Quinidine: Difference between revisions
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*Discontinue quinidine infusion if<ref>Quinidine gluconate dilution. GlobalRPH. http://www.globalrph.com/quinidine_gluconate_dilution.htm</ref>: | *Discontinue quinidine infusion if<ref>Quinidine gluconate dilution. GlobalRPH. http://www.globalrph.com/quinidine_gluconate_dilution.htm</ref>: | ||
**Sinus rhythym restored | **Sinus rhythym restored | ||
**QRS complex widens > 130% of pre- | **QRS complex widens > 130% of pre-treatment QRS duration | ||
**QTc widens > 130% of pre- | **QTc widens > 130% of pre-treatment duration OR > 500 ms | ||
**Disappearance of T-waves | **Disappearance of T-waves | ||
**Development of significant tachycardia, symptomatic bradycardia, hypotension | **Development of significant tachycardia, symptomatic bradycardia, hypotension | ||
Revision as of 02:59, 29 September 2016
Background
- Inexpensive with restricted indications, causing it to be inaccessible in many areas globally
- Main manufacturer halted production in 2010[1]
- Historically both supraventricular tachydysrhytmia, ventricular dysrhythmia, malaria treatment, many other first-line therapies have replaced its use
- An effective treatment and prevention strategy for[2]:
- Brugada syndrome arrhythmic electrical storm
- Idiopathic ventricular fibrillation
- Early repolarization syndrome (though NOT benign, see benign early repolarization)
- Congenital short QT syndrome
Administration[3]
- For ventricular dysrhythmias:
- Quinidine gluconate IV 0.25 mg/kg/min over 20-40 min, max 10 mg/kg per conversion attempt
- PO alternative: 648 mg PO q8 x3-4 doses
- For severe malaria: load 10 mg/kg IV over 2hrs, then 0.02 mg/kg/min IV/PO x3 days, in conjunction with doxycycline
Monitoring
- Discontinue quinidine infusion if[4]:
- Sinus rhythym restored
- QRS complex widens > 130% of pre-treatment QRS duration
- QTc widens > 130% of pre-treatment duration OR > 500 ms
- Disappearance of T-waves
- Development of significant tachycardia, symptomatic bradycardia, hypotension
Sources
- ↑ Olsson G.; To the editor—Market withdrawal of quinidine bisulfate (Kinidin Durules) in 2006. Heart Rhythm. 2010;7:864
- ↑ Viskin S et al. Quinidine, A Life-Saving Medication for Brugada Syndrome, Is Inaccessible in Many Countries. J Am Coll Cardiol. 2013;61(23):2383-2387.
- ↑ Athena Health. Epocrates. Quinidine Gluconate Monograph. https://online.epocrates.com/u/10a72/quinidine+gluconate.
- ↑ Quinidine gluconate dilution. GlobalRPH. http://www.globalrph.com/quinidine_gluconate_dilution.htm