Quinidine
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