Quinidine: Difference between revisions
No edit summary |
|||
| (2 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
==Administration== | ==Administration== | ||
*Type: | *Type: [[Antimalarial]], [[Antiarrhythmic]] (Class I) | ||
*Routes of Administration: IV (discontinued in America), oral | |||
*Routes of Administration: | *Common Trade Names: | ||
*Common Trade Names: | **Quinaglute | ||
**Quinidex | |||
==Adult Dosing== | ==Adult Dosing== | ||
| Line 11: | Line 12: | ||
===Severe [[malaria]]=== | ===Severe [[malaria]]=== | ||
*Load 10 mg/kg IV over 2hrs, then 0.02 mg/kg/min IV/PO x3 days, in conjunction with [[doxycycline]] | *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== | ==Pediatric Dosing== | ||
*Malaria: same weight-based dosing as above | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*[[Lactation risk categories|Lactation risk]]: | *[[Lactation risk categories|Lactation risk]]: Infant risk minimal | ||
*Renal dosing: No adjustment | |||
*Hepatic dosing: May lengthen half-life | |||
* | |||
==Indications== | ==Indications== | ||
| Line 34: | Line 33: | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *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== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Prolonged QT, torsades de points, ventricular arrythmia | |||
*Hepatotoxicity | |||
*Kidney disease | |||
===Common=== | ===Common=== | ||
*Diarrhea, nausea/vomiting | |||
*Headache, lightheadedness | |||
*Palpitations | |||
*Rash | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 3-8h | ||
*Metabolism: | *Metabolism: Hepatic | ||
*Excretion: | *Excretion: | ||
==Mechanism of Action== | ==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== | ==Comments== | ||
| Line 53: | Line 63: | ||
**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 | ||
==See Also== | ==See Also== | ||
*[[Antimalarial medications]] | |||
*[[Antiarrhythmics]] | |||
==References== | ==References== | ||
| Line 63: | Line 75: | ||
[[Category:Pharmacology]] | [[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
- Pregnancy Rating: C
- Lactation risk: Infant risk minimal
- Renal dosing: No adjustment
- Hepatic dosing: May lengthen half-life
Indications
- 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
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
- ↑ Athena Health. Epocrates. Quinidine Gluconate Monograph. https://online.epocrates.com/u/10a72/quinidine+gluconate.
- ↑ 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.
- ↑ Olsson G.; To the editor—Market withdrawal of quinidine bisulfate (Kinidin Durules) in 2006. Heart Rhythm. 2010;7:864
- ↑ Quinidine gluconate dilution. GlobalRPH. http://www.globalrph.com/quinidine_gluconate_dilution.htm