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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  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Codeine
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
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  • Acetaminophen; Propoxyphene
  • Acetaminophen; Tramadol
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  • Albuterol; Ipratropium
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