Quinolex Syrup

Introduction

Quinolex Syrup 80 mg/5 ml is a medication primarily used for the prevention and treatment of malaria. It is also used in the treatment of certain autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Chloroquine is a 4-aminoquinoline compound that has been used for decades due to its efficacy in combating malaria and its anti-inflammatory properties.

Uses

Quinolex Syrup 80 mg/5 ml is used for:

Prophylaxis and treatment of malaria caused by Plasmodium species, including P. falciparum and P. vivax.
Treatment of extraintestinal amebiasis (e.g., caused by Entamoeba histolytica).
Treatment of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus (SLE).

It is used in combination with other antimalarial agents for severe or resistant cases of malaria.

Brand Name	Quinolex
Type	Syrup
Weight	80 mg/5 ml
Generic	Chloroquine Phosphate
Manufacturer	Globe Pharmaceuticals Ltd.
Available in	English বাংলা

Mechanism of Action

Chloroquine works by interfering with the growth of malaria parasites in red blood cells. It is believed to inhibit heme polymerase, an enzyme crucial for the detoxification of heme, which is toxic to the parasite. By disrupting this process, Chloroquine accumulates in the parasite’s food vacuole, leading to its death. For autoimmune conditions, Chloroquine is thought to have anti-inflammatory effects by modulating immune system activity and reducing the production of inflammatory mediators.

How Long Does It Take to Work?

For malaria, Chloroquine usually starts to reduce symptoms within 24 to 48 hours of administration, with more significant improvements typically observed within 2 to 3 days. For autoimmune diseases, the therapeutic effects may take several weeks to become evident. The full benefits may not be apparent until several months of treatment.

Absorption

Chloroquine is well-absorbed from the gastrointestinal tract, with peak plasma concentrations occurring 1 to 2 hours after oral administration. The drug has good bioavailability, and its absorption is not significantly affected by food.

Route of Elimination

Chloroquine is primarily metabolized in the liver and excreted via the kidneys. The drug is also eliminated through bile and feces. Its metabolites are also excreted in the urine.

Dosage

Doses are normally expressed in terms of chloroquine base, and as a general guide chloroquine base 300 mg is approximately equivalent to chloroquine phosphate 500 mg.

For the treatment of acute attack of malaria:

Adults and children: 25 mg of chloroquine base per kg body-weight given over 3 days. This total dose is given in a variety of ways. One way is to give 10 mg per kg followed after 6 to 8 hours by 5 mg per kg, then 5 mg per kg daily for the next 2 days; alternatively, 10 mg per kg may be given daily for the first 2 days and 5 mg per kg on the 3rd day. Sometimes the adult doses are not expressed in terms of body weight but as 600 mg followed after 6 to 8 hours by 300 mg, then 300 mg daily for the next 2 days.

For clinical prophylaxis:

Adult: An oral dose equivalent to 300 mg chloroquine base is given every 7 days for about one week before, during, and for at least 4 weeks after exposure.
Children: A weekly oral dose of 5 mg per kg body-weight has been recommended.

For hepatic amoebiasis: Adult:

600 mg base daily for two days, followed by 300 mg base daily for at least 2-3 weeks. Treatment is usually combined with an effective intestinal amoebicide.
For discoid and systemic lupus erythematosus: Suggested oral dose is 150 mg of base daily, reducing gradually once symptoms have been controlled.

For rheumatoid arthritis:

Adult: 150 mg of base daily, some clinicians suggest that treatment should be given for only 10 months in each year.
Children: 3 mg/kg body-weight base daily.

For the management of photoallergic reactions:

Adult: 150 to 300 mg of base daily during periods of intense light exposure.
Children: 3 mg/kg body-weight

For porphyria cutanea tarda:

Adult: When chloroquine was first used at this condition at doses of 150 mg to 600 mg of base per day for 4-7 days, a severe life threatening toxic hepatitis developed. Use of low dose therapy with 75 mg of base 2 to 3 times per week for 6 to 18 months can avoid such effects and lead to remission.

The dosage of Quinolex Syrup 80 mg/5 ml varies depending on the condition being treated:

For Malaria Prophylaxis: 300 mg once weekly, starting 1 to 2 weeks before travel and continuing for 4 weeks after leaving the endemic area.
For Acute Malaria Treatment: 600 mg as an initial dose, followed by 300 mg at 6, 24, and 48 hours.
For Rheumatoid Arthritis: Initial dose of 400-600 mg daily, followed by a maintenance dose of 200-400 mg daily.
For Systemic Lupus Erythematosus: 400 mg daily, with adjustments based on clinical response and tolerance.

Dosage should be adjusted based on patient-specific factors and disease severity. Always follow specific instructions provided by a healthcare provider.

Administration

Quinolex Syrup 80 mg/5 ml is administered orally in tablet form. It should be taken with a full glass of water. To minimize gastrointestinal side effects, it is recommended to take it with food. For prophylaxis, it is important to start the medication before exposure to malaria and continue as directed.

Side Effects

Common side effects include:

Gastrointestinal disturbances (nausea, vomiting, diarrhea)
Headache
Dizziness
Rash

Serious side effects may include:

Retinopathy (long-term use may affect vision)
Hearing loss
Severe allergic reactions (e.g., anaphylaxis)
Blood disorders (e.g., anemia, leukopenia)

Regular monitoring is required to detect and manage potential adverse effects.

Toxicity

Chloroquine toxicity can occur with overdose or prolonged use. Symptoms of toxicity include:

Nausea and vomiting
Headache
Severe hypotension
Cardiac arrhythmias
Convulsions

Immediate medical attention is required in cases of overdose, and supportive care should be provided.

Precautions

Precautions include:

Monitoring for ocular toxicity during long-term use
Cautious use in patients with liver or kidney disease, as these conditions can affect drug metabolism and elimination
Use with caution in patients with G6PD deficiency, as hemolysis may occur

Regular check-ups are important to monitor for side effects and ensure proper use.

Interaction

Chloroquine may interact with other medications, including:

Antacids and other drugs affecting stomach pH (which may reduce Chloroquine absorption)
Antiepileptic drugs (risk of increased toxicity)
Medications affecting cardiac conduction (risk of arrhythmias)

Inform healthcare providers of all medications being taken to avoid potential interactions.

Disease Interaction

Caution is advised when using Chloroquine in patients with:

Liver disease
Kidney disease
Retinal disorders
G6PD deficiency

Adjustments in dosage or monitoring may be necessary based on the presence of these conditions.

Drug Interaction

Chloroquine can interact with:

Drugs affecting the cytochrome P450 system (potential alterations in drug metabolism)
Drugs with potential for additive cardiac effects (e.g., certain antihypertensives)

Always consult a healthcare provider before combining Chloroquine with other medications.

Food Interactions

No significant food interactions are known with Chloroquine, although taking it with food may help reduce gastrointestinal side effects. Avoid consuming excessive alcohol, which can exacerbate side effects.

Pregnancy Use

Chloroquine is classified as pregnancy category C. It should be used during pregnancy only if the potential benefits outweigh the risks. Consult a healthcare provider for alternatives or adjustments based on individual needs.

Lactation Use

Chloroquine is excreted in breast milk. It is generally considered safe during breastfeeding in recommended doses, but caution is advised. Consult a healthcare provider to discuss potential risks and benefits.

Acute Overdose

In cases of acute overdose, symptoms may include severe gastrointestinal distress, cardiovascular effects, and neurological symptoms. Immediate medical attention is required. Treatment may involve supportive care, gastric lavage, and monitoring of cardiac and neurological status.

Contraindication

Chloroquine is contraindicated in:

Patients with known hypersensitivity to Chloroquine or related compounds
Patients with pre-existing retinal or visual field abnormalities
Patients with severe liver or kidney impairment without proper monitoring

Use Direction

Chloroquine should be used as directed:

Follow prescribed dosage schedules for prophylaxis or treatment.
Do not exceed the recommended dose.
Regular monitoring is recommended for long-term use, especially for side effects related to vision and hearing.

Storage Conditions

Quinolex Syrup 80 mg/5 ml should be stored at room temperature (15-30°C or 59-86°F), away from light and moisture. Keep the medication tightly closed and out of reach of children. Do not use beyond the expiration date.

Volume of Distribution

The volume of distribution of Chloroquine is approximately 250 to 350 liters, indicating extensive distribution throughout the body, including the liver, spleen, and other tissues.

Half-Life

The terminal half-life of Chloroquine is approximately 4 to 7 days, which reflects its prolonged action and slow elimination from the body.

Clearance

Chloroquine is cleared from the body primarily through the liver and kidneys. The clearance rate varies with renal and hepatic function, and adjustments may be necessary in patients with compromised liver or kidney function.

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