Quinidine

What is Quinidine

Quinidine is a natural alkaloid prepared from cinchona bark and is the optical isomer of quinine. Both drugs are effective antimalarial agents, and, in some parts of the world, quinidine is actually superior.

Quinidine is considered to be the prototypical antiarrhythmic agent.

As early as 1749, it was noted that administering quinine to patients with malaria who also had atrial fibrillation occasionally resulted in correction of the arrhythmia. Further studies of the antiarrhythmic effects of quinine and quinidine were performed in 1918, and quinidine was found to be more effective in correcting atrial fibrillation.

Quinidine is used today as a class Ia antiarrhythmic agent for the management of atrial flutter and fibrillation, paroxysmal supraventricular tachycardia, paroxysmal atrioventricular junctional rhythm, premature atrial contractions, atrial tachycardia, and ventricular tachycardia.

At the inception of the FDA in 1938, quinidine was approved for use.

Indications

1. atrial fibrillation
2. atrial flutter
3. paroxysmal supraventricular tachycardia (PSVT)
4. paroxysmal supraventricular tachycardia (PSVT) prophylaxis
5. Plasmodium falciparum
6. Plasmodium malariae
7. Plasmodium ovale
8. Plasmodium vivax
9. singultus (hiccups)
10. ventricular tachycardia
11. Wolff-Parkinson-White (WPW) syndrome

Side Effects

1. acute generalized exanthematous pustulosis (AGEP)
2. agranulocytosis
3. angioedema
4. arrhythmia exacerbation
5. arthralgia
6. asthenia
7. ataxia
8. blurred vision
9. bradycardia
10. bronchospasm
11. confusion
12. delirium
13. depression
14. diarrhea
15. diplopia
16. dizziness
17. esophageal stricture
18. esophageal ulceration
19. esophagitis
20. exfoliative dermatitis
21. fatigue
22. fever
23. headache
24. hearing loss
25. hemolytic anemia
26. hepatitis
27. hypotension
28. lupus-like symptoms
29. lymphadenopathy
30. maculopapular rash
31. myalgia
32. mydriasis
33. nausea
34. night blindness
35. optic neuritis
36. palpitations
37. photophobia
38. photosensitivity
39. pneumonitis
40. PR prolongation
41. pruritus
42. pyrosis (heartburn)
43. QT prolongation
44. rash
45. scotomata
46. seizures
47. syncope
48. tinnitus
49. torsade de pointes
50. tremor
51. urticaria
52. uveitis
53. vasculitis
54. ventricular tachycardia
55. vertigo
56. visual impairment
57. vomiting
58. weakness

Monitoring Parameters

• CBC
• ECG
• serum quinidine concentrations

Contraindications

• alcoholism
• asthma
• AV block
• bradycardia
• breast-feeding
• bundle-branch block
• cardiac arrhythmias
• cardiac disease
• coronary artery disease
• diabetes mellitus
• digitalis toxicity
• females
• fever
• geriatric
• heart failure
• hepatic disease
• hypertension
• hypocalcemia
• hypokalemia
• hypomagnesemia
• labor
• long QT syndrome
• malnutrition
• mefloquine hypersensitivity
• mortality
• myasthenia gravis
• myocardial infarction
• pregnancy
• QT prolongation
• quinidine hypersensitivity
• quinine hypersensitivity
• renal failure
• renal impairment
• thyroid disease

Interactions

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