Editing Quinine (section)

==Adverse effects==
Quinine can cause unpredictable serious and life-threatening blood and cardiovascular reactions including [[thrombocytopenia|low platelet count]] and [[hemolytic–uremic syndrome]]/[[thrombotic thrombocytopenic purpura]] (HUS/TTP), [[long QT syndrome]] and other serious cardiac arrhythmias including ''[[torsades de pointes]]'', [[blackwater fever]], [[disseminated intravascular coagulation]], [[leukopenia]], and [[neutropenia]].<ref name=AHFS2020/> Some people who have developed TTP due to quinine have gone on to develop [[kidney failure]].<ref name=AHFS2020/><ref name=USlabel2013/> It can also cause serious hypersensitivity reactions including anaphylactic shock, [[urticaria]], serious skin rashes, including [[Stevens–Johnson syndrome]] and [[toxic epidermal necrolysis]], [[angioedema]], facial edema, [[bronchospasm]], [[Idiopathic granulomatous hepatitis|granulomatous hepatitis]], and itchiness.<ref name=AHFS2020/><ref name=USlabel2013/>

The most common adverse effects involve a group of symptoms called [[cinchonism]], which can include headache, vasodilation and sweating, nausea, [[tinnitus]], hearing impairment, [[vertigo]] or dizziness, blurred vision, and disturbance in color perception.<ref name=AHFS2020/><ref name=liles/><ref name=USlabel2013/> More severe cinchonism includes vomiting, diarrhea, abdominal pain, deafness, blindness, and disturbances in heart rhythms.<ref name=USlabel2013/> Cinchonism is much less common when quinine is given by mouth, but oral quinine is not well tolerated (quinine is exceedingly bitter and many people will vomit after ingesting quinine tablets).<ref name=AHFS2020/> Other drugs, such as Fansidar ([[sulfadoxine]] with [[pyrimethamine]]) or Malarone ([[proguanil]] with [[atovaquone]]), are often used when oral therapy is required. Quinine ethyl carbonate is tasteless and odourless,<ref>{{cite journal |vauthors = Jamaludin A, Mohamad M, Navaratnam V, Selliah K, Tan SC, Wernsdorfer WH, Yuen KH |title = Relative bioavailability of the hydrochloride, sulphate and ethyl carbonate salts of quinine |journal = British Journal of Clinical Pharmacology |volume = 25 |issue = 2 |pages = 261–263 |date = February 1988 |pmid = 3358888 |pmc = 1386482 |doi = 10.1111/j.1365-2125.1988.tb03299.x }}</ref> but is available commercially only in Japan. Blood glucose, electrolyte and cardiac monitoring are not necessary when quinine is given by mouth.

Quinine has diverse [[Drug interaction|unwanted interactions]] with numerous [[prescription drug]]s, such as potentiating the [[anticoagulant]] effects of [[warfarin]].<ref name=AHFS2020/> It is a strong inhibitor of [[CYP2D6]],<ref name="PMID27618912">{{cite journal | vauthors = Fasinu PS, Tekwani BL, Avula B, Chaurasiya ND, Nanayakkara NP, Wang YH, Khan IA, Walker LA | title = Pathway-specific inhibition of primaquine metabolism by chloroquine/quinine | journal = Malaria Journal | volume = 15 | issue = 1 | pages = 466 | date = September 2016 | pmid = 27618912 | pmc = 5020452 | doi = 10.1186/s12936-016-1509-x | doi-access = free }}</ref> an enzyme involved in the metabolism of many drugs.