1 Quinine is a front-line antimalarial drug but is prescribed most commonly in nonmalarious countries for cramps. Postural hypotension, hearing loss and hyperinsulinaemic hypoglycaemia occur in malaria and overdose but little is known of quinine kinetics and toxicity in the elderly. 2 We studied 12 non-insulin-dependent diabetics and 10 non-diabetic controls aged 51-79 years. Subjects attended on two occasions >7 days apart. On each test day, subjects were given a 600 Cal meal at 18.00 h (0 h) and, on one occasion, quinine sulphate 600 mg at 22.00 h (4 h). Venous blood samples for glucose, insulin and quinine assay were drawn pre-prandially and then regularly over the next 38 h. Supine and erect blood pressures were taken and audiometry was performed at 4, 6, 8 and 14 h. A one-compartment open pharmacokinetic model was fitted to serum quinine concentrations. 3 Absorption and elimination half-times, volume of distribution and oral clearance of quinine were comparable in the two groups (P > 0.2) and there was a mean absorption lag-time of approximately 1 h. Basal and immediate post-prandial (< 4 h) serum glucose and insulin concentrations on both test days were similar in the diabetics and also in the non-diabetics, but quinine produced a mean reduction in serum glucose of 1.0 mmol 1-1 from 3-5 h post-dose in both groups without affecting serum insulin concentrations. Quinine administration did not alter postural blood pressure changes or produce significant hearing loss in either group. 4 These data suggest that a nocturnal post-prandial dose of quinine lowers early morning plasma glucose concentrations in both non-diabetic and diabetic subjects. Other potentially significant toxic effects in elderly patients were not observed.

Drugs used in prehospital care are exposed to extremes of temperature, which exceed the manufacturerer's recommended storage conditions, and may result in degradahon of the formulation. Adrenaline, which can be degraded by high temperatures, is a key agent for the effective management of cardiac arrest and acute anaphylaxis in the prehospital setting. We demonstrate that the activity of adrenaline vials carried in St John's ambulances in the Perth metropolitan area during summer months when ambient temperatures can reach 40°C was not significantly altered.

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