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Mansor SM, Ward SA, Edwards G, Hoaksey PE, Breckenridge AM. The effect of malaria infection on the disposition of quinine and quinidine in the rat isolated perfused liver preparation. J Pharm Pharmacol 1990; 42:428-32. [PMID: 1979624 DOI: 10.1111/j.2042-7158.1990.tb06584.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effect of malaria on the disposition of quinine and quinidine was studied in livers isolated from young rats infected with merozoites of Plasmodium berghei, a rodent malaria model, and non-infected controls. Following bolus administration of quinine (1 mg) or quinidine (1 mg) to the 100 mL recycling perfusion circuit, perfusate was sampled (0-4 h) and plasma assayed for quinine and quinidine by HPLC. Higher quinine (AUC:6470 +/- 1101 vs 3822 +/- 347 ng h mL-1, P less than 0.001) and quinidine (AUC: 6642 +/- 1304 vs 4808 +/- 872 ng h mL-1, P less than 0.05) concentrations were observed during malaria infection (MI). MI resulted in decreased quinine clearance (CL) (0.33 +/- 0.08 vs 0.64 +/- 0.09 mL min-1 g-1, P less than 0.001) and volume of distribution (Vd) (53.0 +/- 13.3 vs 81.2 +/- 23.7 mL g-1, P less than 0.05) but no significant change in elimination half-life (t1/2) (1.93 +/- 0.6 vs 1.37 +/- 0.25 h, P greater than 0.05). With quinidine, however, MI resulted in decreased CL (0.38 +/- 0.16 vs 0.64 +/- 0.09, P less than 0.05) with no change in Vd and a significant increase in t1/2 (1.62 +/- 0.42 vs 0.88 +/- 0.22, P less than 0.01). In summary, the hepatic disposition of quinine and quinidine is altered in the malaria-infected rat.
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Affiliation(s)
- S M Mansor
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
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Sanderson JE, Whiteley E, Neubauer K, Barry M. Two management policies for patients after myocardial infarction: Does exercise testing and a more intensive approach make any difference? BMJ (CLINICAL RESEARCH ED.) 1989; 299:1435-6. [PMID: 2575412 PMCID: PMC1838273 DOI: 10.1136/bmj.299.6713.1435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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54
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Panday S, Raynor DK. Parenteral antimalarial drugs: availability in acute hospitals. BMJ (CLINICAL RESEARCH ED.) 1989; 299:1436. [PMID: 2514828 PMCID: PMC1838275 DOI: 10.1136/bmj.299.6713.1436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- S Panday
- Department of Paediatrics and Child Health, St. James's University Hospital, Leeds
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55
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Miller KD, Greenberg AE, Campbell CC. Treatment of severe malaria in the United States with a continuous infusion of quinidine gluconate and exchange transfusion. N Engl J Med 1989; 321:65-70. [PMID: 2659994 DOI: 10.1056/nejm198907133210201] [Citation(s) in RCA: 125] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
During the past decade the incidence of Plasmodium falciparum malaria in the United States has increased 10-fold. Treatment may be delayed because the therapy recommended for severe or complicated disease, intravenous quinine dihydrochloride, is available only from the Centers for Disease Control. We studied 17 patients who were treated for severe or complicated P. falciparum malaria in the United States between 1985 and 1987. Five patients were treated with a continuous infusion of quinidine gluconate, 10 with an exchange transfusion in addition to the continuous infusion of quinidine gluconate, and 2 with intermittently administered intravenous quinine dihydrochloride and an exchange transfusion. All 16 patients with P. falciparum malaria (1 patient had P. vivax malaria) had hyperparasitemia at the time of diagnosis (6 to 54 percent of the erythrocytes infected; median, 13 percent). Three patients with marked hyperparasitemia (54, 38, and 30 percent) and multiple other indicators of a poor prognosis, including advanced age, died. The 13 patients who completed their courses of quinidine with or without exchange transfusion had a parasitemia level of 1.1 percent or less 28 to 72 hours (mean, 44.4 hours) after the start of therapy. Side effects of quinidine treatment were observed in only two patients, one of whom had a serum quinidine concentration above the toxic level. We conclude that the continuous infusion of quinidine gluconate is well tolerated alone and with exchange transfusion and is effective in the treatment of severe and complicated malaria.
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Affiliation(s)
- K D Miller
- Division of Parasitic Diseases, Centers for Disease Control, Atlanta
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56
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Karle JM, Karle IL. Crystal and molecular structure of the antimalarial agent enpiroline. Antimicrob Agents Chemother 1989; 33:1081-9. [PMID: 2782859 PMCID: PMC176066 DOI: 10.1128/aac.33.7.1081] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
To identify common spatial and structural features of amino alcohol antimalarial agents with the eventual goal of designing more effective drugs and a better understanding of the mechanism of action of this class of antimalarial agents, the three-dimensional crystal and molecular structure of enpiroline, a new antimalarial agent active against chloroquine-resistant Plasmodium falciparum, was determined by X-ray crystallography and compared with the crystal structures of the cinchona alkaloids and of the new antimalarial agent WR 194,965. The aromatic rings of the phenyl-pyridine ring system of enpiroline are twisted from each other by approximately 18 degrees. The intramolecular aliphatic N-O distance in enpiroline was 2.80 A (1 A = 0.1 nm), which is close to the N-O distance found in the antimalarial cinchona alkaloids. Enpiroline contains both an intramolecular hydrogen bond between the aliphatic nitrogen and oxygen atoms and an intermolecular hydrogen bond between the aliphatic nitrogen and oxygen atoms of two neighboring molecules. One enantiomer of enpiroline superimposed best with quinine, and the other enantiomer of enpiroline superimposed best with quinidine, suggesting that both enantiomers of enpiroline possess antimalarial activity. Since a common feature of the crystal structures of the amino alcohol antimalarial agents is the formation of intermolecular hydrogen bonds, the common spatial direction of hydrogen bond formation indicates the potential ability of these antimalarial agents to bind to a common receptor site. The crystallographic parameters were as follows: C19H18F6N5O; Mr = 404.3; symmetry of unit cell, monoclinic; space group, P2(1)/a; parameters of unit cell---a = 9.454 +/- 0.004 A, b = 18.908 +/- 0.008 A, c = 10.300 +/- 0.004 A, and beta = 96.55 +/- 0.03 degrees: V (volume of unit cell) = 1829.2 A3; Z (number of molecules per unit cell) = 4; Dchi (calculated density) = 1.46 g cm-3; source of radiation, CuK alpha (lambda = 1.54178 A); mu (absorption coefficient) = 11.49 cm-1; F(000) (sum of atomic scattering factors at zero scattering angle) = 832; room temperature; final R = 8.7% for 1,798 reflections with [F0] > 3 sigma.
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Affiliation(s)
- J M Karle
- Department of Pharmacology, Walter Reed Army Institute of Research, Washington, D.C. 20307-5100
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57
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Abstract
Severe malaria is a major cause of infant and childhood death in the tropics. Effective management relies on rapid diagnosis, prompt administration of parenteral schizonticidal antimalarial drugs, careful fluid balance, prevention of convulsions and early recognition of complications such as hypoglycemia, metabolic acidosis, anemia, pulmonary edema, renal failure, bleeding and supervening bacterial sepsis. The mortality of treated cerebral malaria remains 20%. New, more rapidly acting antimalarials and earlier referral of children with complicated infections should reduce this unacceptable death rate.
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Matsuura GK, Chan LA. Ineffectiveness of continuous quinidine gluconate infusion in the treatment of severe chloroquine-resistant Plasmodium falciparum malaria. DRUG INTELLIGENCE & CLINICAL PHARMACY 1988; 22:883-5. [PMID: 3069426 DOI: 10.1177/106002808802201110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The drug of choice in the treatment of chloroquine-resistant Plasmodium falciparum malaria is parenteral quinine dihydrochloride. Due to limited use, the drug is not commercially available in the U.S. and must be obtained through the Centers for Disease Control (CDC) in Atlanta, Georgia. As an alternative, the CDC has developed a protocol to treat P. falciparum malaria with parenteral quinidine gluconate. Following this protocol, a 10 mg/kg loading dose of quinidine gluconate followed by a 0.02 mg/kg/min continuous infusion was administered to a 53-year-old man with severe life-threatening chloroquine-resistant P. falciparum malaria. Although the patient described did not survive, the use of parenteral quinidine gluconate still appears to be a viable alternative to parenteral quinine dihydrochloride in the treatment of severe chloroquine-resistant P. falciparum malaria.
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Affiliation(s)
- G K Matsuura
- Pacific Presbyterian Medical Center, San Francisco, CA
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60
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Herwaldt BL, Krogstad DJ, Schlesinger PH. Antimalarial agents: specific chemoprophylaxis regimens. Antimicrob Agents Chemother 1988; 32:953-6. [PMID: 3056247 PMCID: PMC172323 DOI: 10.1128/aac.32.7.953] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- B L Herwaldt
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Krogstad DJ, Herwaldt BL, Schlesinger PH. Antimalarial agents: specific treatment regimens. Antimicrob Agents Chemother 1988; 32:957-61. [PMID: 3056248 PMCID: PMC172324 DOI: 10.1128/aac.32.7.957] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- D J Krogstad
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Schlesinger PH, Krogstad DJ, Herwaldt BL. Antimalarial agents: mechanisms of action. Antimicrob Agents Chemother 1988; 32:793-8. [PMID: 3046479 PMCID: PMC172284 DOI: 10.1128/aac.32.6.793] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- P H Schlesinger
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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63
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Druilhe P, Brandicourt O, Chongsuphajaisiddhi T, Berthe J. Activity of a combination of three cinchona bark alkaloids against Plasmodium falciparum in vitro. Antimicrob Agents Chemother 1988; 32:250-4. [PMID: 3284455 PMCID: PMC172144 DOI: 10.1128/aac.32.2.250] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In vitro studies with quinine, quinidine, cinchonine, and cinchonidine showed that despite a similarity of chemical structure, the effectiveness of these cinchona bark alkaloids against several culture lines of Plasmodium falciparum varied widely. Depending on the strain tested, quinidine and cinchonine were 1 to 10 and 1 to 5 times, respectively, more active than quinine. A combination made of equal parts of quinine, quinidine, and cinchonine was found to have several interesting features; it had activity similar to that of quinine against quinine-susceptible strains but was found to be 2 to 10 times more effective against strains resistant to quinine and had a more consistent effect than any of the alkaloids used singly. The potentiation was found to depend mainly on the presence of cinchonine in the mixtures studied. Synergism was also confirmed in a study of 25 P. falciparum strains isolated from Thai patients. Combinations of cinchona bark alkaloids could thus be of interest in areas where P. falciparum is becoming less susceptible to quinine.
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Affiliation(s)
- P Druilhe
- Département de Médecine Tropicale, Hôpital de la Salpetrière, Paris, France
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64
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Affiliation(s)
- G C Cook
- Department of Clinical Tropical Medicine, Hospital for Tropical Diseases, London, UK
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65
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Affiliation(s)
- N J White
- Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand
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66
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27jährige Patientin mit Continua, Diarrhoe und plasmodiennegativer Hämolyse nach Afrikaaufenthalt. Internist (Berl) 1988. [DOI: 10.1007/978-3-662-39609-4_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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67
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Mihaly GW, Ching MS, Klejn MB, Paull J, Smallwood RA. Differences in the binding of quinine and quinidine to plasma proteins. Br J Clin Pharmacol 1987; 24:769-74. [PMID: 3440096 PMCID: PMC1386402 DOI: 10.1111/j.1365-2125.1987.tb03244.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
1. Little is known about the comparative plasma protein binding of the antimalarial agents quinine (QN) and its isomer quinidine (QD). We have examined the in vitro binding of QN and QD to albumin, alpha 1-acid glycoprotein, normal human plasma, and maternal and foetal umbilical cord plasma. 2. QN was more avidly bound than QD, and binding of both drugs was substantially higher to alpha 1-acid glycoprotein than to albumin, indicating that alpha 1-acid glycoprotein is the more important binding protein. 3. Protein and drug concentration dependent binding was evident for both QN and QD. The unbound fraction of both drugs fell with increasing albumin (10 to 60 g l-1) and alpha 1-acid glycoprotein (0.5 to 2.0 g l-1) concentration, and there was a marked increase in unbound fraction of QN (6 to 19%) and QD (13 to 36%) in human plasma when drug concentrations were increased over the antimalarial therapeutic range (0.5 to 10 mg l-1). 4. In human volunteer plasma, the unbound fractions of QN and QD were 7.5 +/- 2.2% and 12.3 +/- 2.3% respectively, whilst the unbound fractions for both drugs were significantly higher in maternal plasma (QN = 13.0 +/- 5.4%, QD = 18.3 +/- 2.5%) and significantly higher still in foetal umbilical cord plasma (QN = 25.7 +/- 10%, QD = 35 +/- 5.3%).
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Affiliation(s)
- G W Mihaly
- Department of Medicine, University of Melbourne, Austin Hospital, Victoria, Australia
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68
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Mihaly GW, Hyman KM, Smallwood RA, Hardy KJ. High-performance liquid chromatographic analysis of quinine and its diastereoisomer quinidine. JOURNAL OF CHROMATOGRAPHY 1987; 415:177-82. [PMID: 3584354 DOI: 10.1016/s0378-4347(00)83207-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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69
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Abstract
Because malaria remains a major worldwide public health problem, and resistance to currently available drugs is becoming more prevalent, interest has focused on the clinical pharmacology of antimalarials. Previously many of these drugs had been little studied, and it is now hoped that increasing information on the disposition of current drugs, and those under development may improve their rational use. This article therefore reviews the current information on the pharmacology of the commoner drugs, and describes possible future tools to combat malaria.
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Affiliation(s)
- P A Winstanley
- Department of Pharmacology and Therapeutics, University of Liverpool
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Phillips RE, Looareesuwan S, White NJ, Chanthavanich P, Karbwang J, Supanaranond W, Turner RC, Warrell DA. Hypoglycaemia and antimalarial drugs: quinidine and release of insulin. BRITISH MEDICAL JOURNAL 1986; 292:1319-21. [PMID: 3085830 PMCID: PMC1340320 DOI: 10.1136/bmj.292.6531.1319] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Life threatening hypoglycaemia has been closely associated with the use of quinine, but the effect of quinidine and the synthetic antimalarials on the homoeostasis of glucose has not been investigated. In volunteers given a fixed dose of 500 mg base and patients with malaria given a quinidine loading dose (15 mg base/kg) mean (SEM) plasma insulin concentrations rose from 6.1 (1.5) mU/l to 10.9 (4.4) mU/l (p less than 0.02) and 10.4 (2.0) mU/l to 18.5 (5.3) mU/l (p less than 0.04), respectively. Plasma glucose concentrations fell from 4.5 (1.1) mmol/l (81 (20) mg/100 ml) to 4.0 (0.3) mmol/l (72 (5) mg/100 ml) in volunteers (p less than 0.04) and from 5.7 (1.3) mmol/l (102 (23) mg/100 ml) to 4.8 (1.6) mmol/l (86 (29) mg/100 ml) in patients (p less than 0.05). One of two patients with cerebral malaria and acute renal failure became profoundly hypoglycaemic (plasma glucose concentration 1.4 mmol/l (25 mg/100 ml), plasma insulin concentration 3.1 mU/l). Hypoglycaemia may occur in any severely ill fasting patient given parenteral quinidine. The other antimalarials tested, chloroquine, amodiaquine, mefloquine, and halofantrine, did not stimulate the release of insulin, an important advantage that should be taken into account when treatment is chosen for Plasmodium falciparum malaria.
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72
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Trowell H. Prevalence of known diabetes in Asians and Europeans. West J Med 1985. [DOI: 10.1136/bmj.291.6508.1572-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Warrell DA, White NJ, Looareesuwan S, Phillips RE, Warrell MJ, Bunnag D, Harinasuta KT. The treatment of severe falciparum malaria. BMJ : BRITISH MEDICAL JOURNAL 1985; 291:1573-4. [PMID: 3933753 PMCID: PMC1418194 DOI: 10.1136/bmj.291.6508.1573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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75
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Hall A. The treatment of severe falciparum malaria. West J Med 1985. [DOI: 10.1136/bmj.291.6508.1573-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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