Quinidine: Difference between revisions
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== | ==Administration== | ||
* | *Type: [[Antimalarial]], [[Antiarrhythmic]] (Class I) | ||
* | *Routes of Administration: IV (discontinued in America), oral | ||
* | *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]] | ||
| Line 9: | Line 31: | ||
**Congenital [[short QT syndrome]] | **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<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>: | |||
**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== | |||
*[[Antimalarial medications]] | |||
*[[Antiarrhythmics]] | |||
==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
- 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