Quinidine: Difference between revisions
 
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==Background==
==Administration==
*Inexpensive with restricted indications, causing it to be inaccessible in many areas globally
*Type: [[Antimalarial]], [[Antiarrhythmic]] (Class I)
*Main manufacturer halted production in 2010<ref>Olsson  G.; To the editor—Market withdrawal of quinidine bisulfate (Kinidin Durules) in 2006. Heart Rhythm. 2010;7:864</ref>
*Routes of Administration: IV (discontinued in America), oral
*Historically both supraventricular tachydysrhytmia, ventricular dysrhythmia, malaria treatment, many other first-line therapies have replaced its use
*Common Trade Names:
**Quinaglute
**Quinidex
 
==Adult Dosing==
===Ventricular dysrhythmias<ref>Athena Health. Epocrates. Quinidine Gluconate Monograph. https://online.epocrates.com/u/10a72/quinidine+gluconate.</ref>===
*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
 
===Severe [[malaria]]===
*Load 10 mg/kg IV over 2hrs, then 0.02 mg/kg/min IV/PO x3 days, in conjunction with [[doxycycline]] '''OR'''
*Load 24 mg/kg IV infused over 4 hours, then 12 mg/kg IV infused over 4h q8h starting 8h after initial loading dose
 
==Pediatric Dosing==
*Malaria: same weight-based dosing as above
 
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
*Renal dosing: No adjustment
*Hepatic dosing: May lengthen half-life
 
==Indications==
*An effective treatment and prevention strategy for<ref>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.</ref>:
*An effective treatment and prevention strategy for<ref>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.</ref>:
**[[Brugada syndrome]] arrhythmic [[electrical storm]]
**[[Brugada syndrome]] arrhythmic [[electrical storm]]
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**Early repolarization syndrome (though NOT benign, see [[benign early repolarization]])
**Early repolarization syndrome (though NOT benign, see [[benign early repolarization]])
**Congenital [[short QT syndrome]]
**Congenital [[short QT syndrome]]
==Administration<ref>Athena Health. Epocrates. Quinidine Gluconate Monograph. https://online.epocrates.com/u/10a72/quinidine+gluconate.</ref>==
 
*For ventricular dysrhythmias:
==Contraindications==
**Quinidine gluconate IV 0.25 mg/kg/min over 20-40 min, max 10 mg/kg per conversion attempt
*Allergy to class/drug
**PO alternative: 648 mg PO q8 x3-4 doses
*Cardiac rhythm dependent upon junctional or idioventricular pacemaker (in absence of artificial pacemaker)
*For severe [[malaria]]: load 10 mg/kg IV over 2hrs, then 0.02 mg/kg/min IV/PO x3 days, in conjunction with [[doxycycline]]
*Myasthenia gravis
==Monitoring==
*History of ITP or TTP associated with quinine or quinidine
 
==Adverse Reactions==
===Serious===
*Prolonged QT, torsades de points, ventricular arrythmia
*Hepatotoxicity
*Kidney disease
===Common===
*Diarrhea, nausea/vomiting
*Headache, lightheadedness
*Palpitations
*Rash
 
==Pharmacology==
*Half-life: 3-8h
*Metabolism: Hepatic
*Excretion:  
 
==Mechanism of Action==
*Class IA antiarrhythmic: inhibits depolarizing sodium channels in cardiac muscle and purkinje fibers
*Antimalarial action: intraerythrocytic schizonticide to p. vivax and p. malariae, acts against asexual erythrocytic phase of p. falciparum
 
==Comments==
*Inexpensive with restricted indications, causing it to be inaccessible in many areas globally
*Main manufacturer halted production in 2010<ref>Olsson  G.; To the editor—Market withdrawal of quinidine bisulfate (Kinidin Durules) in 2006. Heart Rhythm. 2010;7:864</ref>
*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-treatment QRS duration
**QRS complex widens > 130% of pre-treatment QRS duration
**QTc widens > 130% of pre-treatment duration OR > 500 ms
**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


==Sources==
==See Also==
*[[Antimalarial medications]]
*[[Antiarrhythmics]]
 
==References==
<references/>
<references/>
 
[[Category:Pharmacology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:ID]]

Latest revision as of 19:23, 7 March 2019

Administration

  • Type: Antimalarial, Antiarrhythmic (Class I)
  • Routes of Administration: IV (discontinued in America), oral
  • Common Trade Names:
    • Quinaglute
    • Quinidex

Adult Dosing

Ventricular dysrhythmias[1]

  • 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

Severe malaria

  • Load 10 mg/kg IV over 2hrs, then 0.02 mg/kg/min IV/PO x3 days, in conjunction with doxycycline OR
  • Load 24 mg/kg IV infused over 4 hours, then 12 mg/kg IV infused over 4h q8h starting 8h after initial loading dose

Pediatric Dosing

  • Malaria: same weight-based dosing as above

Special Populations

Indications

Contraindications

  • Allergy to class/drug
  • Cardiac rhythm dependent upon junctional or idioventricular pacemaker (in absence of artificial pacemaker)
  • Myasthenia gravis
  • History of ITP or TTP associated with quinine or quinidine

Adverse Reactions

Serious

  • Prolonged QT, torsades de points, ventricular arrythmia
  • Hepatotoxicity
  • Kidney disease

Common

  • Diarrhea, nausea/vomiting
  • Headache, lightheadedness
  • Palpitations
  • Rash

Pharmacology

  • Half-life: 3-8h
  • Metabolism: Hepatic
  • Excretion:

Mechanism of Action

  • Class IA antiarrhythmic: inhibits depolarizing sodium channels in cardiac muscle and purkinje fibers
  • Antimalarial action: intraerythrocytic schizonticide to p. vivax and p. malariae, acts against asexual erythrocytic phase of p. falciparum

Comments

  • Inexpensive with restricted indications, causing it to be inaccessible in many areas globally
  • Main manufacturer halted production in 2010[3]
  • 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

See Also

References

  1. ↑ Athena Health. Epocrates. Quinidine Gluconate Monograph. https://online.epocrates.com/u/10a72/quinidine+gluconate.
  2. ↑ 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.
  3. ↑ Olsson G.; To the editor—Market withdrawal of quinidine bisulfate (Kinidin Durules) in 2006. Heart Rhythm. 2010;7:864
  4. ↑ Quinidine gluconate dilution. GlobalRPH. http://www.globalrph.com/quinidine_gluconate_dilution.htm
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