Various side-effects of quinine use exist, but cinchonism includes nausea, vomiting and tinnitus as constitutive features [7]. Flushing, marked visual and auditory abnormalities, as well as abdominal pain and hypersensitivity reactions (ranging from urticaria to bronchospasm and anaphylactic shock) may be encountered [4].

• Malaise

  His systems were intermittent fevers, chills, and tremors for approximately 12 days; general malaise that would begin with a bitter taste in his mouth that wouldn't go away. [alcademics.com]

  A 60-year-old man developed malaise, weakness, chills, and oral ulcerations within three days of beginning quinidine and digoxin for atrial fibrillation. [drugs.com]

  Patients may report cough, fever, hemoptysis, malaise, dyspnea, weight loss, and occasionally pleuritis. [emedicine.medscape.com]

• Gastric Lavage

  Quinine is quickly absorbed, so any attempts to take out quinine in the stomach through gastric lavage might not be effectual. Multiple-dose of activated charcoal has shown to reduce concentrations of plasma quinine. [signssymptoms.org]

  Induce emesis and gastric lavage as soon as possible. Metabolism of drug: Rapidly absorbed after oral administration with peak plasma concentrations within 1-3 hours. Metabolized by liver and excreted in the urine. [cdc.gov]

• Cough

  Patients may report cough, fever, hemoptysis, malaise, dyspnea, weight loss, and occasionally pleuritis. [emedicine.medscape.com]

• Nausea

  They also experienced the classic symptoms of cinchonism, including nausea, vomiting, and tinnitus. Prolongation of the Q-T interval developed in both patients. Serum quinine levels of 5.3 mg/L and 13 mg/L were measured. [ncbi.nlm.nih.gov]

  […] cinchonism [sin´ko-nizm] toxicity due to overdosage of cinchona alkaloids; symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea. Called also quininism. [medical-dictionary.thefreedictionary.com]

  Various side-effects of quinine use exist, but cinchonism includes nausea, vomiting and tinnitus as constitutive features. [symptoma.com]

  Patients may also report nausea and vomiting. Flecainide Flecainide has generally nonfatal extracardiac effects that are promarily CNS in nature. These include visual blurriness, nausea, dizziness, confusion, and headache. [emedicine.medscape.com]

• Vomiting

  They also experienced the classic symptoms of cinchonism, including nausea, vomiting, and tinnitus. Prolongation of the Q-T interval developed in both patients. Serum quinine levels of 5.3 mg/L and 13 mg/L were measured. [ncbi.nlm.nih.gov]

  Various side-effects of quinine use exist, but cinchonism includes nausea, vomiting and tinnitus as constitutive features. [symptoma.com]

  EMAIL PRINT SAVE EMAIL SAVE Cinchonism occurs from quinidine or quinine use (a class I antiarrhythmic drug) and consists of tinnitus, blurred vision, dizziness, nausea and vomiting. Quinidine is also used to treat malaria. [healio.com]

  Cinchonism, or quinine toxicity, includes nausea, vomiting, and tinnitus. Many other side effects have been reported in the literature. A case report demonstrating the side effects of quinine is presented. [jhu.pure.elsevier.com]

• Abdominal Pain

  pain, and visual disturbance. [britannica.com]

  Symptoms of mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, [academickids.com]

  More severe manifestations include diarrhea, vomiting, deafness, abdominal pain, blindness & cardiac rhythm disturbances. Most symptoms can be reversed & resolved through discontinuing the use of quinine. [signssymptoms.org]

• Diarrhea

  That gave me constant diarrhea for about 5-6 days, then recurring when I had to take it again. [patientsville.com]

  Includes tinnitus, headache, nausea, diarrhea, altered auditory acuity, and blurred vision. The term derives from cinchona bark, the natural source of quinine. [definedterm.com]

  […] maxtoshow= ), vertigo, dizziness, dysphoria (feeling uneasy), nausea and vomiting, and diarrhea. [academickids.com]

  […] flushed and sweaty skin, tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, lichenoid photosensitivity, vertigo, dizziness, dysphoria (feeling uneasy), nausea and vomiting, and diarrhea [the-medical-dictionary.com]

  Cinchonism, a syndrome characterized by GI symptoms (abdominal cramping, nausea, vomiting, and diarrhea), tinnitus, and altered mental status may occur in both chronic and acute toxicity. [emedicine.medscape.com]

• Hypotension

  Patients treated with quinine may also suffer from hypoglycemia (especially if administered intravenously ) and hypotension (low blood pressure ). [academickids.com]

  Patients treated with quinine may also suffer from hypoglycemia (especially if administered intravenously) and hypotension (low blood pressure). [the-medical-dictionary.com]

  Procainamide's ganglion-blocking properties may lead to periperal vasodilation and systemic hypotension. [emedicine.medscape.com]

• Tinnitus

  All rights reserved. cin·cho·nism (sin'kō-nizm), Poisoning by cinchona, quinine, or quinidine; characterized by tinnitus, headache, deafness, and occasionally, anaphylactoid shock. [medical-dictionary.thefreedictionary.com]

  Various side-effects of quinine use exist, but cinchonism includes nausea, vomiting and tinnitus as constitutive features. [symptoma.com]

  He is complaining of dizziness, #headaches and tinnitus. Which of the following drugs are MOST likely responsible? - A. Propranolol B. Procainamide C. [galleryofsocial.com]

• Hearing Impairment

  Symptoms & Signs Mild cinchonism symptoms include vasodilation, headache, sweating, tinnitus, nausea, dizziness, hearing impairment, color perception disturbance & blurred vision. [signssymptoms.org]

  The most common symptoms occurring from an antimalarial drug dosage or long-term exposure to quinine includes repeated headaches and nausea; tinnitus, which produces a sensation like ringing in the ears; or more serious hearing impairment including deafness [wisegeek.com]

  Cinchonism (a symptom complex characterized by tinnitus, hearing impairment, postural hypotension, and vertigo or dizziness) occurs in a high proportion of treated patients. [cdc.gov]

• Blurred Vision

  Includes tinnitus, headache, nausea, diarrhea, altered auditory acuity, and blurred vision. The term derives from cinchona bark, the natural source of quinine. [definedterm.com]

  EMAIL PRINT SAVE EMAIL SAVE Cinchonism occurs from quinidine or quinine use (a class I antiarrhythmic drug) and consists of tinnitus, blurred vision, dizziness, nausea and vomiting. Quinidine is also used to treat malaria. [healio.com]

  Symptoms of mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, [academickids.com]

  Symptoms & Signs Mild cinchonism symptoms include vasodilation, headache, sweating, tinnitus, nausea, dizziness, hearing impairment, color perception disturbance & blurred vision. [signssymptoms.org]

• Photophobia

  […] cinchonism [sin´ko-nizm] toxicity due to overdosage of cinchona alkaloids; symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea. Called also quininism. [medical-dictionary.thefreedictionary.com]

  Found on http://www.encyclo.co.uk/local/20973 cinchonism (sin´ko-niz″әm) toxicity due to overdosage of cinchona alkaloids; symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache [encyclo.co.uk]

  More rare cases of adverse effects from cinchonism include anaphylactoid shock; photophobia, or sensitivity to light; and mental conditions like dullness and confusion. Two other possible exposure methods can result in cinchonism symptoms. [wisegeek.com]

  Blurred vision, diplopia, and photophobia may be part of the dose-related cinchonism syndrome. [drugs.com]

  Visual disturbances may include blurred vision, distorted color perception, photophobia, diplopia and night blindness. Other effects include cutaneous flushing, pruritis, rashes, fever, dyspnea. [cdc.gov]

• Diplopia

  Visual disturbances may include blurred vision, distorted color perception, photophobia, diplopia and night blindness. Other effects include cutaneous flushing, pruritis, rashes, fever, dyspnea. [cdc.gov]

  Blurred vision, diplopia, and photophobia may be part of the dose-related cinchonism syndrome. [drugs.com]

• Visual Impairment

  Attempted suicide by intake of a large dose of quinine has caused irreversible tunnel vision and very severe visual impairment.[2] Patients treated with quinine may also suffer from low blood sugar, especially if it is administered intravenously, and [en.wikipedia.org]

  impairment.[13] Magnesium plays a central role in metabolism and muscle function by participating in many of the biochemical reactions that take place in the body, particularly in those processes involving the formation and use of adenosin triphosphate [the-medical-dictionary.com]

• Night Blindness

  Visual disturbances may include blurred vision, distorted color perception, photophobia, diplopia and night blindness. Other effects include cutaneous flushing, pruritis, rashes, fever, dyspnea. [cdc.gov]

  Granulomatous hepatitis has been reported. [ Ref ] Ocular Ocular side effects have included mydriasis, color perception changes, night blindness, scotomata, optic neuritis, and visual field loss. [drugs.com]

• Photosensitivity

  […] maxtoshow= ) - letter printed in the British Medical Journal ( http://www.bmj.com ) with a photograph of hands affected by lichenoid photosensitivity Effects of Quinine on the Excitability and Voltage-Dependent Currents of Isolated Spiral Ganglion Neurons [academickids.com]

  External links IPCS INTOX databank entry for quinine Side effect of quinine for nocturnal cramps - letter printed in the British Medical Journal with a photograph of hands affected by lichenoid photosensitivity Effects of Quinine on the Excitability and [wikidoc.org]

  Retired consultant dermatologist Portadown, Craigavon, County Armagh BT63 5SF EDITOR,—Malcolm Man-Son-Hing and George Wells report a meta-analysis of the use of quinine for nocturnal night cramps in elderly people. 1 I wish to draw attention to lichenoid photosensitivity [doi.org]

  […] mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, lichenoid photosensitivity [the-medical-dictionary.com]

• Flushing

  This is a condition associated with a number of symptoms, including flushed/sweaty skin, tinnitus, confusion, headaches, and more. Mild cinchonism should not be a reason to cease treatment with quinine, however. [malaria.com]

  Symptoms of mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, [academickids.com]

  Signs and symptoms Symptoms of mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, ringing of the ears ( tinnitus ), blurred vision, impaired hearing, confusion, reversible high-frequency hearing [ipfs.io]

• Skin Rash

  Large doses of quinine may lead to severe symptoms of cinchonism: skin rashes, deafness, somnolence, diminished visual acuity or blindness, anaphylactic shock, and disturbances in cardiac rhythm or conduction, death from cardiotoxicity. [academickids.com]

  Large doses of quinine may lead to severe symptoms of cinchonism : skin rashes, deafness (reversible), somnolence, diminished visual acuity or blindness, anaphylactic shock, and disturbances in cardiac rhythm or conduction, death from cardiotoxicity. [diki.pl]

  Large doses of quinine may lead to severe symptoms of cinchonism: skin rashes, deafness (reversible), somnolence, diminished visual acuity or blindness, anaphylactic shock, and disturbances in cardiac rhythm or conduction, death from cardiotoxicity. [ipfs.io]

• Eruptions

  Manzi S, Kraus VB, St Clair EW "An unusual photoactivated skin eruption: quinidine-induced livedo reticularis." Arch Dermatol 125 (1989): 417-8 61. [drugs.com]

• Headache

  […] cinchonism * * * cin·cho·nism 'siŋ-kə-.niz-əm, 'sin-chə- n a disorder due to excessive or prolonged use of cinchona or its alkaloids and marked by temporary deafness, ringing in the ears, headache, dizziness, and rash * * * n. poisoning caused by an overdose [medicine.academic.ru]

  Pathol. poisoning by any of the cinchona alkaloids, characterized by headache, deafness, and ringing in the ears. [1855 60; CINCHON(A) + ISM] * * * … Universalium cinchonism — Poisoning by cinchona, quinine, or quinidine; characterized by tinnitus, headache [translate.academic.ru]

  A pathological condition resulting from an overdose of cinchona bark or its alkaloid derivatives and marked by headache, dizziness, hearing loss, and ringing in the ears. [medical-dictionary.thefreedictionary.com]

• Dizziness

  The symptoms are commonly ringing noises in the ears, dizziness, blurring of vision ( and sometimes complete blindness), rashes, fever, and low blood pressure. [medicine.academic.ru]

  The symptoms are commonly ringing noises in the ears, dizziness, blurring of vision (and sometimes complete blindness), rashes,… … The new mediacal dictionary cinchonism — /ˈsɪŋkənɪzəm/ (say singkuhnizuhm) noun poisoning from cinchona or its alkaloids [translate.academic.ru]

  A pathological condition resulting from an overdose of cinchona bark or its alkaloid derivatives and marked by headache, dizziness, hearing loss, and ringing in the ears. [yourdictionary.com]

  He is complaining of dizziness, #headaches and tinnitus. Which of the following drugs are MOST likely responsible? - A. Propranolol B. Procainamide C. [galleryofsocial.com]

• Vertigo

  * * * cin·cho·nism (sinґko-niz″ ə m) poisoning by the injudicious use of cinchona bark or its alkaloids, characterized by nausea, vomiting, headache, tinnitus, deafness, symptoms of cerebral congestion, vertigo, and visual disturbances. [medicine.academic.ru]

  A condition produced by the excessive or long-continued use of quinine, and marked by deafness, roaring in the ears, vertigo, etc. [encyclo.co.uk]

  A condition produced by the excessive or long continued use of quinine, and marked by deafness, roaring in the ears, vertigo, etc. [1913 Webster] … The Collaborative International Dictionary of English cinchonism — [sin′kə niz΄əm, siŋ′kə niz΄əm] n. a [translate.academic.ru]

  A condition produced by the excessive or long-continued use of quinine, and marked by deafness, roaring in the ears, vertigo, etc. from Wiktionary, Creative Commons Attribution/Share-Alike License. noun A pathological condition in humans caused by an [wordnik.com]

  Webster Dictionary(4.00 / 1 vote)Rate this definition: Cinchonismnoun a condition produced by the excessive or long-continued use of quinine, and marked by deafness, roaring in the ears, vertigo, etc Etymology: [From Cinchona.] [definitions.net]

• Confusion

  […] cinchonism [sin´ko-nizm] toxicity due to overdosage of cinchona alkaloids; symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea. Called also quininism. [medical-dictionary.thefreedictionary.com]

  This is a condition associated with a number of symptoms, including flushed/sweaty skin, tinnitus, confusion, headaches, and more. Mild cinchonism should not be a reason to cease treatment with quinine, however. [malaria.com]

  Not to be confused with Quinism. Cinchonism Other names Quinine toxicity Specialty Emergency medicine Cinchonism is a pathological condition caused by an overdose of quinine or its natural source, cinchona bark. [en.wikipedia.org]

  House Unabridged Dictionary, Copyright © 1997, by Random House, Inc., on Infoplease. cinchonine Cincinnati ✖ Related Content Daily Word Quiz: bivouac Analogy of the Day: Today’s Analogy Frequently Misspelled Words Frequently Mispronounced Words Easily Confused [infoplease.com]

  Symptoms of mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, tinnitus, blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, [academickids.com]

• Excitement

  […] maxtoshow= ) - letter printed in the British Medical Journal ( http://www.bmj.com ) with a photograph of hands affected by lichenoid photosensitivity Effects of Quinine on the Excitability and Voltage-Dependent Currents of Isolated Spiral Ganglion Neurons [academickids.com]

  External links Effects of Quinine on the Excitability and Voltage-Dependent Currents of Isolated Spiral Ganglion Neurons in Culture [ipfs.io]

  External links IPCS INTOX databank entry for quinine Side effect of quinine for nocturnal cramps - letter printed in the British Medical Journal with a photograph of hands affected by lichenoid photosensitivity Effects of Quinine on the Excitability and [wikidoc.org]

  "Effects of Quinine on the Excitability and Voltage-Dependent Currents of Isolated Spiral Ganglion Neurons in Culture". Journal of Neurophysiology. 79 (5): 2503–12. doi:10.1152/jn.1998.79.5.2503. PMID 9582223. [en.wikipedia.org]

If patient history reveals history of quinine use, the diagnosis should be made immediately, whereas electrocardiography (ECG) and determination or renal function through measurement of blood urea nitrogen (BUN) and creatinine is recommended to assess the state of the cardiovascular system.

• Hypoglycemia

  Patients treated with quinine may also suffer from hypoglycemia (especially if administered intravenously ) and hypotension (low blood pressure ). [academickids.com]

  Patients treated with quinine may also suffer from hypoglycemia (especially if administered intravenously) and hypotension (low blood pressure). [the-medical-dictionary.com]

• Plasmodium Falciparum

  Kasthuri The Journal of the Association of Physicians of… 1994 Twelve cases of cerebral malaria due to plasmodium falciparum, treated with loading dose of quinine (20 mg/kg salt in 500 ml of 5… (More) [semanticscholar.org]

  This drug (and its stereoisomer quinidine) is very efficient against Plasmodium vivax and ovale species, but not Plasmodium falciparum and it is one of the main drugs against babesiosis. [symptoma.com]

  The Jesuits were the first to bing cinchona to Europe using it to treat malaria in Rome, this was in fact the first effective treatment against Plasmodium falciparum and the drug of choice until the 1940s when other drugs such as chloroquine emerged. [lifeinthefastlane.com]

  However, the US FDA issued a warning [ link ] against this use: "Quinine is FDA-approved for the treatment of uncomplicated Plasmodium falciparum malaria. [cocktailsafe.org]

  Bhavnani SM, Preston SL "Monitoring of intravenous quinidine infusion in the treatment of plasmodium falciparum malaria." Ann Pharmacother 29 (1995): 33-5 11. [drugs.com]

Treatment of cinchonism is mainly in the form of dose reduction or cessation of quinine use, but patients in whom other manifestations of quinine toxicity (for ex. severe central nervous system and renal impairment) can be severe or even life-threatening [4], hemodialysis may be option, with a goal of prompt removing of the drug from circulation [5].

Depending on the dose ingested and severity of symptoms, the prognosis may range from self-limiting complaints to life-threatening organ failure [5]. For this reason, a prompt diagnosis is vital to ensure a quick recovery and to prevent further complications.

Cinchonism is an entity describing an adverse reaction to quinine, which is derived from the bark of the cinchona tree in South America, hence the term cinchonism [2].

The exact rates of cinchonism remain unknown. A significant risk factor for this condition, however, is seen in patients with long QT syndrome, renal disease, myasthenia gravis, optic neuritis and G6PD, suggesting that this drug should be contraindicated in these patients [6].

The exact mechanism of action of quinine is yet to be determined and which mechanisms lead to the development of cinchonism remains unknown [7].

Proper patient monitoring and dose tapering can significantly reduce the risk of cinchonism [8].

Cinchonism is a clinical syndrome associated with ingestion of quinine, an antiprotozoal drug that exerts various effects in the body [1]. Quinine is derived from the bark of the cinchona tree that grows in the Andes, South America and its synthetic production started during the 20th century to combat malarial disease [2]. Although the mechanism of action of quinine still remains incompletely understood, analgesic, antipyretic and antiinflammatory properties have been described [3]. This drug (and its stereoisomer quinidine) is very efficient against Plasmodium vivax and ovale species, but not Plasmodium falciparum and it is one of the main drugs against babesiosis [4]. Unfortunately, various side-effects have been observed at regular dosages, one of them being cinchonism, which is characterized by tinnitus, headaches, both auditory and visual deficits and anaphylactic shock in rare cases [5]. The diagnosis is relatively easy to make, whereas treatment may include discontinuation of the drug, dose tapering or hemodialysis [5]. To reduce the risk of cinchonism, quinine should be avoided in patients suffering from cardiac (most importantly long QT syndrome) or renal disease, myasthenia gravis, optic neuritis or glucose-6-phosphate deficiency (G6PD) [1] [6], as a more severe reaction to the drug is observed under such circumstances.

Cinchonism is a medical term that is used to describe the appearance of specific symptoms as a result of quinine toxicity. Quinine is a drug derived from the bark of the cinchona tree that grows in the Andes in South America (hence the term cinchonism) and it is primarily used as an antiparasitic agent in treatment of malaria and babesiosis. Its exact mechanism of action remains unknown, but it can cause various adverse affects. Visual and auditory disturbances, tinnitus, headaches, nausea and vomiting are main features of cinchonism, whereas patients with a severe reaction to the drug can develop anaphylaxis (a profound, life-threatening allergic reaction to the drug). The diagnosis should be made as soon as the use of quinine is discovered during patient history taking and discontinuation of the drug (or dose reduction) is sufficient in the majority of cases. To reduce the risk of cinchonism, quinine should never be administered to patients suffering from renal disease, cardiac abnormalities such as long QT syndrome, myasthenia gravis, optic neuritis or glucose-6-phosphate deficiency (G6PD).

1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
2. Howard MA, Hibbard AB, Terrell DR, Medina PJ, Vesely SK, George JN. Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities. Proc (Bayl Univ Med Cent). 2003;16(1):21-26.
3. Bateman DN, Dyson EH. Quinine toxicity. Adverse Drug React Acute Poisoning Rev. 1986;5(4):215-233.
4. Katzung, BG, Masters SB, Trevor AJ. Basic & Clinical pharmacology. New York, NY: McGraw-Hill; 2012.
5. Goldenberg AM, Wexler LF. Quinine overdose: review of toxicity and treatment. Clin Cardiol. 1988;11(10):716-718.
6. Gilbert DN, Chambers HF, Eliopoulos GN, Saag MS. The Sanford Guide to Antimicrobial Therapy 2015. 45th ed. Antimicrobial Therapy, Inc, Sperryville, VA; 2015.
7. Barrocas AM, Cymet T. Cinchonism in a patient taking Quinine for leg cramps. Compr Ther. 2007;33(3):162-163.
8. Vieira JL, Midio AF. Drug monitoring of quinine in men with nonsevere falciparum malaria: study in the Amazon region of Brazil. Ther Drug Monit. 2001;23(6):612-615.