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Although tetracycline may be concomitantly administered with Qualaquin, patients should be monitored closely for adverse reactions associated with quinine sulfate. Qualaquin is also contraindicated in patients with known hypersensitivity to mefloquine or quinidine because cross-sensitivity to quinine has been documented (See PRECAUTIONS). If Qualaquin is used concomitantly with any of these statins, lower starting and maintenance doses of the statin should be considered. When a single oral 324 mg capsule of Qualaquin was administered to healthy volunteers (N=26) with a standardized high-fat breakfast, the mean Tmax of quinine was prolonged to about 4. Patients using Qualaquin for any other use should have their therapy discontinued. Therefore, concomitant administration of Qualaquin and theophylline or aminophylline is likely to decrease the plasma theophylline concentrations, possibly reducing the effect of theophylline or aminophylline. Qualaquin should be discontinued in case of any signs or symptoms of hypersensitivity (See CONTRAINDICATIONS). Therefore, concomitant administration of erythromycin with Qualaquin is likely to increase plasma quinine concentrations, and should be avoided (See WARNINGS). Although cimetidine may be used concomitantly with Qualaquin, patients should be monitored closely for adverse events associated with quinine. Therefore the concomitant administration of rifampin with Qualaquin should be avoided (See WARNINGS). Do not take quinine (Qualaquin) or quinidine (used to treat malaria or irregular heart beat) with Lariam. Computer assisted modeling and simulation indicates that in patients with malaria and severe chronic renal failure, a dosage regimen consisting of one loading dose of 648 mg Qualaquin followed 12 hours later by a maintenance dosing regimen of 324 mg every 12 hours will provide adequate systemic exposure to quinine (See DOSAGE AND ADMINISTRATION). Despite these pharmacokinetic changes, an alteration in the Qualaquin dosage regimen in elderly patients is not needed. Carbamazepine, phenobarbital, and phenytoin are CYP3A4 inducers and may decrease quinine plasma concentrations if used concurrently with Qualaquin. Patients taking medications that are CYP2D6 substrates with Qualaquin should be monitored closely for adverse reactions associated with these medications. Plasma theophylline concentrations should be monitored frequently during concurrent therapy with theophylline or aminophylline and Qualaquin. Concurrent use of Qualaquin and mefloquine may also increase the risk of seizures (See PRECAUTIONS/Drug Interactions). Although no change in the Qualaquin dosage regimen is necessary with concomitant ketoconazole, patients should be monitored closely for adverse reactions associated with quinine. Concomitant administration of these antacids with Qualaquin should be avoided. Adjustment of Qualaquin dosage is not necessary when isoniazid is given concomitantly. Therefore, concomitant administration of Qualaquin is likely to increase plasma halofantrine concentrations (See WARNINGS).

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