Drug interactions
Itraconazole + Quinine
Severity: Major
Itraconazole and Quinine: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Itraconazole can increase quinine levels, and both drugs prolong the QTc interval. Together this raises the risk of QT prolongation, torsades de pointes and cinchonism.
What this interaction means in plain words
Itraconazole and Quinine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Itraconazole belongs to Anti Fungals; Quinine belongs to Anti Parasitic.
Why it happens
CYP3A4 and P-glycoprotein inhibition by itraconazole reduces quinine clearance, plus additive QT prolongation.
What to do
Avoid the combination where possible; if used, monitor ECG and electrolytes and watch for cinchonism, and consider a quinine dose reduction.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
Other interactions of Quinine
- Arsenic trioxide + Quinine Contraindicated
- Dofetilide + Quinine Contraindicated
- Dronedarone + Quinine Contraindicated
- Ibutilide + Quinine Contraindicated
- Mefloquine + Quinine Contraindicated
- Nilotinib + Quinine Contraindicated
Frequently asked questions
Can I take Itraconazole with Quinine?
MediHelp rates the interaction as major. Itraconazole and Quinine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Itraconazole can increase quinine levels, and both drugs prolong the QTc interval. Together this raises the risk of QT prolongation, torsades de pointes and cinchonism.
How serious is the interaction between Itraconazole and Quinine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible; if used, monitor ECG and electrolytes and watch for cinchonism, and consider a quinine dose reduction.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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