Quinine and Nevirapine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nevirapine
Quinine
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Decreased quinine efficacy
Interaction Deep Dive
Concomitant use of nevirapine, a CYP3A inducer1, and quinine, a CYP3A4 substrate 2, may lead to decreased quinine plasma concentrations and loss of efficacy. Increasing parasitemia was seen 24 hours after the initiation of quinine 600 mg every 8 hours for malaria treatment in a 52-year-old HIV-positive patient receiving nevirapine-containing antiretroviral therapy; parasitemia resolved within 48 hours once quinine was switched to proguanil/atovaquone 3.
Why it happens (mechanism)
Induction of CYP3A4-mediated quinine metabolism
Literature reports
1 report — tap to read
a) A 52-year-old HIV-positive Nigerian man taking abacavir, lamivudine, nevirapine, and amlodipine developed increasing parasitemia 24 hours after the initiation of quinine for malaria treatment. The patient, who had an undetectable viral load and a CD4 count of 388 x 10(6) cells/L, had a malarial film showing 1% Plasmodium falciparum parasitemia after returning from a trip to Nigeria and was initiated on quinine 600 mg every 8 hours. After 24 hours, although clinical improvement was seen, a repeat malarial film showed 2.5% parasitemia. Quinine was switched to proguanil/atovaquone 4 tablets daily for 3 days. Another repeat malarial film 24 hours after switching therapy showed less than 1% parasitemia, and no parasites were seen 48 hours after the switch 3.
Common questions
Can I take Quinine and Nevirapine together?
Decreased quinine efficacy Always confirm with your pharmacist or prescriber before making any change.
How serious is the Quinine and Nevirapine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Quinine or Nevirapine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: Viramune(R) XR(TM) oral extended-release tablets, nevirapine oral extended-release tablets. Boehringer Ingelheim Pharmaceuticals, Inc (per FDA), Ridgefield, CT, 2011. DailyMed
- Product Information: QUALAQUIN(R) oral capsules, quinine sulfate oral capsules. AR Scientific, Inc. Philadelphia, PA, 2011. DailyMed
- Uriel A & Lewthwaite P: Malaria therapy in HIV: drug interactions between nevirapine and quinine. Int J STD AIDS 2011; 22(12):768-768. PubMed
Keep reading about Nevirapine
Keep reading about Quinine
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