin (quinine sulfate) is an antimalarial drug chemically described as cinchonan-9-ol, 6'-methoxy-, (8α, 9R)-, sulfate (2:1) (salt), dihydrate with a molecular formula of (C₂₀H₂₄N₂O₂)₂•H₂SO₄•2H₂O and a molecular weight of 782.96. The structural formula of quinine sulfate is:

Quinine sulfate occurs as a white, crystalline powder that darkens on exposure to light. It is odorless and has a persistent very bitter taste. It is only slightly soluble in water, alcohol, chloroform, and ether.

Qualaquin is supplied for oral administration as capsules containing 324 mg of the active ingredient quinine sulfate USP, equivalent to 269 mg free base. Inactive ingredients: corn starch, magnesium stearate, and talc.

Administration of multiple-dose activated charcoal (50 grams administered 4 hours after quinine dosing followed by 3 further doses over the next 12 hours) decreased the mean quinine elimination half-life from 8.2 to 4.6 hours, and increased the mean quinine clearance by 56% (from 11.8 L/h to 18.4 L/h) in 7 healthy adult volunteers who received a single oral 600 mg dose of quinine sulfate. Likewise, in 5 symptomatic patients with acute quinine poisoning who received multiple-dose activated charcoal (50 grams every 4 hours), the mean quinine elimination half-life was shortened to 8.1 hours in comparison to a half-life of approximately 26 hours in patients who did not receive activated charcoal (See OVERDOSAGE).

In 6 patients with quinine poisoning, forced acid diuresis did not change the half-life of quinine elimination (25.1 ± 4.6 hours vs. 26.5 ± 5.8 hours), or the amount of unchanged quinine recovered in the urine, in comparison to 8 patients not treated in this manner (See OVERDOSAGE).

QTc interval prolongation was evaluated in a crossover pharmacokinetic study in healthy volunteers (N=24) who received single oral doses of Qualaquin (324 mg and 648 mg). The mean ± SD maximum QTc change from baseline around the quinine T_max was 10 ± 19 msec and 12 ± 18 msec, respectively for the 324 mg and 648 mg doses. There were no subjects who had a QTc interval greater than 500 msec, or had a maximum QTc change from baseline of greater than 60 msec (See WARNINGS).

Qualaquin is indicated only for treatment of uncomplicated Plasmodium falciparum malaria. Quinine sulfate has been shown to be effective in geographical regions where resistance to chloroquine has been documented (See CLINICAL STUDIES).

Qualaquin oral capsules are not approved for patients with severe or complicated P. falciparum malaria.

Qualaquin oral capsules are not approved for prevention of malaria.

Qualaquin oral capsules are not approved for the treatment or prevention of nocturnal leg cramps.

Qualaquin is contraindicated in patients with a prolonged QT interval. One case of a fatal ventricular arrhythmia was reported in an elderly patient with a prolonged QT interval at baseline, who received quinine sulfate intravenously for P. falciparum malaria (See WARNINGS).

Qualaquin is contraindicated in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (See WARNINGS).

Qualaquin is contraindicated in patients with myasthenia gravis (See WARNINGS).

Qualaquin is contraindicated in patients with known hypersensitivity to quinine. Qualaquin is also contraindicated in patients with known hypersensitivity to mefloquine or quinidine because cross-sensitivity to quinine has been documented (See PRECAUTIONS).

Qualaquin is contraindicated in patients with a history of potential hypersensitivity reactions associated with previous quinine use. These include, but are not limited to the following:

• Thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS)
• Thrombocytopenia
• Blackwater fever (acute intravascular hemolysis, hemoglobinuria, and hemoglobinemia)
  (See PRECAUTIONS).

Qualaquin is contraindicated in patients with optic neuritis (See ADVERSE REACTIONS).

Qualaquin may cause unpredictable serious and life-threatening hypersensitivity reactions, QT prolongation, serious cardiac arrhythmias including torsades de pointes, and other serious adverse events requiring medical intervention and hospitalization. Fatalities have also been reported. The risk associated with the use of Qualaquin in the absence of evidence of its effectiveness for treatment or prevention of nocturnal leg cramps, outweighs any potential benefit in treating and/or preventing this benign, self-limiting condition (See CONTRAINDICATIONS, PRECAUTIONS, and ADVERSE REACTIONS).

QT interval prolongation has been a consistent finding in studies which evaluated electrocardiographic changes with oral or parenteral quinine administration, regardless of age, clinical status, or severity of disease. The maximum increase in QT interval has been shown to correspond with peak quinine plasma concentration (See CLINICAL PHARMACOLOGY/Electrocardiogram). Quinine sulfate has been rarely associated with potentially fatal cardiac arrhythmias, including torsades de pointes, and ventricular fibrillation.

Qualaquin is not recommended for use with other drugs known to cause QT prolongation, including Class IA antiarrhythmic agents (e.g., quinidine, procainamide, disopyramide), and Class III antiarrhythmic agents (e.g., amiodarone, sotalol, dofetilide).

Quinine may also inhibit the metabolism of other drugs that are CYP3A4 substrates known to cause QT prolongation, such as astemizole, cisapride, terfenadine, pimozide, halofantrine and quinidine. Torsades de pointes has been reported in patients who received concomitant quinine and astemizole. Therefore, concurrent use of Qualaquin with these medications, or drugs with similar properties, should be avoided (See PRECAUTIONS/Drug Interactions).

Concomitant administration of Qualaquin with the antimalarial drugs, mefloquine or halofantrine, may result in electrocardiographic abnormalities, including QT prolongation, and increase the risk for torsades de pointes or other serious ventricular arrhythmias. Concurrent use of Qualaquin and mefloquine may also increase the risk of seizures (See PRECAUTIONS/Drug Interactions).

The use of macrolide antibiotics such as erythromycin should be avoided in patients receiving Qualaquin. Fatal torsades de pointes was reported in an elderly patient who received concomitant quinine, erythromycin, and dopamine. Although a causal relationship between a specific drug and the arrhythmia was not established in this case, erythromycin is a CYP3A4 inhibitor and could potentially increase quinine plasma levels when used concomitantly. A related macrolide antibiotic, troleandomycin, has been shown to increase quinine exposure in a pharmacokinetic study (See PRECAUTIONS/Drug Interactions).

Qualaquin should also be avoided in patients with known prolongation of QT interval (See CONTRAINDICATIONS), in elderly patients, and in patients with clinical conditions known to prolong the QT interval, such as uncorrected hypokalemia, bradycardia, and certain cardiac conditions.

Treatment failures may result from the concurrent use of rifampin with Qualaquin, due to decreased plasma concentrations of quinine, and concomitant use of these medications should be avoided (See PRECAUTIONS/Drug Interactions).

Hemolysis and hemolytic anemia can occur in patients with G-6-PD deficiency who receive quinine. Qualaquin should be stopped immediately upon the appearance of evidence of hemolysis (See CONTRAINDICATIONS).

Quinine sulfate has neuromuscular blocking activity, and may exacerbate muscle weakness in patients with myasthenia gravis (See CONTRAINDICATIONS).

The use of neuromuscular blocking agents should also be avoided in patients receiving Qualaquin. In one patient who received pancuronium during an operative procedure, subsequent administration of quinine resulted in respiratory depression and apnea. Although there are no clinical reports with succinylcholine or tubocurarine, quinine may also potentiate neuromuscular blockade when used with these drugs (See PRECAUTIONS/Drug Interactions).

Serious hypersensitivity reactions reported with quinine sulfate include anaphylactic shock, anaphylactoid reactions, urticaria, serious skin rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, angioedema, facial edema, bronchospasm, and pruritus (See CONTRAINDICATIONS).

A number of other serious adverse reactions reported with quinine, including thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), thrombocytopenia, immune thrombocytopenic purpura (ITP), blackwater fever, disseminated intravascular coagulation, leukopenia, neutropenia, granulomatous hepatitis, and acute interstitial nephritis may also be due to hypersensitivity reactions. Qualaquin should be discontinued in case of any signs or symptoms of hypersensitivity (See CONTRAINDICATIONS).

Qualaquin should be used with caution in patients with atrial fibrillation or atrial flutter. A paradoxical increase in ventricular response rate may occur with quinine, similar to that observed with quinidine. If digoxin is used to prevent a rapid ventricular response, serum digoxin levels should be closely monitored, because digoxin levels may be increased with use of quinine (See PRECAUTIONS/Drug Interactions).

Quinine stimulates release of insulin from the pancreas, and patients, especially pregnant women, may experience clinically significant hypoglycemia.

Patients should be instructed to:

• Take all of the medication as directed.
• Take no more of the medication than the amount prescribed.
• Take with food to minimize possible gastrointestinal irritation.

If a dose is missed, patients should also be instructed not to double the next dose. If more than 4 hours has elapsed since the missed dose, the patient should wait and take the next dose as previously scheduled. (See Patient Package Insert.)

Results of in vivo and in vitro drug interaction studies suggest that quinine has the potential to inhibit the metabolism of drugs that are substrates of CYP3A4 and CYP2D6, as well as inhibit the biliary excretion of drugs like digoxin.

In an in vitro induction study using human hepatocytes, quinine (5 to 30 µM) increased the metabolic activities of CYP1A2 and CYP3A4. Quinine did not significantly induce the activities of CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP2E1.

Quinine may produce an elevated value for urinary 17-ketogenic steroids when the Zimmerman method is used.

Carcinogenicity studies of quinine have not been conducted.

Genotoxicity studies of quinine were positive in the Ames bacterial mutation assay with metabolic activation and in the sister chromatid exchange assay in mice. There were non-positive genotoxicity findings in the sex-linked recessive lethal test performed in Drosophila, in the in vivo mouse micronucleus assay, and in the chromosomal aberration assay in mice and Chinese hamsters.

Studies to evaluate the effect of quinine upon fertility in animals or in humans have not been conducted.

There is no evidence that quinine causes uterine contractions at the doses recommended for the treatment of malaria. In doses several-times higher than those used to treat malaria, quinine may stimulate the pregnant uterus.

There is limited information on the safety of quinine in breastfed infants. No toxicity was reported in infants in a single study where oral quinine sulfate (10 mg/kg every 8 hours for 1 to 10 days) was administered to 25 lactating women. It is estimated from this study that breastfed infants would receive less than 2 to 3 mg per day of quinine base (< 0.4% of the maternal dose) via breast milk (See CLINICAL PHARMACOLOGY).

Although quinine is generally considered compatible with breastfeeding, the risks and benefits to infant and mother should be assessed.

If malaria is suspected in the infant, appropriate evaluation and treatment should be provided. Plasma quinine levels may not be therapeutic in infants of nursing mothers receiving Qualaquin.

The safety and efficacy of Qualaquin in pediatric patients under the age of 16 has not been established.

Clinical studies of quinine sulfate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.

Quinine can adversely affect almost every body system. The most common adverse events associated with quinine use are a cluster of symptoms called "cinchonism", which occurs to some degree in almost all patients taking quinine. Symptoms of mild cinchonism include headache, vasodilation and sweating, nausea, tinnitus, hearing impairment, vertigo or dizziness, blurred vision, and disturbance in color perception. More severe symptoms of cinchonism are vomiting, diarrhea, abdominal pain, deafness, blindness, and disturbances in cardiac rhythm or conduction. Most symptoms of cinchonism are reversible and resolve with discontinuation of quinine.

The following ADVERSE REACTIONS have been reported with quinine sulfate. Most of these reactions are thought to be uncommon, but the actual incidence is unknown:

General: fever, chills, sweating, flushing, asthenia, lupus-like syndrome, and hypersensitivity reactions (See WARNINGS and PRECAUTIONS).

Hematologic: agranulocytosis, hypoprothrombinemia, thrombocytopenia, disseminated intravascular coagulation, hemolytic anemia; hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura, petechiae, ecchymosis, hemorrhage, coagulopathy, blackwater fever, leukopenia, neutropenia, pancytopenia, aplastic anemia, and lupus anticoagulant.

Neuropsychiatric: headache, diplopia, confusion, altered mental status, seizures, coma, disorientation, tremors, restlessness, ataxia, acute dystonic reaction, aphasia, and suicide.

Dermatologic: cutaneous rashes, including urticarial, papular, or scarlatinal rashes, pruritus, bullous dermatitis, exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, fixed drug eruption, photosensitivity reactions, allergic contact dermatitis, acral necrosis, and cutaneous vasculitis.

Respiratory: asthma, dyspnea, pulmonary edema.

Cardiovascular: chest pain, vasodilatation, hypotension, postural hypotension, tachycardia, bradycardia, palpitations, syncope, atrioventricular block, atrial fibrillation, irregular rhythm, unifocal premature ventricular contractions, nodal escape beats, U waves, QT prolongation, ventricular fibrillation, ventricular tachycardia, torsades de pointes, and cardiac arrest (See WARNINGS).

Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain, gastric irritation, and esophagitis.

Hepatobiliary: granulomatous hepatitis, hepatitis, jaundice, and abnormal liver function tests.

Metabolic: hypoglycemia and anorexia.

Musculoskeletal: myalgias and muscle weakness.

Renal: hemoglobinuria, renal failure, renal impairment, and acute interstitial nephritis.

Special Senses: visual disturbances, including blurred vision with scotomata, sudden loss of vision, photophobia, diplopia, night blindness, diminished visual fields, fixed pupillary dilatation, disturbed color vision, optic neuritis, blindness, vertigo, tinnitus, hearing impairment, and deafness.

Tolerance, abuse, or dependence with quinine sulfate has not been reported.

Quinine overdose can be associated with serious complications, including visual impairment, hypoglycemia, cardiac arrhythmias, and death. Visual impairment can range from blurred vision and defective color perception, to visual field constriction and permanent blindness. Cinchonism occurs in virtually all patients with quinine overdose. Symptoms range from headache, nausea, vomiting, abdominal pain, diarrhea, tinnitus, vertigo, hearing impairment, sweating, flushing, and blurred vision, to deafness, blindness, serious cardiac arrhythmias, hypotension, and circulatory collapse. Central nervous system toxicity (drowsiness, disturbances of consciousness, ataxia, convulsions, respiratory depression and coma) has also been reported with quinine overdose, as well as pulmonary edema and adult respiratory distress syndrome.

Most toxic reactions are dose-related; however some reactions may be idiosyncratic because of the variable sensitivity of patients to the toxic effects of quinine. A lethal dose of quinine has not been clearly defined, but fatalities have been reported after the ingestion of 2 to 8 grams in adults. Quinine, like quinidine, has class I antiarrhythmic properties. The cardiotoxicity of quinine is due to its negative inotropic action, and to its effect on cardiac conduction, resulting in decreased rates of depolarization and conduction, and increased action potential and effective refractory period. ECG changes observed with quinine overdose include sinus tachycardia, PR prolongation, T wave inversion, bundle branch block, an increased QT interval, and a widening of the QRS complex. Quinine's alpha-blocking properties may result in hypotension and further exacerbate myocardial depression by decreasing coronary perfusion. Quinine overdose has been also associated with hypotension, cardiogenic shock, and circulatory collapse, ventricular arrhythmias, including ventricular tachycardia, ventricular fibrillation, idioventricular rhythm, and torsades de pointes, as well as bradycardia, and atrioventricular block (See WARNINGS, PRECAUTIONS, and ADVERSE EVENTS).

Quinine is rapidly absorbed, and attempts to remove residual quinine sulfate from the stomach by gastric lavage may not be effective. Multiple-dose activated charcoal has been shown to decrease plasma quinine concentrations (See CLINICAL PHARMACOLOGY/Extracorporeal elimination).

Forced acid diuresis, hemodialysis, charcoal column hemoperfusion, and plasma exchange were not found to be effective in significantly increasing quinine elimination in a series of 16 patients.

(SEE INDICATIONS AND USAGE)

For treatment of uncomplicated P. falciparum malaria in adults, the Qualaquin dosage is 648 mg (two capsules) every 8 hours for 7 days (See CLINICAL STUDIES).

Qualaquin should be taken with food to minimize gastric upset (See CLINICAL PHARMACOLOGY).

In otherwise healthy subjects with Child-Pugh B hepatic impairment, the AUC of quinine increased by 55% compared to subjects with normal liver function. In patients with mild to moderate hepatic impairment (Child-Pugh A and Child-Pugh B, respectively), dosage reduction is not warranted but patients should be monitored closely for adverse reactions associated with quinine (See CLINICAL PHARMACOLOGY/Special Populations). The effects of severe hepatic impairment (Child-Pugh C) on the safety and pharmacokinetics of quinine sulfate are not known.

In otherwise healthy subjects with severe chronic renal failure not receiving any form of dialysis (mean serum creatinine = 9.6 mg/dL), the median plasma quinine exposure (AUC) increased by 195% compared to subjects with normal renal function. In patients with acute uncomplicated malaria and severe chronic renal failure, the following modified dosage regimen is recommended: one loading dose of 648 mg Qualaquin followed 12 hours later by maintenance doses of 324 mg every 12 hours (See CLINICAL PHARMACOLOGY/Special Populations). The effects of mild and moderate renal impairment on the pharmacokinetics and safety of quinine sulfate are not known.

Qualaquin capsules USP, 324 mg are available as clear/clear capsules imprinted AR 102:

  Bottles of 30              NDC 13310-153-07
  Bottles of 100            NDC 13310-153-01
  Bottles of 500            NDC 13310-153-05
  Bottles of 1000          NDC 13310-153-10

Quinine has been used worldwide for hundreds of years in the treatment of malaria. Thorough searches of the published literature identified over 1300 references to the treatment of malaria with quinine, and from these, 21 randomized, active-controlled studies were identified which evaluated oral quinine monotherapy or combination therapy for treatment of uncomplicated P. falciparum malaria. Over 2900 patients from malaria-endemic areas were enrolled in these studies, and more than 1400 patients received oral quinine. The following conclusions were drawn from review of these studies:

In areas where multi-drug resistance of P. falciparum is increasing, such as Southeast Asia, cure rates with 7 days of oral quinine monotherapy were at least 80%; while cure rates for 7-days of oral quinine combined with an antimicrobial agent (tetracycline or clindamycin) were greater than 90%. In areas where multi-drug resistance of the parasite was not as widespread, cure rates with 7 days of quinine monotherapy ranged from 86 to 100%. Cure was defined as initial clearing of parasliia within 7 days without recrudescence by day 28 after treatment initiation. P. falciparum malaria that is clinically resistant to quinine has been reported in some areas of South America, Southeast Asia, and Bangladesh, and quinine may not be as effective in those areas.

Completion of a 7 day oral quinine treatment regimen may be limited by drug intolerance, and shorter courses (3 days) of quinine combination therapy have been used. However, the published data from randomized, controlled clinical trials for shorter regimens of oral quinine in conjunction with tetracycline, doxycycline, or clindamycin for treatment of uncomplicated P. falciparum malaria is limited, and these shorter course combination regimens may not be as effective as the longer regimens.

QUALAQUIN^®
quinine sulfate
CAPSULES USP 324 mg

This leaflet contains a summary of the most important information about Qualaquin capsules and should be read completely before starting your treatment. This leaflet does not replace talking to your doctor or health care provider about your treatment or medical condition. If you have any questions about your treatment or medical condition, ask your doctor. Only your doctor or other health care provider can prescribe Qualaquin and determine if it is right for you.

Malaria is a serious infection, and if not treated, can be life-threatening. Quinine Sulfate has been used for many years as an effective treatment for uncomplicated malaria caused by the parasite Plasmodium falciparum.

What is Qualaquin?

Qualaquin is a prescription medication used in the treatment of uncomplicated malaria caused by the parasite Plasmodium falciparum.

Qualaquin is NOT approved for the prevention of malaria or for the prevention or treatment of night-time leg cramps.

Who should not take Qualaquin?

Do not take Qualaquin if you:

• Had previous allergic reactions to quinine, quinidine, or mefloquine (Lariam^®).
• Had previous serious side effects to quinine, such as decreased platelets, which are components of blood necessary for clotting.
• Have low levels of an enzyme called Glucose-6-phosphate dehydrogenase (G-6-PD).
• Have myasthenia gravis.
• Have optic neuritis, which is an inflammation of the nerve important for vision.
• Have certain heart rhythm problems or certain inherited abnormalities on your electrocardiogram (ECG). Your doctor will tell you whether your ECG has these abnormalities.

What should I tell my doctor or health care provider before taking Qualaquin?

Tell your doctor or health care provider:

• About all your medical conditions, including any heart, kidney, or liver problems.
• About all the prescription and non-prescription medications you are taking, including vitamins and herbal medications.
• If you are pregnant or could be pregnant. Treatment of malaria is important because it can be a serious disease for a pregnant woman and her unborn baby. Your doctor can tell you more about the benefits and risks of taking this medication during pregnancy for uncomplicated malaria. You and your doctor can decide if Qualaquin is right for you.
• If you are breast-feeding. Small amounts of Qualaquin can pass into the breast milk, but no problems with this medicine have been reported in nursing babies. Discuss with your doctor whether you should breastfeed while taking Qualaquin.

How should I take Qualaquin?

• Take Qualaquin exactly as prescribed.
• Qualaquin is a clear capsule that is taken by mouth.
• Unless directed otherwise by your doctor, the usual dose is 648 mg (two 324 mg capsules) of Qualaquin every 8 hours by mouth at the same time every day for 7 days.
• To lower the chance of stomach upset, take this medication WITH FOOD.
• Finish all the Qualaquin that is prescribed even if you feel better. Do not stop taking the medication without talking to your doctor.
• Do not take more than the amount prescribed. Do not take more than 2 capsules at one time or more than 3 doses in one day. If you take more than the prescribed dose, call your doctor right away.

What should I do if I miss a dose?

If you forget to take Qualaquin, do NOT double the next dose. If it has been more than 4 hours since the missed dose, WAIT and take the regular dose at the next scheduled time. Call your doctor if you are not sure what to do.

What are the possible side effects of Qualaquin?

The most common side effects that you may have when taking Qualaquin are not usually serious, and will usually get better when Qualaquin is stopped. Common side effects with Qualaquin include:

• Headache
• Sweating
• Ringing in your ears
• Dizziness
• Change in color vision
• Nausea
• Flushing
• Mild hearing loss
• Blurred vision

Occasionally, more severe symptoms such as vomiting, diarrhea, and abdominal pain may occur. Rarely, rapid or irregular heart beat, severe hearing loss, or blindness, may occur. If you experience any severe side effects, call your doctor.

Some patients may experience low blood sugar (hypoglycemia) while taking Qualaquin. Symptoms of low blood sugar include lightheadedness, dizziness, sweating, confusion, shakiness, anxiety, and weakness. If you experience symptoms of low blood sugar, drink some fruit juice or eat a snack, and call your doctor.

Elderly patients may be more sensitive to the side effects of Qualaquin than younger patients, and should quickly report any side effects to their doctor.

Qualaquin has other less common side effects that are not uled here. For a complete ul of side effects, ask your doctor. If you notice any side effects not mentioned in this leaflet, or if you have any concerns about a side effect you are having, talk to your doctor.

Qualaquin is NOT approved for the treatment of leg cramps because quinine has not been proven to work for this condition, and may cause serious or life-threatening side effects. Some of the more serious side effects of quinine are blindness, deafness, and abnormal heart rhythm. Your doctor can tell you additional information about serious side effects reported with quinine.

Call your doctor or health care provider right away if:

• You feel worse; or if you do not start feeling better within a day or two of taking Qualaquin.
• If your fevers come back after completing treatment with Qualaquin, call your doctor to make sure that the malaria has not returned.
• You experience serious problems such as:
  • Serious allergic reactions: rash, hives, severe itching, severe flushing, trouble breathing.
  • Eyesight problems: blurred vision, double vision, blindness.
  • Heart problems: chest pain, rapid heart beats, abnormal heart rhythm.
  • Other reactions: dizziness, confusion, lightheadedness, fainting, seizure.
  • Other problems: abnormal bleeding, (such as severe nosebleed, and blood in the urine, or stool), severe bruising, or the appearance of unusual purple-brown or red spots on your skin.

What about other medications I am taking?

• Tell your doctor about all other prescription and non-prescription medications you are taking, including vitamins and herbal supplements.
• Certain medications should be avoided when you are taking Qualaquin.
• Your doctor has a ul of medications that should be avoided or which may require special precautions while taking Qualaquin.

How do I store Qualaquin?

Keep Qualaquin out of reach of children. Keep the capsules in a tightly closed container. Do not refrigerate or freeze. Store at 25-30°C (77-86°F).

General advice about Qualaquin:

Do not use Qualaquin for a condition for which it was not prescribed. Do NOT give Qualaquin to other people, even if they have the same symptoms, because it may be harmful.

This leaflet highlights the most important information about Qualaquin. For more information, you should talk with your doctor or health care provider.

Active Ingredients: Quinine Sulfate, USP
Inactive Ingredients: Corn starch, magnesium stearate, talc

Revised: August 2007S