quinine (Rx)

Malaria

Uncomplicated (P falciparum)

• 648 mg PO q8hr x 7 days

Chloroquine-resistant (P falciparum)

• 648 mg PO q8hr x 3-7 days with concomitant tetracycline, doxycycline, or clindamycin

Chloroquine-resistant (P vivax)

• 648 mg PO q8hr x 3-7 days with concomitant doxycycline (or tetracycline) and PO primaquine

Babesiosis (Off-label)

648 mg PO q8hr x 7 days, with concomitant PO or IV clindamycin

Dosage Modifications

Renal impairment

• Severe: 648 mg PO once, then 324 mg PO q12hr

Hepatic impairment

• Mild or moderate (Child-Pugh A or B): No dosage adjustment required; monitor closely
• Severe (Child-Pugh C): Do not administer

Limitations of use

• Not approved for

  • Treatment of severe or complicated P. falciparum malaria
  • Prevention of malaria
  • Treatment or prevention of nocturnal leg cramps

Malaria

Uncomplicated (P falciparum)

• 30 mg/kg/day PO divided TID x 3–7 days  
• Should not exceed the usual adult PO dosage.

Chloroquine-resistant (P falciparum)

• 30 mg/kg/day PO divided TID x3-7 days, with concomitant doxycycline, tetracycline or clindamycin
• Should not exceed the usual adult PO dosage.

Chloroquine-resistant (P vivax)

• 30 mg/kg/day PO TID x 3–7 days, with concomitant doxycyline & PO primaquine
• Should not exceed the usual adult PO dosage.

Babesiosis (Off-label)

25 mg/kg/day PO divided TID x7 days, with concomitant oral clindamycin  

Contraindicated (5)

• dronedarone

  dronedarone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Although quinine levels are not significantly increased, combination is contraindicated because of potential for both drugs to prolong QT interval
  
  dronedarone and quinine both increase QTc interval. Contraindicated.

• eliglustat

  quinine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

• lefamulin

  lefamulin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• pimozide

  pimozide and quinine both increase QTc interval. Contraindicated.

• thioridazine

  thioridazine and quinine both increase QTc interval. Contraindicated.

Serious - Use Alternative (101)

• adagrasib

  adagrasib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 inhibitor, with sensitive CYP3A substrates unless otherwise recommended in the prescribing information for these substrates.
  
  adagrasib, quinine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• afatinib

  quinine increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• alfuzosin

  alfuzosin and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and quinine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• antithrombin alfa

  quinine increases effects of antithrombin alfa by unknown mechanism. Avoid or Use Alternate Drug.

• antithrombin III

  quinine increases effects of antithrombin III by unknown mechanism. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• argatroban

  quinine increases effects of argatroban by unknown mechanism. Avoid or Use Alternate Drug.

• aripiprazole

  aripiprazole and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  asenapine transdermal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• atomoxetine

  atomoxetine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• atracurium

  quinine increases effects of atracurium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• bemiparin

  quinine increases effects of bemiparin by unknown mechanism. Avoid or Use Alternate Drug.

• bivalirudin

  quinine increases effects of bivalirudin by unknown mechanism. Avoid or Use Alternate Drug.

• bremelanotide

  bremelanotide will decrease the level or effect of quinine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brigatinib

  brigatinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.

• buprenorphine

  buprenorphine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• ceritinib

  ceritinib and quinine both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloroquine

  chloroquine increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug.

• cisatracurium

  quinine increases effects of cisatracurium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• colchicine

  quinine will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment.

• dalteparin

  quinine increases effects of dalteparin by unknown mechanism. Avoid or Use Alternate Drug.

• dapsone topical

  quinine, dapsone topical. unspecified interaction mechanism. Avoid or Use Alternate Drug. Avoid coadministration of dapsone topical with oral dapsone or antimalarial medications because of the potential for hemolytic reactions.

• desflurane

  desflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  donepezil and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  doxepin and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• edoxaban

  quinine will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• efavirenz

  efavirenz and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• eliglustat

  eliglustat and quinine both increase QTc interval. Contraindicated.

• encorafenib

  encorafenib and quinine both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• enoxaparin

  quinine increases effects of enoxaparin by unknown mechanism. Avoid or Use Alternate Drug.

• entrectinib

  quinine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• erdafitinib

  erdafitinib, quinine. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.
  
  erdafitinib, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with erdafitinib and sensitive CYP3A4 substrates with narrow therapeutic indices. Erdafitinib may altered plasma concentrations of CYP3A4 substrates, leading to either loss of activity or increased toxicity of the substrate.
  
  erdafitinib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.
  
  quinine will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. If coadministration of a strong CYP2C9 inhibitors is unavoidable, closely monitor adverse reactions and modify dose of erdafitinib accordingly. If strong CYP2C9 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.

• eribulin

  eribulin and quinine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• fexinidazole

  fexinidazole and quinine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  fingolimod and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• fondaparinux

  quinine increases effects of fondaparinux by unknown mechanism. Avoid or Use Alternate Drug.

• gadobenate

  gadobenate and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  quinine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• granisetron

  granisetron and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• heparin

  quinine increases effects of heparin by unknown mechanism. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  hydroxyzine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• isoflurane

  isoflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and quinine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• lasmiditan

  lasmiditan increases levels of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lithium

  lithium and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• lonafarnib

  lonafarnib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
  
  quinine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• lopinavir

  lopinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lorlatinib

  lorlatinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.

• macimorelin

  macimorelin and quinine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• mefloquine

  quinine, mefloquine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of ECG abnormalities, cardiac arrest.
  
  mefloquine increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• mifepristone

  mifepristone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
  
  mobocertinib and quinine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• nefazodone

  nefazodone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• olutasidenib

  olutasidenib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.

• onabotulinumtoxinA

  quinine increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• ondansetron

  quinine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oxaliplatin

  oxaliplatin and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• pacritinib

  pacritinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• pancuronium

  quinine increases effects of pancuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• pexidartinib

  pexidartinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.

• phenindione

  quinine increases effects of phenindione by unknown mechanism. Avoid or Use Alternate Drug.

• pitolisant

  quinine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pomalidomide

  quinine increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ponesimod

  ponesimod, quinine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• primaquine

  primaquine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• protamine

  quinine increases effects of protamine by unknown mechanism. Avoid or Use Alternate Drug.

• rapacuronium

  quinine increases effects of rapacuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• ribociclib

  ribociclib increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug.

• rimegepant

  quinine will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• riociguat

  quinine will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• ritonavir

  ritonavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Prescribing information for quinine recommends avoiding combination

• rocuronium

  quinine increases effects of rocuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• saquinavir

  saquinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• sevoflurane

  sevoflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  quinine will increase the level or effect of siponimod by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with drugs that cause moderate CYP2C9 AND a moderate or strong CYP3A4 inhibition is not recommended. Caution if siponimod coadministered with moderate CYP2C9 inhibitors alone.
  
  siponimod and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• sotorasib

  sotorasib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
  
  sotorasib will decrease the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• succinylcholine

  quinine increases effects of succinylcholine by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• tepotinib

  tepotinib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

• tetrabenazine

  tetrabenazine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• tipranavir

  tipranavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• topotecan

  quinine will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• tucatinib

  quinine will increase the level or effect of tucatinib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of tucatinib (a CYP2C8 substrate) with a strong or moderate CYP2C8 inhibitors increases tucatinib plasma concentrations and risk of toxicities.
  
  tucatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  quinine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  quinine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vecuronium

  quinine increases effects of vecuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• vemurafenib

  vemurafenib and quinine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venetoclax

  quinine will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• vilanterol/fluticasone furoate inhaled

  quinine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vortioxetine

  quinine increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.

• voxelotor

  voxelotor will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

Monitor Closely (201)

• albuterol

  albuterol and quinine both increase QTc interval. Use Caution/Monitor.

• amantadine

  quinine will increase the level or effect of amantadine by decreasing renal clearance. Use Caution/Monitor. Coadministration of quinine or quinidine with amantadine was shown to reduce the renal clearance of amantadine by ~30%.

• amiodarone

  amiodarone will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  amiodarone and quinine both increase QTc interval. Use Caution/Monitor.

• amitriptyline

  amitriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• amoxapine

  amoxapine and quinine both increase QTc interval. Use Caution/Monitor.

• anagrelide

  anagrelide and quinine both increase QTc interval. Use Caution/Monitor.

• apomorphine

  apomorphine and quinine both increase QTc interval. Use Caution/Monitor.

• arformoterol

  arformoterol and quinine both increase QTc interval. Use Caution/Monitor.

• arsenic trioxide

  arsenic trioxide and quinine both increase QTc interval. Use Caution/Monitor.

• artemether/lumefantrine

  artemether/lumefantrine and quinine both increase QTc interval. Use Caution/Monitor.

• asenapine

  asenapine and quinine both increase QTc interval. Use Caution/Monitor.

• atogepant

  quinine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• avapritinib

  quinine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• axitinib

  quinine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azithromycin

  azithromycin and quinine both increase QTc interval. Use Caution/Monitor.

• bedaquiline

  quinine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• berotralstat

  quinine increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.
  
  berotralstat will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
  
  berotralstat will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.

• betrixaban

  quinine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

• blinatumomab

  blinatumomab increases levels of quinine by decreasing metabolism. Modify Therapy/Monitor Closely. Treatment initiation causes transient release of cytokines that may suppress CYP450 enzymes; highest drug-drug interaction risk is during the first 9 days of the first cycle and the first 2 days of the 2nd cycle in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index.

• bosutinib

  bosutinib and quinine both increase QTc interval. Use Caution/Monitor.

• brexpiprazole

  quinine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.

• brodalumab

  brodalumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, brodalumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of brodalumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• bupivacaine implant

  quinine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

• capecitabine

  capecitabine and quinine both increase QTc interval. Use Caution/Monitor.

• carbamazepine

  carbamazepine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cenobamate

  cenobamate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• ceritinib

  quinine increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and quinine both increase QTc interval. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  cimetidine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• ciprofloxacin

  ciprofloxacin and quinine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

• citalopram

  quinine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  clarithromycin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  clarithromycin and quinine both increase QTc interval. Use Caution/Monitor.

• clomipramine

  clomipramine and quinine both increase QTc interval. Use Caution/Monitor.

• clozapine

  clozapine and quinine both increase QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• crizotinib

  crizotinib increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib and quinine both increase QTc interval. Use Caution/Monitor.

• crofelemer

  crofelemer increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclosporine

  cyclosporine will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dabigatran

  quinine will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• dabrafenib

  dabrafenib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dasatinib

  dasatinib and quinine both increase QTc interval. Use Caution/Monitor.

• deferasirox

  deferasirox will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• degarelix

  degarelix and quinine both increase QTc interval. Use Caution/Monitor.

• desipramine

  desipramine and quinine both increase QTc interval. Use Caution/Monitor.

• deutetrabenazine

  quinine and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• digoxin

  digoxin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• diltiazem

  diltiazem will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• disopyramide

  disopyramide and quinine both increase QTc interval. Use Caution/Monitor.

• dofetilide

  dofetilide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  dofetilide and quinine both increase QTc interval. Use Caution/Monitor.

• dolasetron

  dolasetron and quinine both increase QTc interval. Use Caution/Monitor.

• droperidol

  droperidol and quinine both increase QTc interval. Use Caution/Monitor.

• dulaglutide

  dulaglutide, quinine. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

• dupilumab

  dupilumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, dupilumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of dupilumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• duvelisib

  duvelisib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
  
  quinine will increase the level or effect of duvelisib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• elagolix

  elagolix will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  elagolix decreases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eliglustat

  eliglustat increases levels of quinine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

• elranatamab

  elranatamab will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• eluxadoline

  eluxadoline increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

• epcoritamab

  epcoritamab, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• erythromycin base

  erythromycin base will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin base and quinine both increase QTc interval. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin ethylsuccinate and quinine both increase QTc interval. Use Caution/Monitor.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate and quinine both increase QTc interval. Use Caution/Monitor.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin stearate and quinine both increase QTc interval. Use Caution/Monitor.

• escitalopram

  escitalopram and quinine both increase QTc interval. Use Caution/Monitor.

• ezogabine

  ezogabine, quinine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• ferric maltol

  ferric maltol, quinine. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• finerenone

  quinine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

• flecainide

  flecainide and quinine both increase QTc interval. Use Caution/Monitor.

• flibanserin

  flibanserin increases levels of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Increase monitoring of concentrations of drugs transported by P-gp that have a narrow therapeutic index if coadministered with flibanserin.
  
  quinine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

• floxuridine

  floxuridine and quinine both increase QTc interval. Use Caution/Monitor.

• fluconazole

  fluconazole and quinine both increase QTc interval. Use Caution/Monitor.

• fluoxetine

  fluoxetine and quinine both increase QTc interval. Use Caution/Monitor.

• fluphenazine

  fluphenazine and quinine both increase QTc interval. Use Caution/Monitor.

• formoterol

  formoterol and quinine both increase QTc interval. Use Caution/Monitor.

• foscarnet

  foscarnet and quinine both increase QTc interval. Use Caution/Monitor.

• fostemsavir

  quinine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• gemifloxacin

  gemifloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• gepirone

  gepirone and quinine both increase QTc interval. Modify Therapy/Monitor Closely.

• glecaprevir/pibrentasvir

  quinine will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  glecaprevir/pibrentasvir will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• glofitamab

  glofitamab, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. GlofitamaGlofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adversereactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• glycerol phenylbutyrate

  glycerol phenylbutyrate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.

• guselkumab

  guselkumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• haloperidol

  haloperidol and quinine both increase QTc interval. Use Caution/Monitor.

• ibutilide

  ibutilide and quinine both increase QTc interval. Use Caution/Monitor.

• iloperidone

  iloperidone increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
  
  iloperidone and quinine both increase QTc interval. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, quinine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  indapamide and quinine both increase QTc interval. Use Caution/Monitor.

• isavuconazonium sulfate

  quinine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  isavuconazonium sulfate will increase the level or effect of quinine by Other (see comment). Use Caution/Monitor. Isavuconazonium sulfate, an inhibitor of P-gp and CYP3A4, may increase the effects or levels of sensitive P-gp or CYP3A4 substrates, which may require dose adjustment.

• isoniazid

  isoniazid will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isradipine

  isradipine and quinine both increase QTc interval. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  itraconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  itraconazole and quinine both increase QTc interval. Use Caution/Monitor.

• ixekizumab

  ixekizumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, ixekizumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of ixekizumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• ketoconazole

  ketoconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lapatinib

  lapatinib and quinine both increase QTc interval. Use Caution/Monitor.

• lemborexant

  quinine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

• lenacapavir

  lenacapavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• letermovir

  letermovir increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levofloxacin

  levofloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• levoketoconazole

  levoketoconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lomitapide

  quinine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• lonafarnib

  lonafarnib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

• lonapegsomatropin

  lonapegsomatropin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• lopinavir

  lopinavir and quinine both increase QTc interval. Use Caution/Monitor.

• maprotiline

  maprotiline and quinine both increase QTc interval. Use Caution/Monitor.

• methadone

  methadone and quinine both increase QTc interval. Use Caution/Monitor.

• midazolam intranasal

  quinine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

• mifepristone

  mifepristone, quinine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• mitotane

  mitotane decreases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• moxifloxacin

  moxifloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• naldemedine

  quinine increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• nilotinib

  nilotinib and quinine both increase QTc interval. Use Caution/Monitor.

• nintedanib

  quinine increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

• nortriptyline

  nortriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• octreotide

  octreotide and quinine both increase QTc interval. Use Caution/Monitor.

• ofloxacin

  ofloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• olanzapine

  olanzapine and quinine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  quinine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

• olodaterol inhaled

  quinine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omaveloxolone

  omaveloxolone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.

• oritavancin

  oritavancin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Oritavancin is a weak CYP3A4 inducer; caution if coadministered with CYP3A4 substrates that have a narrow therapeutic index

• osilodrostat

  osilodrostat and quinine both increase QTc interval. Use Caution/Monitor.

• oxaliplatin

  oxaliplatin will increase the level or effect of quinine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• ozanimod

  ozanimod and quinine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paclitaxel

  quinine will increase the level or effect of paclitaxel by Other (see comment). Use Caution/Monitor. Paclitaxel levels/toxicity may increase when coadministered with CYP2C8 inhibitors

• paclitaxel protein bound

  quinine will increase the level or effect of paclitaxel protein bound by Other (see comment). Use Caution/Monitor. Paclitaxel levels/toxicity may increase when coadministered with CYP2C8 inhibitors

• palbociclib

  palbociclib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib

• paliperidone

  paliperidone and quinine both increase QTc interval. Use Caution/Monitor.

• pasireotide

  quinine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  pazopanib and quinine both increase QTc interval. Use Caution/Monitor.

• pentamidine

  pentamidine and quinine both increase QTc interval. Use Caution/Monitor.

• perphenazine

  perphenazine and quinine both increase QTc interval. Use Caution/Monitor.

• phenytoin

  phenytoin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use caution when prescribing phenytoin and quinine together due to a decrease in quinine plasma concentrations and potential lack of efficacy.

• pirtobrutinib

  pirtobrutinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates.

• pitolisant

  pitolisant will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.

• posaconazole

  posaconazole and quinine both increase QTc interval. Use Caution/Monitor.

• procainamide

  procainamide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  procainamide and quinine both increase QTc interval. Use Caution/Monitor.

• propafenone

  propafenone and quinine both increase QTc interval. Use Caution/Monitor.

• protriptyline

  protriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• quetiapine

  quetiapine, quinine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  quinidine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  quinidine and quinine both increase QTc interval. Use Caution/Monitor.

• quizartinib

  quizartinib, quinine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ranolazine

  ranolazine and quinine both increase QTc interval. Use Caution/Monitor.

• ribociclib

  ribociclib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution if ribociclib is coadministered with sensitive CYP3A4 substrates that have a narrow therapeutic index. Dose reduction for sensitive CYP3A4 substrates may be needed.

• rifabutin

  rifabutin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifaximin

  quinine increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of quinine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  risperidone and quinine both increase QTc interval. Use Caution/Monitor.

• ritlecitinib

  ritlecitinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates.

• romidepsin

  romidepsin and quinine both increase QTc interval. Use Caution/Monitor.

• rucaparib

  rucaparib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• saquinavir

  saquinavir and quinine both increase QTc interval. Use Caution/Monitor.

• sarecycline

  sarecycline will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• sarilumab

  sarilumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.

• schisandra

  schisandra will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secukinumab

  secukinumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• selexipag

  quinine will increase the level or effect of selexipag by decreasing metabolism. Modify Therapy/Monitor Closely. Reduce selexipag dose to once daily if coadministered with moderate CYP2C8 inhibitors.

• selpercatinib

  selpercatinib increases toxicity of quinine by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline and quinine both increase QTc interval. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of quinine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of quinine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

• solifenacin

  solifenacin and quinine both increase QTc interval. Use Caution/Monitor.

• somapacitan

  somapacitan will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatrogon

  somatrogon will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatropin

  somatropin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• sorafenib

  sorafenib and quinine both increase QTc interval. Use Caution/Monitor.

• sotalol

  sotalol and quinine both increase QTc interval. Use Caution/Monitor.

• St John's Wort

  St John's Wort will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  stiripentol, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• sunitinib

  sunitinib and quinine both increase QTc interval. Use Caution/Monitor.

• tacrolimus

  tacrolimus and quinine both increase QTc interval. Use Caution/Monitor.

• talazoparib

  quinine will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Talazoparib is a P-glycoprotein (P-gp) substrate; coadministration with P-gp inhibitors may increase talazoparib systemic exposure.

• talquetamab

  talquetamab will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• tamsulosin

  quinine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tazemetostat

  tazemetostat will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  quinine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• teclistamab

  teclistamab will increase the level or effect of quinine by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.

• tecovirimat

  tecovirimat will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  telavancin and quinine both increase QTc interval. Use Caution/Monitor.

• telotristat ethyl

  telotristat ethyl will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.

• tetracaine

  tetracaine, quinine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

• thiothixene

  thiothixene and quinine both increase QTc interval. Use Caution/Monitor.

• tinidazole

  quinine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tobramycin inhaled

  tobramycin inhaled and quinine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

• toremifene

  toremifene and quinine both increase QTc interval. Use Caution/Monitor.

• triclabendazole

  triclabendazole and quinine both increase QTc interval. Use Caution/Monitor.

• trimipramine

  trimipramine and quinine both increase QTc interval. Use Caution/Monitor.

• trofinetide

  trofinetide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).

• tucatinib

  tucatinib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

• turmeric

  turmeric will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ustekinumab

  ustekinumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• vardenafil

  vardenafil and quinine both increase QTc interval. Use Caution/Monitor.

• voclosporin

  voclosporin, quinine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vonoprazan

  vonoprazan will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Vonoprazan is weak CYP3A inhibitor. Caution with sensitive CYP3A substrates.

• voriconazole

  voriconazole and quinine both increase QTc interval. Use Caution/Monitor.

• vorinostat

  vorinostat and quinine both increase QTc interval. Use Caution/Monitor.

• warfarin

  quinine will increase the level or effect of warfarin by decreasing metabolism. Use Caution/Monitor. Cinchona alkaloids, including quinine and quinidine, may increase anticoagulant effect of vitamin K antagonists by inhibiting hepatic synthesis of vitamin K-dependent coagulation proteins.

• ziprasidone

  ziprasidone and quinine both increase QTc interval. Use Caution/Monitor.

Minor (70)

• acetazolamide

  acetazolamide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• amobarbital

  amobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anastrozole

  anastrozole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• aprepitant

  aprepitant will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• armodafinil

  armodafinil will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• artemether/lumefantrine

  artemether/lumefantrine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• atazanavir

  atazanavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bosentan

  bosentan will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• budesonide

  budesonide will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butabarbital

  butabarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butalbital

  butalbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• conivaptan

  conivaptan will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cortisone

  cortisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darifenacin

  darifenacin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darunavir

  darunavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dasatinib

  dasatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexamethasone

  dexamethasone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• DHEA, herbal

  DHEA, herbal will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• efavirenz

  efavirenz will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• etravirine

  etravirine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluconazole

  fluconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosamprenavir

  fosamprenavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosaprepitant

  fosaprepitant will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosphenytoin

  fosphenytoin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• grapefruit

  grapefruit will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• griseofulvin

  griseofulvin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydrochlorothiazide

  hydrochlorothiazide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• indinavir

  indinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lapatinib

  lapatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• larotrectinib

  larotrectinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lumefantrine

  lumefantrine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• marijuana

  marijuana will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• memantine

  memantine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• metformin

  metformin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methyclothiazide

  methyclothiazide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methylprednisolone

  methylprednisolone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metronidazole

  metronidazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miconazole vaginal

  miconazole vaginal will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• midodrine

  midodrine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• nafcillin

  nafcillin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nelfinavir

  nelfinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nevirapine

  nevirapine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  nifedipine will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  nilotinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ofloxacin

  ofloxacin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phenobarbital

  phenobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• posaconazole

  posaconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pramipexole

  pramipexole will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• prednisone

  prednisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primaquine

  primaquine, quinine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.

• primidone

  primidone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rifapentine

  rifapentine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rufinamide

  rufinamide will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib

  quinine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  quinine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• secobarbital

  secobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sulfamethoxazole

  sulfamethoxazole will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• topiramate

  topiramate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• triamterene

  quinine will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• trimethoprim

  quinine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• verapamil

  verapamil will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
  
  quinine will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• voriconazole

  voriconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• zafirlukast

  zafirlukast will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• adagrasib

  Serious - Use Alternative (2)adagrasib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 inhibitor, with sensitive CYP3A substrates unless otherwise recommended in the prescribing information for these substrates.
  
  adagrasib, quinine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• afatinib

  Serious - Use Alternative (1)quinine increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• albuterol

  Monitor Closely (1)albuterol and quinine both increase QTc interval. Use Caution/Monitor.

• alfuzosin

  Serious - Use Alternative (1)alfuzosin and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• amantadine

  Monitor Closely (1)quinine will increase the level or effect of amantadine by decreasing renal clearance. Use Caution/Monitor. Coadministration of quinine or quinidine with amantadine was shown to reduce the renal clearance of amantadine by ~30%.

• amiodarone

  Monitor Closely (2)amiodarone will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  amiodarone and quinine both increase QTc interval. Use Caution/Monitor.

• amisulpride

  Serious - Use Alternative (1)amisulpride and quinine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (1)amitriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• amobarbital

  Minor (1)amobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• amoxapine

  Monitor Closely (1)amoxapine and quinine both increase QTc interval. Use Caution/Monitor.

• anagrelide

  Monitor Closely (1)anagrelide and quinine both increase QTc interval. Use Caution/Monitor.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• antithrombin alfa

  Serious - Use Alternative (1)quinine increases effects of antithrombin alfa by unknown mechanism. Avoid or Use Alternate Drug.

• antithrombin III

  Serious - Use Alternative (1)quinine increases effects of antithrombin III by unknown mechanism. Avoid or Use Alternate Drug.

• apalutamide

  Serious - Use Alternative (1)apalutamide will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apomorphine

  Monitor Closely (1)apomorphine and quinine both increase QTc interval. Use Caution/Monitor.

• aprepitant

  Minor (1)aprepitant will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arformoterol

  Monitor Closely (1)arformoterol and quinine both increase QTc interval. Use Caution/Monitor.

• argatroban

  Serious - Use Alternative (1)quinine increases effects of argatroban by unknown mechanism. Avoid or Use Alternate Drug.

• aripiprazole

  Serious - Use Alternative (1)aripiprazole and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• armodafinil

  Minor (1)armodafinil will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arsenic trioxide

  Monitor Closely (1)arsenic trioxide and quinine both increase QTc interval. Use Caution/Monitor.

• artemether

  Serious - Use Alternative (1)artemether and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Monitor Closely (1)artemether/lumefantrine and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)artemether/lumefantrine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• asenapine

  Monitor Closely (1)asenapine and quinine both increase QTc interval. Use Caution/Monitor.

• asenapine transdermal

  Serious - Use Alternative (1)asenapine transdermal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• atazanavir

  Minor (1)atazanavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• atogepant

  Monitor Closely (1)quinine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Serious - Use Alternative (1)atomoxetine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• atracurium

  Serious - Use Alternative (1)quinine increases effects of atracurium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• avapritinib

  Monitor Closely (1)quinine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• axitinib

  Monitor Closely (1)quinine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)azithromycin and quinine both increase QTc interval. Use Caution/Monitor.

• bedaquiline

  Monitor Closely (1)quinine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• bemiparin

  Serious - Use Alternative (1)quinine increases effects of bemiparin by unknown mechanism. Avoid or Use Alternate Drug.

• berotralstat

  Monitor Closely (3)berotralstat will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
  
  berotralstat will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.
  
  quinine increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.

• betrixaban

  Monitor Closely (1)quinine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

• bivalirudin

  Serious - Use Alternative (1)quinine increases effects of bivalirudin by unknown mechanism. Avoid or Use Alternate Drug.

• blinatumomab

  Monitor Closely (1)blinatumomab increases levels of quinine by decreasing metabolism. Modify Therapy/Monitor Closely. Treatment initiation causes transient release of cytokines that may suppress CYP450 enzymes; highest drug-drug interaction risk is during the first 9 days of the first cycle and the first 2 days of the 2nd cycle in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index.

• bosentan

  Minor (1)bosentan will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bosutinib

  Monitor Closely (1)bosutinib and quinine both increase QTc interval. Use Caution/Monitor.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of quinine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexpiprazole

  Monitor Closely (1)quinine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.

• brigatinib

  Serious - Use Alternative (1)brigatinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.

• brodalumab

  Monitor Closely (1)brodalumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, brodalumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of brodalumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• budesonide

  Minor (1)budesonide will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bupivacaine implant

  Monitor Closely (1)quinine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

• buprenorphine

  Serious - Use Alternative (1)buprenorphine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Serious - Use Alternative (1)buprenorphine buccal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Serious - Use Alternative (1)buprenorphine subdermal implant and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Serious - Use Alternative (1)buprenorphine, long-acting injection and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• butabarbital

  Minor (1)butabarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butalbital

  Minor (1)butalbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• capecitabine

  Monitor Closely (1)capecitabine and quinine both increase QTc interval. Use Caution/Monitor.

• carbamazepine

  Monitor Closely (1)carbamazepine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cenobamate

  Monitor Closely (1)cenobamate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• ceritinib

  Monitor Closely (1)quinine increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)ceritinib and quinine both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloroquine

  Serious - Use Alternative (1)chloroquine increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and quinine both increase QTc interval. Use Caution/Monitor.

• cimetidine

  Monitor Closely (2)cimetidine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  cimetidine will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ciprofloxacin

  Monitor Closely (1)ciprofloxacin and quinine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

• cisatracurium

  Serious - Use Alternative (1)quinine increases effects of cisatracurium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• citalopram

  Monitor Closely (1)quinine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  Monitor Closely (2)clarithromycin and quinine both increase QTc interval. Use Caution/Monitor.
  
  clarithromycin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clomipramine

  Monitor Closely (1)clomipramine and quinine both increase QTc interval. Use Caution/Monitor.

• clozapine

  Monitor Closely (1)clozapine and quinine both increase QTc interval. Use Caution/Monitor.

• cobicistat

  Monitor Closely (1)cobicistat will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• colchicine

  Serious - Use Alternative (1)quinine will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment.

• conivaptan

  Minor (1)conivaptan will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cortisone

  Minor (1)cortisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• crizotinib

  Monitor Closely (2)crizotinib increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib and quinine both increase QTc interval. Use Caution/Monitor.

• crofelemer

  Monitor Closely (1)crofelemer increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclosporine

  Monitor Closely (1)cyclosporine will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dabigatran

  Monitor Closely (1)quinine will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dalteparin

  Serious - Use Alternative (1)quinine increases effects of dalteparin by unknown mechanism. Avoid or Use Alternate Drug.

• dapsone topical

  Serious - Use Alternative (1)quinine, dapsone topical. unspecified interaction mechanism. Avoid or Use Alternate Drug. Avoid coadministration of dapsone topical with oral dapsone or antimalarial medications because of the potential for hemolytic reactions.

• darifenacin

  Minor (1)darifenacin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darunavir

  Minor (1)darunavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dasatinib

  Monitor Closely (1)dasatinib and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)dasatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• deferasirox

  Monitor Closely (1)deferasirox will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• degarelix

  Monitor Closely (1)degarelix and quinine both increase QTc interval. Use Caution/Monitor.

• desflurane

  Serious - Use Alternative (1)desflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Monitor Closely (1)desipramine and quinine both increase QTc interval. Use Caution/Monitor.

• deutetrabenazine

  Monitor Closely (1)quinine and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  Minor (1)dexamethasone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• DHEA, herbal

  Minor (1)DHEA, herbal will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• digoxin

  Monitor Closely (1)digoxin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• diltiazem

  Monitor Closely (1)diltiazem will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• disopyramide

  Monitor Closely (1)disopyramide and quinine both increase QTc interval. Use Caution/Monitor.

• dofetilide

  Monitor Closely (2)dofetilide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  dofetilide and quinine both increase QTc interval. Use Caution/Monitor.

• dolasetron

  Monitor Closely (1)dolasetron and quinine both increase QTc interval. Use Caution/Monitor.

• donepezil

  Serious - Use Alternative (1)donepezil and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  Serious - Use Alternative (1)doxepin and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  Contraindicated (2)dronedarone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Although quinine levels are not significantly increased, combination is contraindicated because of potential for both drugs to prolong QT interval
  
  dronedarone and quinine both increase QTc interval. Contraindicated.

• droperidol

  Monitor Closely (1)droperidol and quinine both increase QTc interval. Use Caution/Monitor.

• dulaglutide

  Monitor Closely (1)dulaglutide, quinine. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

• dupilumab

  Monitor Closely (1)dupilumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, dupilumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of dupilumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• duvelisib

  Monitor Closely (2)quinine will increase the level or effect of duvelisib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  duvelisib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• edoxaban

  Serious - Use Alternative (1)quinine will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• efavirenz

  Serious - Use Alternative (1)efavirenz and quinine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)efavirenz will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• elagolix

  Monitor Closely (2)elagolix will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  elagolix decreases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eliglustat

  Contraindicated (1)quinine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.Monitor Closely (1)eliglustat increases levels of quinine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.Serious - Use Alternative (1)eliglustat and quinine both increase QTc interval. Contraindicated.

• elranatamab

  Monitor Closely (1)elranatamab will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• eluxadoline

  Monitor Closely (1)eluxadoline increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Monitor Closely (1)encorafenib, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious - Use Alternative (1)encorafenib and quinine both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• enoxaparin

  Serious - Use Alternative (1)quinine increases effects of enoxaparin by unknown mechanism. Avoid or Use Alternate Drug.

• entrectinib

  Serious - Use Alternative (1)quinine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• epcoritamab

  Monitor Closely (1)epcoritamab, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• erdafitinib

  Serious - Use Alternative (4)erdafitinib, quinine. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.
  
  erdafitinib, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with erdafitinib and sensitive CYP3A4 substrates with narrow therapeutic indices. Erdafitinib may altered plasma concentrations of CYP3A4 substrates, leading to either loss of activity or increased toxicity of the substrate.
  
  erdafitinib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.
  
  quinine will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. If coadministration of a strong CYP2C9 inhibitors is unavoidable, closely monitor adverse reactions and modify dose of erdafitinib accordingly. If strong CYP2C9 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.

• eribulin

  Serious - Use Alternative (1)eribulin and quinine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• erythromycin base

  Monitor Closely (2)erythromycin base and quinine both increase QTc interval. Use Caution/Monitor.
  
  erythromycin base will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin ethylsuccinate

  Monitor Closely (2)erythromycin ethylsuccinate and quinine both increase QTc interval. Use Caution/Monitor.
  
  erythromycin ethylsuccinate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin lactobionate

  Monitor Closely (2)erythromycin lactobionate and quinine both increase QTc interval. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin stearate

  Monitor Closely (2)erythromycin stearate and quinine both increase QTc interval. Use Caution/Monitor.
  
  erythromycin stearate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• escitalopram

  Monitor Closely (1)escitalopram and quinine both increase QTc interval. Use Caution/Monitor.

• eslicarbazepine acetate

  Minor (1)eslicarbazepine acetate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• etravirine

  Minor (1)etravirine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine, quinine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• ferric maltol

  Monitor Closely (1)ferric maltol, quinine. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• fexinidazole

  Serious - Use Alternative (2)fexinidazole and quinine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• finerenone

  Monitor Closely (1)quinine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

• fingolimod

  Serious - Use Alternative (1)fingolimod and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• flecainide

  Monitor Closely (1)flecainide and quinine both increase QTc interval. Use Caution/Monitor.

• flibanserin

  Monitor Closely (2)quinine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
  
  flibanserin increases levels of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Increase monitoring of concentrations of drugs transported by P-gp that have a narrow therapeutic index if coadministered with flibanserin.

• floxuridine

  Monitor Closely (1)floxuridine and quinine both increase QTc interval. Use Caution/Monitor.

• fluconazole

  Monitor Closely (1)fluconazole and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)fluconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fludrocortisone

  Minor (1)fludrocortisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluoxetine

  Monitor Closely (1)fluoxetine and quinine both increase QTc interval. Use Caution/Monitor.

• fluphenazine

  Monitor Closely (1)fluphenazine and quinine both increase QTc interval. Use Caution/Monitor.

• fondaparinux

  Serious - Use Alternative (1)quinine increases effects of fondaparinux by unknown mechanism. Avoid or Use Alternate Drug.

• formoterol

  Monitor Closely (1)formoterol and quinine both increase QTc interval. Use Caution/Monitor.

• fosamprenavir

  Minor (1)fosamprenavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosaprepitant

  Minor (1)fosaprepitant will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• foscarnet

  Monitor Closely (1)foscarnet and quinine both increase QTc interval. Use Caution/Monitor.

• fosphenytoin

  Minor (1)fosphenytoin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fostemsavir

  Monitor Closely (1)quinine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• gadobenate

  Serious - Use Alternative (1)gadobenate and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• gepirone

  Monitor Closely (1)gepirone and quinine both increase QTc interval. Modify Therapy/Monitor Closely.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  Serious - Use Alternative (1)quinine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• glecaprevir/pibrentasvir

  Monitor Closely (2)quinine will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  glecaprevir/pibrentasvir will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• glofitamab

  Monitor Closely (1)glofitamab, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. GlofitamaGlofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adversereactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• glycerol phenylbutyrate

  Monitor Closely (1)glycerol phenylbutyrate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.

• granisetron

  Serious - Use Alternative (1)granisetron and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• grapefruit

  Minor (1)grapefruit will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• griseofulvin

  Minor (1)griseofulvin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• guselkumab

  Monitor Closely (1)guselkumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• haloperidol

  Monitor Closely (1)haloperidol and quinine both increase QTc interval. Use Caution/Monitor.

• heparin

  Serious - Use Alternative (1)quinine increases effects of heparin by unknown mechanism. Avoid or Use Alternate Drug.

• hydrochlorothiazide

  Minor (1)hydrochlorothiazide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrocortisone

  Minor (1)hydrocortisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  Serious - Use Alternative (1)hydroxyzine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• ibutilide

  Monitor Closely (1)ibutilide and quinine both increase QTc interval. Use Caution/Monitor.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  Monitor Closely (2)iloperidone and quinine both increase QTc interval. Use Caution/Monitor.
  
  iloperidone increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, quinine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Monitor Closely (1)indapamide and quinine both increase QTc interval. Use Caution/Monitor.

• indinavir

  Minor (1)indinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• isavuconazonium sulfate

  Monitor Closely (2)quinine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  isavuconazonium sulfate will increase the level or effect of quinine by Other (see comment). Use Caution/Monitor. Isavuconazonium sulfate, an inhibitor of P-gp and CYP3A4, may increase the effects or levels of sensitive P-gp or CYP3A4 substrates, which may require dose adjustment.

• isoflurane

  Serious - Use Alternative (1)isoflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Monitor Closely (1)isoniazid will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isradipine

  Monitor Closely (1)isradipine and quinine both increase QTc interval. Use Caution/Monitor.

• istradefylline

  Monitor Closely (2)istradefylline will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  Monitor Closely (2)itraconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  itraconazole and quinine both increase QTc interval. Use Caution/Monitor.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib and quinine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ixekizumab

  Monitor Closely (1)ixekizumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, ixekizumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of ixekizumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lapatinib

  Monitor Closely (1)lapatinib and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)lapatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• larotrectinib

  Minor (1)larotrectinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan

  Serious - Use Alternative (1)lasmiditan increases levels of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lemborexant

  Monitor Closely (1)quinine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

• lenacapavir

  Monitor Closely (1)lenacapavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• letermovir

  Monitor Closely (1)letermovir increases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levofloxacin

  Monitor Closely (1)levofloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lithium

  Serious - Use Alternative (1)lithium and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• lomitapide

  Monitor Closely (1)quinine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• lonafarnib

  Monitor Closely (1)lonafarnib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.Serious - Use Alternative (2)lonafarnib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
  
  quinine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• lonapegsomatropin

  Monitor Closely (1)lonapegsomatropin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• lopinavir

  Monitor Closely (1)lopinavir and quinine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)lopinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lorlatinib

  Serious - Use Alternative (1)lorlatinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.

• lumacaftor/ivacaftor

  Serious - Use Alternative (1)lumacaftor/ivacaftor will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.

• lumefantrine

  Minor (1)lumefantrine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• macimorelin

  Serious - Use Alternative (1)macimorelin and quinine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Monitor Closely (1)maprotiline and quinine both increase QTc interval. Use Caution/Monitor.

• marijuana

  Minor (1)marijuana will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• mefloquine

  Serious - Use Alternative (2)mefloquine increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
  
  quinine, mefloquine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of ECG abnormalities, cardiac arrest.

• memantine

  Minor (1)memantine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• metformin

  Minor (1)metformin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methadone

  Monitor Closely (1)methadone and quinine both increase QTc interval. Use Caution/Monitor.

• methyclothiazide

  Minor (1)methyclothiazide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methylprednisolone

  Minor (1)methylprednisolone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metronidazole

  Minor (1)metronidazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miconazole vaginal

  Minor (1)miconazole vaginal will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• midazolam intranasal

  Monitor Closely (1)quinine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

• midodrine

  Minor (1)midodrine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• mifepristone

  Monitor Closely (1)mifepristone, quinine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.Serious - Use Alternative (1)mifepristone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• mirtazapine

  Serious - Use Alternative (1)mirtazapine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• mitotane

  Monitor Closely (1)mitotane decreases levels of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mobocertinib

  Serious - Use Alternative (2)mobocertinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
  
  mobocertinib and quinine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  Monitor Closely (1)moxifloxacin and quinine both increase QTc interval. Use Caution/Monitor.

• nafcillin

  Minor (1)nafcillin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• naldemedine

  Monitor Closely (1)quinine increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• nefazodone

  Serious - Use Alternative (1)nefazodone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Minor (1)nelfinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nevirapine

  Minor (1)nevirapine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  Minor (1)nifedipine will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  Monitor Closely (1)nilotinib and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)nilotinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nintedanib

  Monitor Closely (1)quinine increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

• nortriptyline

  Monitor Closely (1)nortriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• octreotide

  Monitor Closely (1)octreotide and quinine both increase QTc interval. Use Caution/Monitor.

• ofloxacin

  Monitor Closely (1)ofloxacin and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)ofloxacin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• olanzapine

  Monitor Closely (1)olanzapine and quinine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  Monitor Closely (1)quinine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

• olodaterol inhaled

  Monitor Closely (1)quinine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olutasidenib

  Serious - Use Alternative (1)olutasidenib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.

• omaveloxolone

  Monitor Closely (1)omaveloxolone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.

• onabotulinumtoxinA

  Serious - Use Alternative (1)quinine increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• ondansetron

  Serious - Use Alternative (1)quinine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oritavancin

  Monitor Closely (1)oritavancin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Oritavancin is a weak CYP3A4 inducer; caution if coadministered with CYP3A4 substrates that have a narrow therapeutic index

• osilodrostat

  Monitor Closely (1)osilodrostat and quinine both increase QTc interval. Use Caution/Monitor.

• oxaliplatin

  Monitor Closely (1)oxaliplatin will increase the level or effect of quinine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)oxaliplatin and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• oxcarbazepine

  Minor (1)oxcarbazepine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ozanimod

  Monitor Closely (1)ozanimod and quinine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paclitaxel

  Monitor Closely (1)quinine will increase the level or effect of paclitaxel by Other (see comment). Use Caution/Monitor. Paclitaxel levels/toxicity may increase when coadministered with CYP2C8 inhibitors

• paclitaxel protein bound

  Monitor Closely (1)quinine will increase the level or effect of paclitaxel protein bound by Other (see comment). Use Caution/Monitor. Paclitaxel levels/toxicity may increase when coadministered with CYP2C8 inhibitors

• pacritinib

  Serious - Use Alternative (1)pacritinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• palbociclib

  Monitor Closely (1)palbociclib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib

• paliperidone

  Monitor Closely (1)paliperidone and quinine both increase QTc interval. Use Caution/Monitor.

• pancuronium

  Serious - Use Alternative (1)quinine increases effects of pancuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• pasireotide

  Monitor Closely (1)quinine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)pazopanib and quinine both increase QTc interval. Use Caution/Monitor.

• pentamidine

  Monitor Closely (1)pentamidine and quinine both increase QTc interval. Use Caution/Monitor.

• pentobarbital

  Minor (1)pentobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• perphenazine

  Monitor Closely (1)perphenazine and quinine both increase QTc interval. Use Caution/Monitor.

• pexidartinib

  Serious - Use Alternative (1)pexidartinib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.

• phenindione

  Serious - Use Alternative (1)quinine increases effects of phenindione by unknown mechanism. Avoid or Use Alternate Drug.

• phenobarbital

  Minor (1)phenobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use caution when prescribing phenytoin and quinine together due to a decrease in quinine plasma concentrations and potential lack of efficacy.

• pimozide

  Contraindicated (1)pimozide and quinine both increase QTc interval. Contraindicated.

• pirtobrutinib

  Monitor Closely (1)pirtobrutinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates.

• pitolisant

  Monitor Closely (1)pitolisant will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.Serious - Use Alternative (1)quinine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pomalidomide

  Serious - Use Alternative (1)quinine increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ponesimod

  Serious - Use Alternative (1)ponesimod, quinine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• posaconazole

  Monitor Closely (1)posaconazole and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)posaconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pramipexole

  Minor (1)pramipexole will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• prednisone

  Minor (1)prednisone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primaquine

  Serious - Use Alternative (1)primaquine and quinine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)primaquine, quinine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.

• primidone

  Minor (1)primidone will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• procainamide

  Monitor Closely (2)procainamide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  procainamide and quinine both increase QTc interval. Use Caution/Monitor.

• propafenone

  Monitor Closely (1)propafenone and quinine both increase QTc interval. Use Caution/Monitor.

• protamine

  Serious - Use Alternative (1)quinine increases effects of protamine by unknown mechanism. Avoid or Use Alternate Drug.

• protriptyline

  Monitor Closely (1)protriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)quetiapine, quinine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  Monitor Closely (2)quinidine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  quinidine and quinine both increase QTc interval. Use Caution/Monitor.

• quinupristin/dalfopristin

  Minor (1)quinupristin/dalfopristin will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• quizartinib

  Monitor Closely (1)quizartinib, quinine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ranolazine

  Monitor Closely (1)ranolazine and quinine both increase QTc interval. Use Caution/Monitor.

• rapacuronium

  Serious - Use Alternative (1)quinine increases effects of rapacuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution if ribociclib is coadministered with sensitive CYP3A4 substrates that have a narrow therapeutic index. Dose reduction for sensitive CYP3A4 substrates may be needed.Serious - Use Alternative (1)ribociclib increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (1)rifampin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  Minor (1)rifapentine will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rifaximin

  Monitor Closely (1)quinine increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of quinine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• rimegepant

  Serious - Use Alternative (1)quinine will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• riociguat

  Serious - Use Alternative (1)quinine will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• risperidone

  Monitor Closely (1)risperidone and quinine both increase QTc interval. Use Caution/Monitor.

• ritlecitinib

  Monitor Closely (1)ritlecitinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates.

• ritonavir

  Serious - Use Alternative (1)ritonavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Prescribing information for quinine recommends avoiding combination

• rocuronium

  Serious - Use Alternative (1)quinine increases effects of rocuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• romidepsin

  Monitor Closely (1)romidepsin and quinine both increase QTc interval. Use Caution/Monitor.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• rufinamide

  Minor (1)rufinamide will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib

  Minor (1)quinine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  Minor (1)quinine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• saquinavir

  Monitor Closely (1)saquinavir and quinine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)saquinavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• sarecycline

  Monitor Closely (1)sarecycline will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• sarilumab

  Monitor Closely (1)sarilumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.

• schisandra

  Monitor Closely (1)schisandra will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secobarbital

  Minor (1)secobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• secukinumab

  Monitor Closely (1)secukinumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• selexipag

  Monitor Closely (1)quinine will increase the level or effect of selexipag by decreasing metabolism. Modify Therapy/Monitor Closely. Reduce selexipag dose to once daily if coadministered with moderate CYP2C8 inhibitors.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of quinine by QTc interval. Use Caution/Monitor.

• sertraline

  Monitor Closely (1)sertraline and quinine both increase QTc interval. Use Caution/Monitor.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  Serious - Use Alternative (2)quinine will increase the level or effect of siponimod by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with drugs that cause moderate CYP2C9 AND a moderate or strong CYP3A4 inhibition is not recommended. Caution if siponimod coadministered with moderate CYP2C9 inhibitors alone.
  
  siponimod and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of quinine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of quinine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

• solifenacin

  Monitor Closely (1)solifenacin and quinine both increase QTc interval. Use Caution/Monitor.

• somapacitan

  Monitor Closely (1)somapacitan will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatrogon

  Monitor Closely (1)somatrogon will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatropin

  Monitor Closely (1)somatropin will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• sorafenib

  Monitor Closely (1)sorafenib and quinine both increase QTc interval. Use Caution/Monitor.

• sotalol

  Monitor Closely (1)sotalol and quinine both increase QTc interval. Use Caution/Monitor.

• sotorasib

  Serious - Use Alternative (2)sotorasib will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
  
  sotorasib will decrease the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• St John's Wort

  Monitor Closely (1)St John's Wort will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  Monitor Closely (2)stiripentol, quinine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• succinylcholine

  Serious - Use Alternative (1)quinine increases effects of succinylcholine by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• sulfamethoxazole

  Minor (1)sulfamethoxazole will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• sunitinib

  Monitor Closely (1)sunitinib and quinine both increase QTc interval. Use Caution/Monitor.

• tacrolimus

  Monitor Closely (1)tacrolimus and quinine both increase QTc interval. Use Caution/Monitor.

• talazoparib

  Monitor Closely (1)quinine will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Talazoparib is a P-glycoprotein (P-gp) substrate; coadministration with P-gp inhibitors may increase talazoparib systemic exposure.

• talquetamab

  Monitor Closely (1)talquetamab will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• tamsulosin

  Monitor Closely (1)quinine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tazemetostat

  Monitor Closely (2)tazemetostat will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  quinine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• teclistamab

  Monitor Closely (1)teclistamab will increase the level or effect of quinine by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.

• tecovirimat

  Monitor Closely (1)tecovirimat will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  Monitor Closely (1)telavancin and quinine both increase QTc interval. Use Caution/Monitor.

• telotristat ethyl

  Monitor Closely (1)telotristat ethyl will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.

• tepotinib

  Serious - Use Alternative (1)tepotinib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

• tetrabenazine

  Serious - Use Alternative (1)tetrabenazine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• tetracaine

  Monitor Closely (1)tetracaine, quinine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

• thioridazine

  Contraindicated (1)thioridazine and quinine both increase QTc interval. Contraindicated.

• thiothixene

  Monitor Closely (1)thiothixene and quinine both increase QTc interval. Use Caution/Monitor.

• tinidazole

  Monitor Closely (1)quinine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tipranavir

  Serious - Use Alternative (1)tipranavir will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tobramycin inhaled

  Monitor Closely (1)tobramycin inhaled and quinine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

• topiramate

  Minor (1)topiramate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• topotecan

  Serious - Use Alternative (1)quinine will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• toremifene

  Monitor Closely (1)toremifene and quinine both increase QTc interval. Use Caution/Monitor.

• triamterene

  Minor (1)quinine will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• triclabendazole

  Monitor Closely (1)triclabendazole and quinine both increase QTc interval. Use Caution/Monitor.

• trimethoprim

  Minor (1)quinine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• trimipramine

  Monitor Closely (1)trimipramine and quinine both increase QTc interval. Use Caution/Monitor.

• trofinetide

  Monitor Closely (1)trofinetide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).

• tucatinib

  Monitor Closely (1)tucatinib will increase the level or effect of quinine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.Serious - Use Alternative (2)quinine will increase the level or effect of tucatinib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of tucatinib (a CYP2C8 substrate) with a strong or moderate CYP2C8 inhibitors increases tucatinib plasma concentrations and risk of toxicities.
  
  tucatinib will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• turmeric

  Monitor Closely (1)turmeric will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)quinine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• ustekinumab

  Monitor Closely (1)ustekinumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• vandetanib

  Serious - Use Alternative (1)quinine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vardenafil

  Monitor Closely (1)vardenafil and quinine both increase QTc interval. Use Caution/Monitor.

• vecuronium

  Serious - Use Alternative (1)quinine increases effects of vecuronium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and quinine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venetoclax

  Serious - Use Alternative (1)quinine will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• verapamil

  Minor (2)verapamil will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
  
  quinine will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)quinine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• voclosporin

  Monitor Closely (1)voclosporin, quinine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vonoprazan

  Monitor Closely (1)vonoprazan will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Vonoprazan is weak CYP3A inhibitor. Caution with sensitive CYP3A substrates.

• voriconazole

  Monitor Closely (1)voriconazole and quinine both increase QTc interval. Use Caution/Monitor.Minor (1)voriconazole will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• vorinostat

  Monitor Closely (1)vorinostat and quinine both increase QTc interval. Use Caution/Monitor.

• vortioxetine

  Serious - Use Alternative (1)quinine increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• warfarin

  Monitor Closely (1)quinine will increase the level or effect of warfarin by decreasing metabolism. Use Caution/Monitor. Cinchona alkaloids, including quinine and quinidine, may increase anticoagulant effect of vitamin K antagonists by inhibiting hepatic synthesis of vitamin K-dependent coagulation proteins.

• zafirlukast

  Minor (1)zafirlukast will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ziprasidone

  Monitor Closely (1)ziprasidone and quinine both increase QTc interval. Use Caution/Monitor.