• Qualaquin™ capsules are not indicated for the treatment of severe P. falciparum malaria.

• The only approved treatment for severe P. falciparum malaria is intravenous quinidine. It should always be given by rate-controlled infusion, never by bolus ("push") intravenous injection.¹

Severe P. falciparum malaria²

A patient with severe P. falciparum malaria may present with confusion or drowsiness with extreme weakness (prostration). Additional symptoms may develop:

• Cerebral malaria, defined as unrousable coma not attributable to any other cause in a patient with P. falciparum malaria
• Generalized convulsions
• Severe normocytic anemia
• Hypoglycemia
• Metabolic acidosis with respiratory distress
• Fluid and electrolyte disturbances
• Acute renal failure
• Acute pulmonary edema and adult respiratory distress syndrome (ARDS)
• Circulatory collapse, shock, septicemia ("algid malaria")
• Abnormal bleeding
• Jaundice
• Hemoglobinuria
• High fever
• Hyperparasitemia.

These severe manifestations can occur singly or, more commonly, in combination in the same patient. Death is a possible outcome of severe malaria.

1 Notes on antimalarial drugs. Annex 1. Management of Severe Malaria. A practical handbook. Second edition. World Health Organization. Geneva. 2000. Available at: http://www.who.int/malaria/docs/hbsm_annexes.htm#a1. Accessed December 11, 2006.

2 Management of Severe Malaria. A practical handbook. Second edition. World Health Organization. Geneva. 2000. Available at: http://www.who.int/malaria/docs/hbsm_toc.htm#sfm. Accessed December 11, 2006.