Quinine-Induced Hepatotoxicity

Farver, Debra K; Lavin, Megan N

doi:10.1345/aph.18172

Cited by 38 publications

(9 citation statements)

References 18 publications

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“…Severe liver injury and hepatitis in the presence or absence of systemic features have also been described in CQ users [10–12]. Liver being the largest gland and major site for drug metabolism has aroused considerable interest among researchers, and some studies were conducted in the past that have addressed the chloroquine-induced hepatotoxicity [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Protective Effect of Quercetin on Chloroquine-Induced Oxidative Stress and Hepatotoxicity in Mice

Mishra

Singh

Rath

2013

Malaria Research and Treatment

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The present study was aimed to find out the protective effect of quercetin on hepatotoxicity resulting by commonly used antimalarial drug chloroquine (CQ). Swiss albino mice were administered with different amounts of CQ ranging from human therapeutic equivalent of 360 mg/kg body wt. to as high as 2000 mg/kg body wt. We observed statistically significant generation of reactive oxygen species, liver toxicity, and oxidative stress. Our observation of alterations in biochemical parameters was strongly supported by real-time PCR measurement of mRNA expression of key biochemical enzymes involved in hepatic toxicity and oxidative stress. However, the observed hepatotoxicity and accompanying oxidative stress following CQ administration show dose specific pattern with little or apparently no effect at therapeutic dose while having severe effects at higher dosages. We further tested quercetin, an antioxidant flavanoid, against CQ-induced hepatoxicity and found encouraging results as quercetin was able to drastically reduce the oxidative stress and hepatotoxicity resulting at higher dosages of CQ administration. In conclusion, our study strongly suggests co administration of antioxidant flavonoid like quercetin along with CQ for antimalarial therapy. This is particularly important when CQ is administered as long-term prophylactic treatment for malaria as chronic exposure has shown to be resulting in higher dose level of drug in the body.

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Section: Introductionmentioning

confidence: 99%

Protective Effect of Quercetin on Chloroquine-Induced Oxidative Stress and Hepatotoxicity in Mice

Mishra

Singh

Rath

2013

Malaria Research and Treatment

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“…10,11 Quinine-induced hepatotoxicity, blindness, and ototoxicity have been reported. [12][13][14] Adverse cardiac events associated with quinine therapy are torsades de pointes and ventricular fibrillation. 15,16 One patient experienced hypersensitivity syndrome simulating septic shock 2 hours after taking quinine 520 mg. 17 The wide differential diagnosis of pulmonary 18 Our patient's history and physical examination excluded pulmonary infection and hemorrhage, as did the rapid resolution of her symptoms.…”

Section: Discussionmentioning

confidence: 99%

Transient Pulmonary Infiltrates Possibly Induced by Quinine Sulfate

2002

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Quinine sulfate, which has been available for many years, has not been implicated definitively in the development of pulmonary toxicity. A variety of adverse effects, however, have been reported with quinine administration. A 45-year-old woman with longstanding rheumatoid arthritis experienced wheezing, severe anxiety, breathlessness, cough, orthopnea, mild fever, chills, and pleuritic chest discomfort after taking a single dose of quinine for nocturnal leg cramps. Radiographic imaging demonstrated diffuse, bilateral pulmonary infiltrates suggestive of pulmonary edema. No cause other than acute quinine ingestion could be identified despite thorough cardiac and infectious disease evaluations. Clinicians should be aware of a possible association between quinine sulfate and pulmonary toxicity.

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“…On the other hand, it has rarely been described for QD [9–11] and AL regimens [12]. Even pooled analysis of randomized controlled trials with AL did not find significant hepatic toxicity.…”

Section: Introductionmentioning

confidence: 99%

Artemether-lumefantrine and liver enzyme abnormalities in non-severe Plasmodium falciparum malaria in returned travellers: a retrospective comparative study with quinine-doxycycline in a Portuguese centre

Silva‐Pinto

Ruas

Almeida

et al. 2017

Malar J

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Background Artemisinin-based therapy is the current standard treatment for non-severe malaria due to Plasmodium falciparum. The potential for asymptomatic liver toxicity of this therapy and its implication in clinical practice is currently unknown. The aim of this study is to assess the hepatic function in patients treated with a standard three-day artemisinin-based regimen and to compare it with the quinine-doxycycline regimen.MethodsRetrospective and comparative study of returned adult travellers admitted with non-severe P. falciparum malaria. Fifty-seven patients were included: 19 treated with artemisinin-based therapy and 38 with quinine-doxycycline therapy.ResultsDuring treatment, when compared with quinine-doxycycline group, the artemisinin-lumefantrine group presented a higher proportion of significant liver enzyme abnormalities (42 vs. 5%, p < 0.01) and a higher peak value of aspartate aminotransferase (131 vs. 64 U/L, p < 0.01) and alanine aminotransferase (99 vs. 75 U/L, p = 0.05). None of the patients was symptomatic, there were no treatment interruptions and all patients achieved clinical cure.ConclusionsTreatment of uncomplicated falciparum malaria with artemisinin-based therapy might cause asymptomatic liver enzyme abnormalities in the first days of treatment. Nevertheless, these liver enzyme abnormalities seem to be harmless, asymptomatic and self-limited.

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Quinine-Induced Hepatotoxicity

Abstract: Documented hepatotoxicity has occurred with quinidine, the optical isomer of quinine. Limited awareness of quinine-induced hepatotoxicity may result in an unrecognized adverse effect.

Cited by 38 publications

References 18 publications

Protective Effect of Quercetin on Chloroquine-Induced Oxidative Stress and Hepatotoxicity in Mice

Protective Effect of Quercetin on Chloroquine-Induced Oxidative Stress and Hepatotoxicity in Mice

Transient Pulmonary Infiltrates Possibly Induced by Quinine Sulfate

Artemether-lumefantrine and liver enzyme abnormalities in non-severe Plasmodium falciparum malaria in returned travellers: a retrospective comparative study with quinine-doxycycline in a Portuguese centre

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