Læknablaðið - 15.10.2002, Blaðsíða 18
FRÆÐIGREINAR / ALVARLEGAR AUKAVERKANIR KÍNÍNS
Höfundar þessarar greinar tilkynntu Lyfjastofnun
formlega um tilfellin í janúar á þessu ári og í kjölfarið
var tekin ákvörðun um að afturkalla heimild til
lausasölu kíníns. Þetia verður að teljast skynsamleg
ráðstöfun í ljósi þeirra alvarlegu aukaverkana sem
lyfið getur valdið.
Þótt ekki sé lengur völ á kíníni í lausasölu er lík-
legt að notkun lyfsins verði áfram umtalsverð og er
nauðsynlegt að læknar sem ávísa lyfinu til að fyrir-
byggja vöðvakrampa í ganglimum ígrundi vel ávinn-
ing og áhættu og séu á verði gegn aukaverkunum
þess. Sú takmörkun á aðgengi sem felst í stöðvun á
lausasölu kíníns hefur þó ekki áhrif á útsetningu fólks
fyrir kíníni í neysludrykkjum. Loks er mikilvægt að
vara almenning við aukaverkunum kíníns og íhuga
ætti prentun upplýsinga um þær á umbúðir Iyfsins og
á ílát drykkja sem innihalda þetta efni.
Þakkir
Höfundar þakka Ingu Skaftadóttur líffræðingi, Ónæm-
isfræðideild Landspítala, fyrir greiningu kínínháðra
mótefna í sermi.
Heimildir
1. Moss HK, Herrmann LG. The use of quinine for relief of night
cramps in the extremities. JAMA 1940; 115:1358-9.
2. McGee SR. Muscle cramps. Arch Intern Med 1990; 150:511-8.
3. Goldfrank LR, Osborn H. Quinine. In: Goldfrank LR,
Flomenbaum NE, Lewin NA, Weisman RS, Howland RS,
editors. Goldfrank's Toxicologic Emergencies. Sixth ed. East
Norwalk, CT: Appleton & Lange, 1998: 337-40.
4. Belkin G. Cocktail purpura. An unusual case of quinine sensi-
tivity. Ann Intern Med 1967; 66: 583-6.
5. Spearing RL, Hickton CM, Sizeland P, Hannah A, Bailey RR.
Quinine-induced disseminated intravascular coagulation.
Lancet 1990; 336:1535-7.
6. Gottschall JL, Elliot W, Lianos E, McFarland JG, Wolfmeyer
K, Aster RH. Quinine-induced immune thrombocytopenia
associated with hemolytic-uremic syndrome: a new clinical
entity. Blood 1991;77:306-10.
7. Maguire RB, Stroncek DF, Campbell AC. Recurrent pancyto-
penia, coagulopathy, and renal failure associated with multiple
quinine-dependent antibodies. Ann Intem Med 1993; 119:
215-7.
8. Stroncek DF, Vercellotti GM, Hammerschmidt DE, Christie
DJ, Shankar RA, Jacob HS. Characterization of multiple
quinine-dependent antibodies in a patient with episodic hemo-
lytic uremic syndrome and immune agranulocytosis. Blood
1992; 80:241-8.
9. Vipan WH. Quinine as a cause of purpura. Lancet 1865; ii: 37.
10. Shrager J, Kean BH. Purpura as a complication of malaria. Am
J Med Sci 1946; 212:54-9.
11. Bolton FG, Young R. Observations on cases of thrombocyto-
penic purpura due to quinine, sulphamezathine and quinidine.
J Clin Path 1953; 6:320-3.
12. Chong BH, Du X, Berndt MC, Horn S, Chesterman CN.
Characterization of the binding domains on platelet glycopro-
teins Ib-IX and Ilb-IIIa complexes for the quinine/quinidine-
dependent antibodies. Blood 1991; 77: 2190-9.
13. Gottschall JL, Neahring B, McFarland JG, Wu GG, Weite-
kamp LA, Aster RH. Quinine-induced immune thrombocyto-
penia with hemolytic-uremic syndrome: clinical and sero-
Iogical findings in nine patients and review of literature. Am J
Hematol 1994; 47: 283-9.
14. Salama A, Mueller-Eckhardt C. Immune-mediated blood cell
dyscrasias related to drugs. Semin Hematol 1992; 29: 54-63.
15. Remuzzi G, Ruggenenti P. The hemolytic uremic syndrome.
Kidney Int 1995; 48: 2-19.
16. Karmali MA, Steele BT, Petric M, Lim C. Sporadic cases of
haemolytic-uraemic syndrome associated with faecal cyto-
toxin and cytotoxin-producing Escherichia coli in stools.
Lancet 1983; 1: 619-20.
17. Elliot HL, Trash DB. Intravascular coagulation induced by
quinine: Unexpected hazard of „bitter lemon“. Scott Med J
1979; 24: 244-5.
18. Barr E, Douglas JF, Hill CM. Recurrent acute hypersensitivity
to quinine. BMJ 1990; 301:323.
19. McDonald SP, Shanahan EM, Thomas AC, Roxby DJ, Berou-
kas D, Barbara JAJ. Quinine-induced hemolytic uremic synd-
rome. Clin Nephrol 1997; 47: 397-400.
20. Glynne P, Salama A, Chaudhry A, Swirsky D, Lightstone L.
Quinine-induced immune thrombocytopenic purpura followed
by hemolytic uremic syndrome. Am J Kidney Dis 1999; 33:
133-7.
21. Crum NF, Gable P. Quinine-induced hemolytic-uremic synd-
rome. South Med J 2000; 93: 726-8.
22. Kojouri K, Vesely SK, George JN. Quinine-associated throm-
botic thrombocytopenic purpura-hemolytic uremic syndrome:
frequency, clinical features, and long-term outcomes. Ann
Intern Med 2001; 135:1047-51.
23. Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly:
prevalence, drug and disease associations. Int J Clin Pract
1999; 53: 494-6.
24. Moake JL. Haemolytic-uraemic syndrome: basic science.
Lancet 1994; 343: 393-7.
25. Galbusera M, Remuzzi A, Benigni A, Rossi C, Remuzzi G. A
novel interpretation of the role of von Willebrand factor in
thrombotic microangiopathies based on platelet adhesion studies
at high shear rate flow. Am J Kidney Dis 2000; 36: 695-702.
26. Kedia RK, Wright AJ. Quinine-mediated disseminated intra-
vascular coagulation. Postgrad Med J 1999; 75: 429-30.
27. Morton AP. Quinine-induced disseminated intravascular
coagulation and haemolytic-uraemic syndrome. Med J Aust
2002; 176:351.
28. Worden AN, Frape DL, Shephard NW. Consumption of
quinine hydrochloride in tonic water. Lancet 1987; 1: 271-2.
29. Man-Son-Hing M, Wells G. Meta-analysis of efficacy of
quinine for treatment of nocturnal leg cramps in elderly
people. BMJ 1995; 310:13-7.
30. Man-Son-Hing M, Wells G, Lau A. Quinine for nocturnal leg
cramps: a meta-analysis including unpublished data. J Gen
Intern Med 1998; 13: 600-6.
31. Jansen PHP, Veenhuizen KCW, Wesseling AIM, de Boo Th,
Verbeek ALM. Randomised controlled trial of hydroquinine
in muscle cramps. Lancet 1997; 349: 528-32.
32. Diener HC, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P.
Effectiveness of quinine in treating muscle cramps: a double-
blind, placebo-controlled, parallel-group, multicentre trial. Int
J Clin Pract 2002; 56: 243-6.
33. US Department of Health and Human Services. Drug
products for the treatment and/or prevention of noctumal leg
muscle cramps for over-the-counter human use. Federal
Register 1994; 59:43234-52.
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